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| EDITORIAL |
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Year : 2014? |? Volume : 3? |? Issue : 2? |? Page : 75-76 |
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Deep neck space infections: A challenge for every surgeon
Daniel Dalla Torre1, Doris Burtscher2
1?University Clinic for Cranio-Maxillo-Facial Surgery, Medical University Innsbruck, Innsbruck, Austria; Dental Clinic Dalla Torre,Vipiteno, Italy,
2?University Clinic for Prosthodontics, Medical University Innsbruck, Innsbruck, Austria,
| Date of Submission |
29-Mar-2014 |
| Date of Acceptance |
29-Mar-2014 |
| Date of Web Publication |
6-Aug-2014 |
Correspondence Address:
Daniel Dalla Torre
Seestrasse 1, Völs-6176, Austria
DOI: 10.4103/2278-9588.138211
How to cite this article:
Torre DD, Burtscher D. Deep neck space infections: A challenge for every surgeon. J Cranio Max Dis 2014;3:75-6 |
How to cite this URL:
Torre DD, Burtscher D. Deep neck space infections: A challenge for every surgeon. J Cranio Max Dis [serial online] 2014 [cited?2015 Feb 3];3:75-6. Available from:?https://craniomaxillary.com/text.asp?2014/3/2/75/138211 |
Deep neck space infections (DNI) comprise infections along with the potential spaces and fascial planes of the neck. In the pre-antibiotic era DNIs represented a challenge for every otolaryngologist and maxillofacial surgeon because of the potential life-threatening complications due to the proximity of vital structures as the airway. Odontogenic causes have been described as the main origin for DNIs. [1],[2] As mentioned in the following publication by Mumtaz et al., poor oral hygiene is a major risk for the development of severe neck infections, [3] a fact that should be remembered in the prevention of such diseases. Therefore, attention should be paid to the general oral hygiene of the patients in every case of clinical oral investigation regardless of its reason by maxillofacial surgeons as well as otolaryngologists.
As a result of the continuing development in medicine, every sorgeon will encounter more and more difficulties in diagnosis and treatment of severe infections because of the polymorbidity of many patients. For example, the incidence of diabetes mellitus increased in the last decades, demanding exact diagnostic evaluation and early therapy in order to prevent primary disease-related complications of abscesses in the head and neck area.
Thanks to the progress in the anti-infectitous and antibiotic therapy, the incidence of severe infections could be reduced. Nevertheless, complications like mediastinitis, necessity for prolonged intensive care and even death may still occur in serious cases. [4] As a major problem in the diagnosis of DNIs, the possible masked presentation with unclear and unspecific symptoms at the early stage is highlighted in the following article. [3] Additionaly, the course of the disease does not seem to be age-specific. In many studies as well as in the following article, severe complications have been described in elderly, polymorbid patients as well as in young, apparently healthy subjects. [3],[4],[5]
One of the biggest issues regarding deep neck space infections is the airway and its management. As described in the presented analysis, the parapharyngeal space is involved in many cases of DNIs, placing the airway of the patients at risk. [2],[3],[6] Tracheostomy should be evaluated in order to secure the airway before it is too late.
Mumtaz et al. also elucidate the need of a prompt treatment as mentioned above. [3] It has to be underlined, that the possible fulminant and dangerous course of deep neck space infections should not be underestimated. Special consideration should be given to a forceful surgical intervention, a correct airway management and a continuous clinical and radiological evaluation of the patients.
Summarizing the known facts about the therapy of deep neck space infections in addition to the presented results in the following analysis, three major points have to be mentioned: Drug therapy, surgical drainage, and airway management. By respecting these three major pillars in the therapy of DNIs, everyone will have the greatest chance to avoid severe complications.
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Boscolo-Rizzo P, Stellin M, Muzzi E, Mantovani M, Fuson R, Lupato V, et al. Deep neck infections: A study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol 2012;269:1241-9.??
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Mumtaz RM, Suhail A, Rajput SA, Adeel M, Hassan NH. Deep Neck Space Infections; retrospective review of 46 patients. J CranioMaxill Dis 2014;3:21-5.??
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Dalla Torre D, Brunold S, Kisielewsky I, Kloss FR, Burtscher D. Life-threatening complications of deep neck space infections. Wien Klin Wochenschr 2013;125:680-6.??
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Bakir S, Tanriverdi MH, G?n R, Yorgancilar AE, Yildirim M, Tekba? G, et al . Deep neck space infections: A retrospective review of 173 cases. Am J Otolaryngol 2012;33:56-63.??
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Marioni G, Staffieri A, Parisi S, Marchese-Ragona R, Zuccon A, Staffieri C, et al. Rational diagnostic and therapeutic management of deep neck infections: Analysis of 233 consecutive cases. Ann Otol Rhinol Laryngol 2010;119:181-7.??
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