Rational Diagnostic and Therapeutic Management of Deep Neck Infections: Analysis of 233 Consecutive Cases

Objectives: Although deep neck infections ale less common nowadays because of the widespread use of antibiotics. they continue to catty significant morbidity and mortality rates Methods: Between 2000 and 2008. deep neck infections were treated in 233 patients at the University of Padova Cases of peritonsillar abscess, superficial infections, infections due to external neck injuries, and in in head and neck tumors were excluded Clinical, radiologic, laboratory, and microbiological assessments were analyzed Results: The site of origin was identified in 189 of the 233 cases (81 1%), and the most common cause of deep neck infection was dental infection (39 5%) Intravenous antibiotic therapy was given to 78 patients. and 155 required both medical and surgical procedures The bacteria most of isolated were gram-positive anaerobic cocci None of our patients died of the deep neck infection or its complications Conclusions: It is worth emphasizing that airway support is the priority in patients with deep neck infections Empirical antibiotic treatments must cover gram-positive and gram-negative aerobic and anaerobic pathogens Surgical exploration and drainage may be mandatory in selected cases at presentation or in cases that fail to respond to parenteral antibiotics within the first 24 to 48 bouts It is important to perform cultures dui me operation to establish the pathogen(s) involved and to obtain an antibiogram to tailor the antibiotic treatment