3. Congenital cervical cysts and fistulas

THEME I: THE NECK: Cervical Cysts and Fistulas, Deep Neck Infections

1. What is the definition of “deep neck infection”?

• Deep neck infection → is an infection that enters the fascial planes of the neck after originating in the oral cavity, pharynx, or a regional lymph node.
• It may be life-threatening if the infection enters the carotid sheath, the paravertebral spaces, or the mediastinum.

2. Which is the most common source of infection in deep neck abscesses and phlegmonas?

• Most commonly deep neck abscesses and phlegmonas are result of spreading of dental infection, with the first involvement of the submandibular spaces.

3. Once initiated, a deep neck infection can progress in two forms, which are they?

• Once initiated, a deep neck infection can progress to
• Neck cellulitis (phlegmon) or
• Neck abscess with a purulent fluid collection.

4. What does usually the microbiology of deep neck infections reveal?

• The microbiology of deep neck infections usually reveals mixed aerobic and anaerobic organisms, often with a predominance of oral flora.
• Both gram-positive and gram-negative organisms may be cultured.

5. Which are the three most common types of deep neck infections according to their localization?

• The three most common types of deep neck infections are

1. Peritonsillar abscess
2. Parapharyngeal abscess
3. Retropharyngeal abscess.

6. Which space is the most frequently involved in deep neck infections?

• Consequently, the parapharyngeal space is the most frequently involved space in deep neck infections.

7. Which is the most common type of deep neck infection in adolescents and young adults?

• The most common type of deep neck infection in adolescents and young adults is peritonsillar abscess - as a complication of acute bacterial tonsillitis

8. Which is the most dangerous localization of deep neck infection?

• Retropharyngeal space
• Generally, the most dangerous deep neck infection is retropharyngeal abscess.
• Spread of infection to → carotid sheath (internal) carotid artery erosion, jugular vein thrombophlebitis and then mediastinum will result in acute necrotizing mediastinitis with widened mediastinum on chest X-ray.

9. Which are the most common complaints and clinical features in patients with deep neck infections?

• Any patient with a recent history of tonsillitis pharyngitis, an odontogenic infection, or recent dental work with onset of neck swelling and pain, and severe general malaise must be assumed to have a deep neck infection.
• Other common findings include odynophagia, trismus, and respiratory compromise.

10. What is the first step in management of deep neck infection?