Deep neck infections

INTRODUCTION Infections of the various deep spaces of the neck are uncommon. However, when they do occur, they are often life threatening, and even stable-appearing patients are at grave risk for sudden clinical decompensation. This degree of clinical severity is related to both the anatomic nature of the space (Figure 10.1) involved with numerous adjacent critical organs and structures being present as well as the nature of the hosts themselves. Patients with such infections are frequently diabetic or immunecompromised in some other way often having a history of injection drug use, neutropenia, or steroid use. There is often a dental source of these infections, and underlying poor dentition is commonly encountered. On rare occasions, deep neck space infection may complicate head and neck cancers or residual dentiginous cysts or lateral cleft. An example of a deep neck infection of the lateral pharyngeal space in a human immunodeficiency virus (HIV)-infected patient is shown in Figure 10.2. Nocardia asteroides grew from the deep neck cultures. These infections are usually polymicrobial, reflecting the oral cavity source of most of these infections. When associated with injection drug use, community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is the most likely organism to be encountered. The microbiology of these infections is shown in Table 10.1.