Deep neck infections

Introduction Infection of the deep spaces of the neck are becoming more common. Hospital admissions for such infections in the United Kingdom more than doubled between 1996 and 2005. These infections are often life threatening, and even stable-appearing patients are at grave risk for sudden clinical decompensation. Clinical severity is related to both the anatomic nature of the space involved, due to the numerous adjacent critical structures, as well as the nature of the hosts themselves (Figure 10.1). The elderly and diabetics are more likely to have complicated infections than their counterparts. Patients with deep neck infections are frequently either diabetic, human immunodeficiency virus (HIV)-infected (irrespective of antiretroviral therapy status), or immunocompromised in some other way. An example of a deep neck infection of the lateral pharyngeal space in an HIV-infected patient is shown in Figure 10.2. Nocardia asteroides grew from the deep neck cultures. In addition, a history of injection drug use (IDU), neutropenia, or exogenous steroid therapy is common. A dental source is frequently present. On rare occasions, deep neck space infection may complicate head and neck cancers. Cases complicating traumatic airway intubation have also been reported.