Deep neck infections include the parapharyngeal abscess, the retropharyngeal abscess and submandibular abscess.
All deep neck infections are considered emergencies because they have the potential to obstruct the trachea.
SIGNS AND SYMPTOMS
Similar to tonsilitis such as odynophagia, dysphagia, fever, and consittutional symptoms. Trismus and torticollis may also be present.
WORK UP
For all deep neck infecitons must do X-ray CT and Gram Stain.
Treatment for all deep neck infections are similar. Protect airway with intubation and tracheostomy and IV Anti-biotics.
Complications include laryngeal edema, mass effects due to compression of the trachea and rupture which may lead to aspiration and asphyxiation and pneumonia.
Parapharyngeal Abscess
Anatomy is a pyramid shape with the base is at the mastoid and the apex is at the hyoid bone. Cause secondary to trauma in the mouth. Also caused by tonsilitis, adeniditis, nasopharynx infections. Bezold's abscess is a mastoiditis that leaks into the sternucleodomastoid and petrositis. Swelling is located in the jaw and may affect cranial nerve 9, 10, 11, 12.
Retropharyngeal Abscess
Located behind the buccopharyngeal fascia and extends down to the trachea bifurcation. However there is a danger space that extends to diaphragm and the prevertbral space can extend to the psoas muscle. May be secondary retropharyngeal lymph node and Pott's Disease which causes a chronic form of retropharyngeal abscess. Can be seen on the posterior pharynx and affect breathing as well as cervical lymph node tenderness. May cause mediastinitis, pericarditis, temponade, pleuritis, empyema, pneumothorax, osteomyelitis, massive hemorhage due to carotid and jugular invasion.
Submandibular Abscess
Located on the floor of the mouth lateral to the tongue. Caused by dental infection (poor hygiene) usually the lower molar tooth. Presents with tongue pushed up and back as well as swelling of the chin.
28 авг 2024
