Deep neck space infection – diagnostic and therapeutic challenges: two case reports

Abstract

Introduction. The infections of the deep neck spaces, are often a clinical challenge, being a medico-surgical emergency with a bad prognosis and lethal potential in the absence of early diagnosis and well applied treatment. Case report 1. The first case presented is a woman, 72-year-old, known with anaemia due to myelodysplastic syndrome, admitted in the haematology department. The symptoms were dysphagia with odynophagia and right submandibular tumefaction, on an afebrile background. In this case the infection started with the peritonsillar abscess which then developed into a parapharyngeal abscess. The main medical difficulties appeared after the surgery, the general condition of the patient worsening despite the favourable evolution of the surgical wound. A total recovery, including deglutition, was possible two months after discharge. Case report 2. The second patient is a young female, aged 26, with a good social and material status, without associated comorbidities. The triggering factor is the extraction of the 3.7 molar prior to the appearance of the symptoms. The condition of the patient was critical during the first seven days after surgery due to the severity of the cervical and mediastinal lesions. Conclusions The management of deep neck infections is a diagnostic and therapeutic challenge, and must be based on the multidisciplinary aid. The prevalence of deep neck infections is decreasing, due to antibiotics, but still remains an ENT emergency.

Keywords

• cervical suppurations
• neck fascia layers
• parapharyngeal collection
• exploratory cervicotomy
• neck ct scan