Deep Neck Infections

A "deep neck" infection refers to an infection or abscess (collection of pus) located deep under the skin near blood vessels, nerves, and muscles.

Where is the "deep neck" located?

There is a band of tissue in the neck called the cervical fascia, which divides the neck into superficial (just under the skin) and deep layers. The deep layer of the neck is then further subdivided into various spaces. A deep neck infection is an infection that is located in one of these spaces in the deep layer of the neck.

Although a deep neck infection can be seen in any of the deep neck spaces, the most common spaces in which deep neck infections are found in children are:

  • Retropharyngeal space This space is located directly behind the mouth under the back wall of the throat. The lymph nodes (infection fighting structures) that drain the adenoids sinuses and nose are located in this space. Infections can result in spread of infection to these lymph nodes, resulting in a swelling of these lymph nodes. If an infection goes untreated for several days, the infection will collect into an abscess (collection of pus). The retropharyngeal lymph nodes become significantly smaller after five years of age; therefore, this infection is usually seen only in younger children.
  • Peritonsillar space The tissue space located above and behind the tonsils. Untreated tonsillitis can cause an infection in this space. This infection occurs most frequently in young adults, but can occur at any age.
  • Parapharyngeal space It is located just behind the carotid artery (delivers blood to the head) and is found in each side of the neck. Infections in this area are due to common upper respiratory infections that spread to the lymph nodes located in this space.
  • Submandibular space This space is located under the jaw on each side. Infection of this space is usually the result of a dental infection and is known as Ludwig's angina. It is more commonly seen in adolescents, but can also occur in younger children.

Common symptoms of a deep neck infection:

  • asymmetric swelling of the neck, face, under the jaw or back of the throat
  • difficulty or pain when swallowing
  • drooling
  • change in the voice
  • decreased ability to move the neck
  • sick appearance
  • fever
  • difficult or fast breathing

What are the complications of a deep neck infection?

The complications of deep neck infections can be life threatening; therefore, early detection and treatment are of extreme importance.

Some of these complications include:

  • Airway obstruction -probably the most serious initial complication; a deep neck infection can create swelling that pushes in on the airway causing partial or complete obstruction (blockage)
  • Spread of the infection - deep neck infections can spread to other deep neck spaces, as well as the mediastinum (middle chest cavity), lungs bloodstream, and bones
  • Thrombus (clot) formation in arteries and veins of the neck
  • Nerve involvement - the nerves which affect vocal cord movement, eyelid closure, sweating, and pupil constriction may also be pressed upon causing nerve dysfunction

How is a deep neck infection evaluated?

  • a careful history and physical examination
  • blood tests: blood counts (for signs of infection), chemistry profiles (to check for lack of fluid intake), and blood cultures (to check if the infection has spread to the blood).
  • X-rays of the neck, teeth, and chest may also be indicated depending on the type of deep neck infection suspected.
  • a CT scan provides the most accurate picture of the infection's location

How is a deep neck infection treated?

Because of the immediate threat of airway obstruction, most deep neck infections require hospitalization. When the airway is narrowed, an endotracheal (breathing tube passed through the mouth) or nasotracheal (breathing tube passed through the nose) tube may be placed to hold open the airway until the infection can be treated. In severe cases, when a breathing tube cannot be inserted, a tracheotomy may be temporarily required.

Most patients will have a history of decreased fluid and food intake, therefore fluids given by vein will usually be required.

All patients with deep neck infections are started on antibiotics given by vein. In a select group of patients, careful hospital observation and antibiotics may be enough to treat the infection. However, surgical drainage is required in some cases.

When is an ear, nose, and throat specialist involved in the treatment of a deep neck abscess?

Because airway obstruction is always a concern with a deep neck infection, an ear, nose and throat specialist is usually consulted immediately to help manage the airway and determine whether surgical therapy is needed.


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