Management of Deep Neck Infections
Summary
Deep neck infections (DNIs) encompass a spectrum of bacterial invasions within the potential spaces of the neck, carrying significant morbidity and mortality if not managed promptly. Common origins include odontogenic sources, pharyngeal infections and salivary gland pathology. Clinical presentation often involves fever, neck pain, odynophagia and trismus. Rapid diagnosis hinges on cross-sectional imaging—computed tomography (CT) for speed and magnetic resonance imaging (MRI) for soft-tissue contrast—complemented by laboratory markers of inflammation. Empirical intravenous antibiotic regimens target streptococci, staphylococci and anaerobes, with adjustments guided by culture and sensitivity. Surgical intervention remains central: abscesses that are large, loculated or refractory to antibiotics require incision and drainage, performed transcervically, intraorally or under image guidance. Airway assessment is paramount, with awake fibre-optic intubation or tracheostomy indicated in cases of impending compromise. Intensive care support is crucial for severe sepsis or mediastinal extension. Management increasingly follows multidisciplinary protocols that integrate risk stratification, minimally invasive drainage techniques and antimicrobial stewardship, reflecting global efforts to standardise care and improve patient outcomes.
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Management of Deep Neck Infections publication trend
The graph below shows the total number of articles in management of deep neck infections across all publications each year (not limited to Nature Index journals).
Technical terms
Deep neck spaces: Anatomical fascial compartments within the neck where infections can localise and spread, including parapharyngeal, retropharyngeal and submandibular areas.
Incision and drainage (I&D): A surgical procedure involving cutting into an abscess cavity to evacuate pus and infected material, often followed by placement of a drain.
Ultrasound-guided drainage (USD): A minimally invasive technique using real-time ultrasound to guide needle or catheter placement for abscess evacuation.
Magnetic resonance imaging (MRI): A non-ionising imaging modality that provides high-contrast depiction of soft tissues and fluid collections in the neck, aiding in the differentiation of abscesses from cellulitis.
References
- MRI of acute neck infections: evidence summary and pictorial review. Insights into Imaging (2023).
- Emergency neck MRI: feasibility and diagnostic accuracy in cases of neck infection. Acta Radiologica (2020).
- Surgical vs ultrasound-guided drainage of deep neck space abscesses: a randomized controlled trial: surgical vs ultrasound drainage. Journal of Otolaryngology (2013).
- Airway management in patients with deep neck infections. Medicine (2016).
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