Diagnosis and treatment of deep cervical cavity infections

The article is professionally consulted by Master, Doctor Le Thi Minh Huong - Doctor of Resuscitation - Emergency, Department of Resuscitation - Emergency, Vinmec Nha Trang International General Hospital

When infected with deep neck cavity, the patient will often present symptoms of swelling and pain in the neck accompanied by toxic fever. These cases need urgent diagnosis and treatment because they can quickly damage the airways, then spread quickly to the mediastinum or cause septicemia, affecting the patient's life.

Based on the relationship to the hyoid bone, the deep cervical cavity is divided into 3 groups as follows:
Cavities extending along the length of the neck: With this group, the deep cervical cavities along the length of the neck will include the vascular compartments. serosa, the “danger” space, the anterior vertebral space, the retropharyngeal space. Suprahyoid space: The spaces above the hyoid bone are meant to be above the hyoid bone. These compartments include the submandibular space, the peritonsillar space, the occlusal space, the peripharyngeal space, the temporal space, and the parotid space. Subhyoid space: This space has only one space below the hyoid bone, which is the preserosal space.

When the infection is deep in the neck cavity, the patient will often have symptoms of swelling and pain in the neck along with toxic fever. These cases are often very urgent because they can quickly damage the airway, then spread rapidly to the mediastinum or cause sepsis, affecting the patient's life. Deep neck infections are caused by many causes, some common causes are as follows:
Oral cavity infections: Infection from the oral cavity is the most common cause of deep neck cavity infections. Some diseases cause infections of the oral cavity such as tonsillitis, pharynx; tooth abscess; tooth infection; infection caused by oral surgery; parotid gland infection or thyroid cysts, gill slit abnormality or inflamed thyroid gland;... Disease of local purulent lymph nodes and local abscess causing deep cervical cavity infection such as: cervical lymphadenitis or cervical tumor necrosis and pus. Extensive infection: Deep cervical cavity infection may result from extension from other spaces into the deep cervical cavity through anastomosis; Mastoid osteomyelitis with osteomyelitis, Bezold's body abscess can also cause infection. Trauma: Some trauma to the oral cavity, pharynx, neck area, having a foreign body in the mouth can be the causes of deep neck cavity infection. Bacterial: Infection of the deep neck cavity can be caused by some aerobic and anaerobic bacteria such as Klebsiella, Neisseria, H. influenza, S. pneumonia, Borrelia vincentii. Or it can also be caused by anaerobic bacteria such as Fusobacterium, Peptostreptococcus, Bacteroides. In some cases, gram-negative bacilli cause deep purulent infections in the elderly, people with diabetes, weakened or weakened immune systems. However, in some cases, deep neck cavity infections may not be able to find the cause of the disease, making treatment more difficult.

Diagnosis of deep neck cavity infection is usually based on clinical symptoms and imaging studies, because the diagnosis of deep cervical cavity infection based on history and physical examination is difficult. Therefore, imaging can help diagnose the disease most accurately, and can also differentiate between cellulitis and abscess. Specific diagnostic methods are as follows:
Diagnosis of deep neck infection based on clinical symptoms
Signs of infection syndrome: Symptoms of infection syndrome such as fever, rapid breathing, tachycardia, white blood cell count > 11,000/mm3, mainly Neutrophil. Local manifestations: When the deep cervical cavity is infected, the patient often has a swollen, hot, red, painful neck or loss of the laryngeal column of the spine and aspiration of pus. Respiratory manifestations: Patients often have difficulty breathing, the cause of shortness of breath is due to edema, narrowing of the throat or due to accumulation of viscous sputum, difficulty swallowing and difficulty spitting in the throat when infected with deep throat cavity. Symptoms of shortness of breath will increase when the patient lies on his back. Diagnosis of deep neck cavity infection based on imaging:
Using straight neck x-ray method: With this method, the doctor can detect infection of the retropharyngeal space, anterior vertebral space on the images. of X-ray film. Ultrasound: Ultrasonography is useful in guided aspiration abscesses. Contrast-enhanced CT scan and MRI: These two methods are very effective in helping to confirm the diagnosis and differentiate from cellulitis as well as guide the surgical incision to drain the abscess.

Infection of the deep neck cavity often causes very dangerous complications such as airway obstruction leading to asphyxiation; ruptured abscess, lung abscess causing pneumonia and empyema. In addition, deep cervical cavity infection can cause mediastinal abscess, mediastinitis, jugular vein embolism, carotid artery rupture, and especially recurrent deep neck infection. Therefore, treatment is needed to limit and prevent these dangerous complications.
The usual treatment regimen for deep neck cavity infections is to secure the airway, use intravenous antibiotics and surgical drainage. The specific treatment is as follows:
Secure the airway:
When the patient has signs of shortness of breath or wheezing due to upper airway obstruction, it is necessary to intubate. However, in difficult cases, endotracheal intubation can be performed under the guidance of a flexible bronchoscope. In some cases, a tracheostomy may be used. The cases should use this method is the patient awake, local anesthesia. If the patient has a Ludwig abscess, prompt and proactive tracheostomy is required. Direct laryngoscopy: This method is rarely applied, can rupture the abscess, causing pneumonia. Intravenous antibiotic use:
In case the clinical symptoms do not improve after 24 - 48 hours of medical treatment, it is necessary to re-order imaging tests and conduct surgical drainage incision. In some cases, deep neck abscesses can be relieved with medical treatment of broad-spectrum antibiotics, using high doses intravenously. The group of antibiotics commonly used in clinical practice includes 3rd generation Cephalosporin combined with Metronidazole. Note, when treating should be based on clinical response such as fever, swelling... and antibiogram to adjust the type of antibiotic as well as the most appropriate antibiotic dose and duration for the patient. Surgical drainage for deep neck cavity infections:
The location of drainage incisions for deep neck cavity infections will depend primarily on the location of the abscess and its relationship to other structures in the neck. Whether to appoint an intraoral incision or an external drainage will depend on each specific case. In the case of isolated abscesses that have not spread to other compartments in the deep cervical space and are small, ultrasound or CT-guided aspiration of the abscess should be used. This approach avoids manipulation of vital vital structures in the patient's neck.

In short, patients need to go to a reputable hospital to conduct examination and treatment as soon as there are signs of deep neck cavity infection. Currently, Vinmec International General Hospital is one of the leading prestigious hospitals in the country, trusted by a large number of patients for medical examination and treatment. Not only the physical system, modern equipment: 6 ultrasound rooms, 4 DR X-ray rooms (1 full-axis machine, 1 light machine, 1 general machine and 1 mammography machine) , 2 DR portable X-ray machines, 2 multi-row CT scanner rooms (1 128 rows and 1 16 arrays), 2 Magnetic resonance imaging rooms (1 3 Tesla and 1 1.5 Tesla), 1 room for 2 level interventional angiography and 1 room for bone mineral density measurement... Vinmec is also the place to gather a team of experienced doctors and nurses who will greatly assist in diagnosis and early detection. abnormal signs of the patient's body. In particular, with a space designed according to 5-star hotel standards, Vinmec ensures to bring the patient the most comfort, friendliness and peace of mind.