Title:Deep Neck Infections: Decisional Algorithm for Patients with Multiple
Spaces Involvement
Volume: 17
Issue: 1
Author(s): Filippo Ricciardiello, Salvatore Mazzone, Pasquale Viola*, Gianluca Guggino, Giuseppe Longo, Alberto Napolitano, Giuseppe Russo, Giulio Sequino, Flavia Oliva, Pasquale Salomone, Marco Perrella, Giovanni Marco Romano, Pietro Cinaglia, Teresa Abate, Maurizio Gargiulo, Davide Pisani and Giuseppe Chiarella
Affiliation:
- Department of Experimental and Clinical
Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University,
Catanzaro, Italy
Keywords:
Deep neck infections, therapeutic algorithm, polymicrobial infections, infection complications, neck surgery, fascial planes.
Abstract:
Background: Deep Neck Infections (DNIs) spread along fascial planes and involve
neck spaces. Recently, their incidence has decreased due to the introduction of antibiotics; nevertheless,
complications related to DNIs are often life-threatening.
Objective: The purpose of this article is focused on the identification of predisposing factors of these
complications, as well as on the development of a reliable therapeutic algorithm.
Methods: Sixty patients with DNIs were enrolled from 2006 to 2019 for a retrospective study. The
exclusion criteria for the present study were cellulitis, small abscesses responding to empiric or specific
antibiotic therapy, or involvement of only one deep neck space. During the analysis, the following
parameters of interest have been evaluated: gender, age, site of origin, pathways of spread,
comorbidities, clinical features, bacteriology data, type of surgical approach required, complications,
duration of hospitalization and mortality rate. On admission, microbial swab analysis was
performed.
Results: Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), iron deficiency
anemia and the involvement of multiple spaces have been associated with a significantly higher
risk of developing complications. Most of our patients had polymicrobial infections. All patients
underwent surgical drainage. The complication rate had occurred in 56.6% of patients, while death
in 18.3%.
Conclusion: DNIs represent a medical and surgical emergency with potentially serious complications;
thus, avoidance of diagnostic delay is mandatory. Our preliminary data suggest the importance
of evaluating the extent of infections because the involvement of multiple spaces requires
timely surgery due to the higher risk of complications and mortality.