Diagnosis and Management of Severe Deep Neck Infections

Abstract

Purpose: Report the clinical, paraclinical, therapeutic and evolutive characteristics of severe deep neck infection (DNI).Methods: It was a descreptive, retrospective study about 15 patients managed for a severe DNI, in the ENT department of Taheur Maamouri Universitary Hospital in Tunisia, over a period of 15 years [2019][2020][2021].Results: A male predominance was noted with a sex-ratio of 2. The mean age was 42 years old.The most frequent risk factors were diabetes mellitus (6 cases), chronic renal failure (2 cases) and an inappropriate initial treatment (anti inflammatory drugs: 10 cases).The most common complaints were a cervico-facial swelling, dysphagia and fever.Clinical features often include neck pain and swelling (12 cases), torticollis (3 cases), subcutaneous emphysema (5 cases) and trismus (9 cases).Contrast enhanced computed tomography confirmed severe DNI in all cases.An abscess was found in all cases.Etiologies were dominated by dental causes (8 cases).Complications were frequently encountered.Eleven patients had upper airway compromise, six had mediastinitis, three had internal jugular vein thrombosis and three necrotizing fasciitis.One patient died during his hospital stay due to septic shock.The therapeutic management was medico-surgical and urgent.Seven patients (46,6%) required emergency tracheotomy for initial airway management.One patient needed hyperbaric oxygen therapy.The average hospital stay was of 23 days.The outcome was favorable in 93% of cases. Conclusion:DNI is a serious life-threatening disease.Early diagnosis and immediate medico-surgical treatment are essentiel.