Fascial Spaces and Deep Neck Infections

Deep Neck Infection

Infectious and inflammatory conditions of the upper aerodigestive tract are the primary cause of

Dental Infections

most common cause of DNI in adults.

Oropharyngeal Infections

most common cause of DNI in children.

Staphylococcus aureus

more common in the nose and throat and may participate in mixed odontogenic infections.

Actinomyces

endogenous saprophytic organisms of the oral cavity and tonsil.

Actinomyces

A granulomatous reaction with central abscess formation and necrosis with “sulfur granules” is characteristic.

TUBERCULOUS AND NONTUBERCULOUS INFECTIONS OF THE HEAD AND NECK

• most commonly come to medical attention with cervical lymphadenopathy.

• Histopathologically, caseating necrotizing granulomatous inflammation is present.

CAT SCRATCH DISEASE

Carotid Sheath

Condensation of fascia of ALL THREE LAYERS OF DEEP CERVICAL FASCIA

Common Carotid

What structure is the most medial?

Internal Jugular Vein

What is the most lateral part?

Vagus Nerve (CN X)

What nerve is in between the IJV and Common carotid?

D

CAROTID SHEATH REPRESENTS THE CONFLUENCE OF

WHAT LAYERS OF CERVICAL FASCIA?

a. Superficial and deep

b. Investing and pretracheal

c. Pretracheal and prevertenral

d. all three layers of deep cervical fascia

Canine Spave

Buccal Space

2 Maxillary Space

Canine Space

becomes infected almost exclusively as a result of apical infection of the root of the maxillary canine tooth.

Canine Space

located between the anterior surface of the maxilla and the levator labii superioris.

BUCCAL SPACE

an ovoid space below the zygomatic arch and above the inferior border of the mandible.

SUBMENTAL SPACE

lies between the anterior bellies of the digastric muscles and between the mylohyoid muscle and the skin.

SUBLINGUAL AND SUBMANDIBULAR SPACE

Both spaces exit on the medial aspect of the mandible.

SUBLINGUAL SPACE

• lies between the lingual oral mucosa and the mylohyoid muscle.

• Its posterior boundary is open, so it communicates freely with the submandibular space and the secondary spaces located more posteriorly and superiorly.

SUBMANDIBULAR SPACE

• lies between the mylohyoid muscle and the skin.

• When this space becomes infected, the swelling begins at the inferior lateral border of the mandible and extends medially to the digastric area and posteriorly to the hyoid bone.

Ludwig’s Angina

If all three primary mandibular spaces bilaterally become infected, the infection is known as

• Trismus

• Drooling

• Dysphonia

• Dysphagia

Ludwig Angina Presentation (4)

Ludwig Angina

Tense and swollen floor of the mouth, submandibular area

• Incision and Drainage

• Tracheostomy

• Antibiotics

Ludwig Angina Management (3)

Mediastinitis

most common major complication of DNSI

Peritonsillar abscess (PTA)

• AKA QUINSY

• Localized deep neck infection that develops between the tonsil and its capsule.

Peritonsillar abscess (PTA)

most common deep neck space infection.

Peritonsillar cellulitis

inflammatory reaction of the tissue between the capsule of the palatine tonsil

and the pharyngeal muscles that is caused by infection

Peritonsillar abscess

collection of pus located between the capsule of the palatine tonsil and the

pharyngeal muscles.

Streptococcus pyogenes

Most common aerobic organisms

Fusobacterium

Most common anaerobic organisms

Peritonsillar Space

Consist of loose alveolar tissue overlying the palatine tonsils.

Tonsillar Fossa

Symptoms:

• Fever

• Malaise

• Severe sore throat (worse on one side) –UNILATERAL

• Dysphagia

• Otalgia (ipsilateral) – HYPOGLOSSAL NERVE

Tonsillar Fossa

• Erythematous, swollen soft palate with uvula deviation to contralateral side and enlarged tonsil

• Trismus - irritation and reflex spasm of the medial pterygoid muscle

• Drooling or Pooling of saliva

• Muffled voice (“hot potato voice”)

• Needle Aspiration

• Incision and Drainage

• Antimicrobial Therapy

• Tonsillectomy

Tonsillar Fossa Management (4)

Lemierre Syndrome

rare thrombophlebitis of the internal jugular vein most often caused by the anaerobic, gram-negative bacillus Fusobacterium necrophorum.

Lemierre Syndrome

• period of pharyngitis before progressing to fever, lethargy, lateral neck tenderness and edema, occasional trismus, and septic emboli

• bilateral

• nodular infiltrates on chest radiography or as septic arthritis

IV β-lactamase

Lemierre Syndrome Management (1)

CAVERNOUS SINUS THROMBOSIS

retrograde spread of infection from the upper dentition or paranasal sinuses via the valveless ophthalmic venous system to the cavernous sinus

Mediastinitis

Relatively rare complication of DNI caused by spread of infection along the retropharyngeal and prevertebral planes of the neck into the upper mediastinum

Necrotizing Fasciitis

• Severe form of DNI that occurs more often in

• Older adults (age >60 years)

• Immunocompromised patients

• Poorly controlled diabetes.

Necrotizing Fasciitis

• PITTING NECK EDEMA

• ORANGE-PEEL APPEARANCE from obstructed dermal lymphatics

• with or without subcutaneous CREPITUS