Deep Fascial Space Infection of the Neck
Deep Fascial Space Infection of the Neck
We present our clinical experience with two complex cases of deep fascial space infections of the neck. The first was a case of cervical necrotizing fasciitis involving the submental space. The second was an infection beginning at the soft palate and extending to the anterior mediastinum. Both infections emanated from an oral source in patients with diabetes mellitus, and both patients required multiple surgical debridements and endotracheal intubation for airway protection. Despite the declining incidence of deep space neck infections, our cases illustrate the challenging diagnostic and treatment dilemmas for the clinician managing patients with diabetes.
Life-threatening infections of the deep fascial space of the head and neck are usually odontogenic. These suppurative processes can also arise as complications of infections of the salivary glands, the epiglottis, hard and soft palate, tonsils, and retropharynx. Infections of the deep fascial spaces of the neck are ominous because of the propensity of bacteria to spread hematogenously and contiguously along the fascial planes to involve the anterior mediastinum, pleuropulmonary spaces, retropharyngeal space, prevertebral spaces, "danger" space, and the heart valves. Recognized risk factors of deep neck space infections include dentoalveolar abscesses, neck trauma, endotracheal intubation, traumatic foreign body ingestion, and IV drug abuse. In one study, 56% of the deep space neck infections involving the retropharynx were idiopathic.
We present two cases of deep fascial space infections of the neck that occurred at our institution during the past year. The first was a case of cervical necrotizing fasciitis involving the submental space, and the second began as a case of cellulitis of the soft palate that evolved into pyogenic anterior mediastinitis. Both infections emanated from an oropharyngeal source in patients with diabetes who required multiple surgical debridements and endotracheal intubation for airway protection. Despite the declining incidence of deep space infections, these illustrative cases are a reminder of the complexity inherent in the management of these entities in patients with diabetes.
Abstract and Introduction
Abstract
We present our clinical experience with two complex cases of deep fascial space infections of the neck. The first was a case of cervical necrotizing fasciitis involving the submental space. The second was an infection beginning at the soft palate and extending to the anterior mediastinum. Both infections emanated from an oral source in patients with diabetes mellitus, and both patients required multiple surgical debridements and endotracheal intubation for airway protection. Despite the declining incidence of deep space neck infections, our cases illustrate the challenging diagnostic and treatment dilemmas for the clinician managing patients with diabetes.
Introduction
Life-threatening infections of the deep fascial space of the head and neck are usually odontogenic. These suppurative processes can also arise as complications of infections of the salivary glands, the epiglottis, hard and soft palate, tonsils, and retropharynx. Infections of the deep fascial spaces of the neck are ominous because of the propensity of bacteria to spread hematogenously and contiguously along the fascial planes to involve the anterior mediastinum, pleuropulmonary spaces, retropharyngeal space, prevertebral spaces, "danger" space, and the heart valves. Recognized risk factors of deep neck space infections include dentoalveolar abscesses, neck trauma, endotracheal intubation, traumatic foreign body ingestion, and IV drug abuse. In one study, 56% of the deep space neck infections involving the retropharynx were idiopathic.
We present two cases of deep fascial space infections of the neck that occurred at our institution during the past year. The first was a case of cervical necrotizing fasciitis involving the submental space, and the second began as a case of cellulitis of the soft palate that evolved into pyogenic anterior mediastinitis. Both infections emanated from an oropharyngeal source in patients with diabetes who required multiple surgical debridements and endotracheal intubation for airway protection. Despite the declining incidence of deep space infections, these illustrative cases are a reminder of the complexity inherent in the management of these entities in patients with diabetes.
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