deep neck space infections
DESCRIPTION
Overview of deep neck space infectionsTRANSCRIPT
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Deep Neck Space Infections
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Fascial Planes of the Neck Superficial cervical fascia
Envelopes; Boundaries; Significance
Deep cervical fascia Superficial layer (investing layer)▪ Envelopes; Boundaries; Significance
Middle layer (visceral fascia)▪ Envelopes; Boundaries; Significance
Deep layer (prevertebral fascia)▪ Envelopes; Boundaries; Significance
Carotid sheath fascia Envelopes; Boundaries; Significance
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Neck Spaces(Boundaries & Contents)
Parapharyngeal space Pterygopalatine (pterygomaxillary) fossa Masticator space Temporal fossa Infratemporal fossa Parotid space Peritonsillar space Submandibular space Carotid sheath space Visceral (pretracheal) space Retropharyngeal (retrovisceral) space Danger space Prevertebral space
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Etiology
Dental infections (most common in adults) Acute pharyngitis of Waldeyer’s ring (most common
in children) Cervical lymphadenitis (r/o cancer in adult) Acute rhinosinusitis (retropharyngeal lymphadenitis) Acute mastoiditis (Bezold abscess) Iatrogenic (oral surgery; intubation; endoscopic
trauma) Sialadenitis Foreign body Penetrating cervicofacial trauma (including IV drug) Cellulitis Congenital cysts (thyroglossal duct; branchial cleft) Acquired cysts (laryngoceles; saccular cysts)
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Microbiology
Mixed aerobic & anaerobic oropharyngeal flora (most common)
Strep. viridans Strep. pyogenes Peptostreptococcus Staph. epidermidis Staph. aureus MRSA Bacteroides Fusobacterium Neisseria, Pseudomonas, Escherichia, Haemophilus Actinomyces Mycobacteria Baronella henselae
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History
Inflammatory symptomsLocalizing symptomsRecent infectionRecent traumaRecent surgery Immunodeficiency status
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Physical Examination
PalpationOtoscopyOral cavity & Pharynx
Dentition Trismus Salivary ducts Unilateral tonsil swelling
Awake flexible fiberoptic airway evaluation
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Diagnostic Testing
Blood testsPlain x-rays
Lateral neck film Chest film
CT with IV contrastMRIUltrasound
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Treatment
Airway management Fluid resuscitation IV antibiotics Surgical management
Indications Goals Needle aspiration Transoral incision & drainage (peritonsillar
abscess, buccal space, masticator space, pterygomaxillary space)
Tonsillectomy Transcervical incision & drainage Surgical technique
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Complications
Ludwig’s anginaCavernous sinus thrombosisLemierre syndromeCarotid artery pseudo-aneurysm
or ruptureMediastinitisNecrotizing fasciitis