Deep neck space infections – a 3 year study at tertiary care centre of west bengal, india

Aims: To find out the epidemiological profile of the patients with deep neck space infections (DNSI), to study the rate of life-threatening complications & their predisposing factors in these cases and to find out the mortality rates in DNSI & to compare it with previous studies.
Material & methods: A total number of 138 cases of deep neck space infection were admitted in Dept. of ENT, Calcutta National Medical College from May 2015 to April 2018. All patients underwent detailed ENT & systemic examinations and bacteriological investigations. Selected cases were subjected to radiological investigations like plain radiography and CT scan of neck. All the patients were treated with parenteral antibiotics and surgical drainage of the abscess whenever required.
Results: In our study, the mean age of presentation was 32.2 +/- 18.7 years (ranging from 3 months to 77 years), with male: female ratio of 1:1. Peritonsillar abscess (26.1 %)was the most common type of DNSI according to our study, followed by para-pharyngeal (18.8 %), retropharyngeal (15.2 %), Ludwig’s angina (11.6 %), parotid (8 %), anterior visceral space (7.2 %), submandibular space (6.5 %), sublingual (4.3 %) and prevertebral abscess (2.2 %). Odynophagia (66.7 %) and remittent fever (57.2 %) were the commonest presenting symptom in our cases. Odontogenic infection (52.9 %) was the commonest etiological factor noted in our study, followed by chronic tonsillitis (23.2 %). Diabetes Mellitus was the most common systemic disease found to be associated with DNSIs (27.5 %). Aerobic Streptococci (40.6 %) and E. coli (31.9 %) were the most common pathogen associated with deep neck space infection in our study. The cases with superficial infections only (e.g. peritonsillar space infections and Ludwig’s angina) could be diagnosed clinically, but other deeper infections needed plain radiography or CT scan for diagnosis. 26 patients developed life-threatening complications like airway obstruction (16.7 %), pneumonitis (11.6 %), gram-negative septicemia (8 %), descending mediastinitis (1.4 %) &Jugular vein thrombosis (0.7 %). 102 cases were treated by surgical drainage (73.9 %) the remaining 36 cases responded promptly to intravenous antibiotic therapy and surgical drainage was not necessary. 7 patients died.
Conclusion: Our study showed that time was the most important factor governing the outcome of the DNSI cases– early & accurate diagnosis and timely referral to the tertiary care center is essential. In all the cases airway, breathing and circulation should be assessed and attended to if required. Antibiotic therapy with or without definitive surgical drainage is the management modality. These simple steps will go a long way in saving the lives of these patients.