DEEP NECK SPACE INFECTIONS

Deep neck space infections are uncommon but can occur as a complication of pharyngitis or tonsillitis. The accumulation of pus within the fascial spaces of the neck is life-threatening, thus early recognition is imperative.

The bacteria causing deep neck infections are generally those implicated in pharyngitis and tonsillitis with Streptococcal species causing up to 80%. The remainder of the infections being caused most commonly by mixed flora, usually oral flora (anaeorobes).

In general, infants are more prone to retropharyngeal abscess, young children (2-12) more prone to parapharyngeal abscess and adults are more prone to peritonsillar abscess.

RETROPHARYNGEAL ABSCESS

Most common in infants because the retropharyngeal lymph nodes atrophy very early in life. Often starts as a cold or adenoiditis.

Patients generally have fever, systemic toxicity as well as neck pain, dysphagia, muffled voice and stridor. Physical findings reveal erythema and bulging of the posterior wall of the pharynx. Lateral view of the neck shows soft tissue swelling/mass from the base of the skull extending toward the chest with forward displacement of the larynx. CT is useful for identifying abscess.

Manage with antibiotics and surgical drainage. Pen. is traditional abx. of choice. Drainage is vital to prevent aspiration, asphyxiation and extension into the mediastinum.

PARAPHARYNGEAL ABSCESS

Most often a sequela of tonsillitis, but can occur as a complication of pharyngitis, parotitis, or dental infection.

Patients generally have severe trismus, externally visible inflammation behind the angle of the jaw and inflammation along the lateral wall of the pharynx with medial displacement of the tonsils.

Infection in this space is particularily dangerous because the carotid sheath passes through this area, thus infection can spread into the chest. Also infection can spread to the jugular vein causing postanginal sepsis (Lemiere syndrome) with septic phlebitis, septic pulmonary emboli and anaerobic bacteremia.

Management of parapharyngeal abscess consists of IV Pen. and surgical drainage.

PERITONSILLAR ABSCESS (QUINSY THROAT)

Most often complication of strep tonsillitis.

Patients present with fever, unilateral sore throat with pain often times referred to the ear. Dysphagia can result in difficulty swallowing saliva and drooling. Also may have muffled voice and trismus. Affected tonsil is displaced forward, downward, and medially.

Management consists of Pen. and drainage. Traditionally had been done as inpatient but recently good results obtained with needle aspiration and po abx. obviating need for hospitilization.