Deep Neck Space InfectionSchool of Medicine Padjajaran UniversityDepartmen of Otolaryngology HNSHasan Sadikin General HospitalBandung 2007Dr Sinta Sari R, M.Kes,Sp THT-KL
IntroductionDEEP NECK SPACE INFECTIONS
antibiotics decreased the incidence and mortalitydeep neck space infections remain life threateningdelay in diagnosis/inadequate/inappropriate treatment complications (mediastinitis) mortality rates : 40%head and neck surgeon :cervical fascias & potential spaces understand the treatment & potential complications
Anatomy Of The Cervical Fascia Superficial cervical fascia Deep cervical fascia 1. Superficial layer 2. Middle layer - Muscular division - Visceral division 3. Deep layer - Prevertebral division - Alar division
Cervical Fascia
Retropharyngeal Space InfectionSource Nose Sinuses Adenoids Nasopharynx
Manifestations Acute URTI in infants & children Dysphagia & odynophagia Drooling & difficult to expell excretions Cervical rigidity Muffled voice Dyspnea Unilateral bulging of posterior pharyngeal wall Sepsis
Retropharyngeal Space Infection
Retropharyngeal Space InfectionTreatmentFastingI.V. antibioticsTracheotomyEmergent surgical drainage- intraoral drainage- external drainageComplicationsRupture of abcess w/ aspiration & pneumoniaMediastinitisAirway obstruction
Danger Space InfectionSourceRetropharyngeal spacePrevetebral spaceParapharyngeal spaceManifestationsSame as primary space infectionSevere sepsisTreatmentSame as for primary space infectionComplications Potential for rapid spread through the loose areolar tissue Inferior spread to the posterior mediastinum to the level of diafragma
Prevertebral Space InfectionManifestations Midline abcess Cold abcess posterior pharynx Slow spread of suppuration of this areaTreatmentNeedle aspiration w/ subsequent antituberculosis th/Stabilization of spineSource Vertebral bodies Penetrating injuries Tuberculosis of the spineComplicationsSpine instability progression of vetebral process
Visceral Vascular Space Infectionpotential space within the carotid sheathinfections remain relatively localized compact space contains little areolar connective tissue lymphatics contained within this space receive secondary drainage from most of the lymphatics of the head and neck Lincoln Highway of The Neck (Mosher) all three layers of the DCF contribute to the carotid sheath
Visceral Vascular Space InfectionSourceParapharyngeal spaceSubmandibular spaceVisceral space
ManifestationsPitting edema over SCMTorticollis
TreatmentExternal drainageI.V. antibioticsPossible ligation of IJV
ComplicationsSeptic shockCarotid artery erotionsEndocarditisCavernous sinus thrombosis
Pharingomaxillary Space Infection
Pharingomaxillary Space InfectionPrestyloid Compartement [anterior-muscular]FatLymph nodesInternal maxilarry arteryInferior alveolar, lingual,auriculotemporal nerves
Poststyloid Compartement [posterior-neurovascular]Carotid arteryInternal jugular veinSymphatetic chainIX, X, XI, XII nerves
Pharingomaxillary Space InfectionSource Tonsil Pharynx Teeth Temporal bone (petrous) Parotis gland Lymph nodes of nose & nasopharynxManifestations Medial displacement of lateral pharyngeal wall and tonsils Trismus Parotid edema Retromandibular neck fullness Dysphagia
Pharingomaxillary Space InfectionTreatment External drainageTracheotomyComplications Septic thrombosis of IJV Carotid artery erosions Cranial nerve involvement Mediastinitis
Pharingomaxillary Space InfectionPMSMasticatorSubmandibularPeritonsillarVVSDangerMediastinumAnterior VisceralTemporalParotidPrevertebralRetropharingeal
Submandibular Space InfectionSublingual space Sublingual gland Hypoglossal nerve Whartons ductsSubmaxillary space Central compartement Submental compartement Submaxillary compartementsubdivided by anterior bellies of digastric m.Contents Submandibular gland Lymph nodes
Submandibular Space InfectionSource Teeth Salivary glands Pharynx & tonsils SinusesManifestations Dysphagia Odynophagia
TreatmentUnderlying pathologyExternal drainage if it progress- sublingual- submandibula
Complications Ludwigs Angina
Masticator Space InfectionSourceMolar teeth
ManifestationsExtreme trismus Edema & tenderness over the posterior ramus of mandible
TreatmentExternal drainage
Temporal Space InfectionTemporalis m. :- superficial compartments- deep compartments ManifestationPain in this area Trismus TreatmentExternal drainage
Peritonsillar Space InfectionSourceTonsils & pharynx
Manifestations Dysphagia/odynophagia Drooling and hot potato voice Muffleed voice Reffered otalgia Trismus Displaced tonsil toward midline Deviated uvula
PERITONSILLAR ABSCESS
Peritonsillar Space InfectionTreatment Peroral drainage tonsilectomy
Complications Spread into pharyngomaxilary space through posterior pharyngeal wall
Anterior Visceral SpaceContents Pharynx Esophagus Larynx Trachea Thyroid gland
Source Tonsils Esophageal injury Blunt trauma w/ mucosal tear Acute thyroiditis Chest infection
Anterior Visceral SpaceManifestationsDysphagia/odynophagiaHoarsenessDyspneaEmphysema
ComplicationsSerious infectionLaryngeal edemaMediastinal emphysemaBronchopneumoniaSepsis TreatmentFastingI.V. hydrationAntibioticsTracheotomySurgical drainage
historyPhysical examinationSecure airwayCulture, IV antibioticCT scanSmall abcessNeedle aspiration for culture and drainageImpending complication ?No abcessLarge abcessWatch and wait 24-48 hoursClinical improvement ?Continue antibiotic,Needle aspirationsSurgical incisionAnd drainageNoYesYesNo
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