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Eur Arch Otorhinolaryngol. 2012 Apr;269(4):1241-9. doi: 10.1007/s00405-011-1761-1. Epub 2011 Sep 14.

Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment.

Author information

1
Department of Medical and Surgical Specialities, University of Padua, School of Medicine, Padua, Italy. paolo.boscolorizzo@unipd.it

Abstract

The aims of this investigation were to review the clinical behavior of deep neck infections (DNIs) treated in our institution in order to identify the predisposing factors of life-threatening complications and propose valuable recommendations for management and treatment. A total of 365 adult patients with DNIs were retrospectively identified. One-hundred and thirty-nine patients (38.1%) underwent surgical drainage. Overall, 226 patients (61.9%) responded effectively to intravenous antimicrobial therapy only. There were 67 patients (18.4%) developing life-threatening complications. Diabetes mellitus (odd ratio 5.43; P < 0.001) and multiple deep neck spaces involvement (odd ratio 4.92; P < 0.001) were the strongest independent predictors of complications. The mortality rate was 0.3%. Airway obstruction and descending mediastinitis are the most troublesome complications of DNIs. In selected patients, a trial of intravenous antibiotic therapy associated with an intensive computed tomography-based wait-and-watch policy may avoid an unnecessary surgical procedure. However, about one-fourth of patients present significant comorbidities, which may negatively affect the course of the infection. In these cases and in patients with large or multiple spaces infections, a more aggressive surgical strategy is mandatory.

PMID:
21915755
DOI:
10.1007/s00405-011-1761-1
[Indexed for MEDLINE]

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