Ghada Kharrat¹, Fatma Ajlani¹*, Sana Ferchichi¹ and Salma Aloui²

¹ENT Department of Taheur Maamouri Hospital in Nabeul, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
²Radiology Department of Taheur Maamouri Hospital in Nabeul, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia

*Corresponding Author: Fatma Ajlani, ENT Department of Taheur Maamouri Hospital in Nabeul, University of Tunis El Manar, Faculty of Medecine of Tunis, Tunisia.

Received: April 03, 2023; Published: May 16, 2023

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 [2019-2021].

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.

 Keywords: Deep Neck Infection; Mediastinitis; Mortality; Surgical Drainage; Tracheostomy

References

1. Velhonoja Jarno., et al. “Deep Neck Space Infections: An Upward Trend and Changing Characteristics”. European Archives of Oto-Rhino-Laryngology3 (2019): 863-872.
2. Kimura Akari., et al. “Clinical Predictors of Descending Necrotizing Mediastinitis After Deep Neck Infections”. The Laryngoscope11 (2019).
3. Hidaka Hiroshi., et al. “Clinical and Bacteriological Influence of Diabetes Mellitus on Deep Neck Infection: Systematic Review and Meta-analysis”. Head and Neck, edited by David W. Eisele 37.10 (2014): 1536-1546.
4. Wang Ling-Feng., et al. “Characterizations of Life-threatening Deep Cervical Space Infections: A Review of One Hundred Ninety-six Cases”. American Journal of Otolaryngology2 (2003): 111-117.
5. Chang Geng-He., et al. “End-stage Renal Disease: A Risk Factor of Deep Neck Infection - a Nationwide Follow-up Study in Taiwan”. BMC Infectious Diseases1(2017).
6. Boscolo-Rizzo Paolo., et al. “Deep Neck Infections: A Study of 365 Cases Highlighting Recommendations for Management and Treatment”. European Archives of Oto-Rhino-Laryngology4 (2011): 1241-1249.
7. Demeslay J., et al. “Implications Des Anti-inflammatoires Dans Les Complications Des Pharyngites. Une Analyse Rétrospective De 163 Cas”. Annales Françaises D’Oto-rhino-laryngologie Et De Pathologie Cervico-faciale5 (2014): 286-290.
8. Sproston Nicola R and Jason J Ashworth. “Role of C-Reactive Protein at Sites of Inflammation and Infection”. Frontiers in Immunology 9 (2018).
9. Yang Shih-Wei., et al. “Analysis of Life-Threatening Complications of Deep Neck Abscess and the Impact of Empiric Antibiotics”. ORL4 (2008): 249-256.
10. Yanık Fazlı., et al. “Management of a Difficult Infectional Disease: Descending Necrotizing Mediastinitis”. The Journal of Infection in Developing Countries09 (2018): 748-754.
11. Rzepakowska Anna., et al. “The Factors Contributing to Efficiency in Surgical Management of Purulent Infections of Deep Neck Spaces”. Ear, Nose and Throat Journal5 (2019): 354-359.
12. Tapiovaara, Laura., et al. “Comparison of Intubation and Tracheotomy in Patients With Deep Neck Infection”. European Archives of Oto-Rhino-Laryngology10 (2017): 3767-3772.
13. Chen Shih-Lung., et al. “Factors Affecting the Necessity of Tracheostomy in Patients With Deep Neck Infection”. Diagnostics9 (2021): 1536.
14. Li Ying-Hsien., et al. “Lemierre Syndrome Complicating Deep Neck Infection and Descending Necrotizing Mediastinits Caused by Odontogenic Infections”. Journal of Microbiology, Immunology and Infection2 (2020): 357-359.
15. Lee JW., et al. “Techniques for Early Diagnosis and Management of Cervicofacial Necrotising Fasciitis”. The Journal of Laryngology and Otology7 (2010): 759-764.

Citation

Citation: Fatma Ajlani., et al. “Diagnosis and Management of Severe Deep Neck Infections".Acta Scientific Otolaryngology 5.6 (2023): 26-32.

Copyright

Copyright: © 2023 Fatma Ajlani., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.