Neck infect 980225

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Deep Neck Space Abscesses and Life-Threatening Infections of the Head and Neck: 

Deep Neck Space Abscesses and Life-Threatening Infections of the Head and Neck Carl Schreiner, MD F. B. Quinn, MD February 25, 1998

INTRODUCTION: 

INTRODUCTION Life-threatening infections - rare Influence of antibiotics Lack of systemic signs and Sx Immunosupression

ANATOMIC CONSIDERATIONS: 

ANATOMIC CONSIDERATIONS Teeth, tonsils Polymicrobial infections 10:1 anaerobes Pathways of spread fascial planes intracranial periorbital

DEEP NECK SPACE INFECTIONS: 

DEEP NECK SPACE INFECTIONS Usually odontogenic young, healthy, delayed Tx Cervical Fascial Layers Superficial fascia Deep fascia superficial (investing) middle(visceral) deep (prevertebral and alar layers)

SUBMANDIBULAR SPACE: 

SUBMANDIBULAR SPACE 1836 - Wilhelm Von Ludwig implies bilateral involvement boundaries Hyoid to FOM Ant/lat - mandible Mylohyoid “sling” bucopharyngeal gap

LUDWIG’S ANGINA: 

LUDWIG’S ANGINA dysphagia, drooling, muffled voice “woody” induration, no fluctuance Treatment airway control IV ABX Surgical drainage

LATERAL PHARYNGEAL SPACE: 

LATERAL PHARYNGEAL SPACE Inverted cone - hyoid to base of skull Pre-styloid compartment fat, lymph nodes, muscle Post-styloid carotid, IJ, CN IX - XII pain, fever, neck swelling, ?trismus

LATERAL PHARYNGEAL SPACE: 

LATERAL PHARYNGEAL SPACE Ominous signs Horners, bleeding, CN palsies, mediastinitis Treatment Surgical drainage IV ABX jugular vein thrombosis

RETROPHARYNGEAL SPACE: 

RETROPHARYNGEAL SPACE Retropharyngeal space between alar layer and sup. constrictors extends to sup mediastinum Danger space between alar and prevertebral layers diaphragm prevertebral space down to coccyx

MASTICATOR SPACE: 

MASTICATOR SPACE Pterygoids, masseter, temporalis m. Comm w/ temporal space superiorly Trismus! CT can direct surgical approach

PERITONSILLAR ABSCESS: 

PERITONSILLAR ABSCESS Areolar tissue bound by sup. constrictors Rarely life-threatening but can spread Serial aspiration vs I and D

NECROTIZING FASCIITIS: 

NECROTIZING FASCIITIS Synergistic, polymicrobial infection Sup layer of deep fascia Determining necrosis is Key gas, crepitance, failure to respond to ABX Treatment IV ABX Radical surgical debridement

ACUTE EPIGLOTTITIS: 

ACUTE EPIGLOTTITIS Now rare in children “Hot potato” voice, drooling, fever No FILMS - go to OR! no fiberoptic exam bronch, trach equipment ready change to nasotracheal tube

MUCORMYCOSIS: 

MUCORMYCOSIS Progressive, invasive fungal infection Severe DM or immunocompromised Black necrotic lesions of nose or palate Radical surgical debridement to bleeding Broad, nonseptate hyphae, right angles Amphoterrible

COMPLICATIONS OF SINUSITIS: 

COMPLICATIONS OF SINUSITIS Parameningeal, periorbital location Frontoethmoid sinuses frontal lobe abscess, meningitis, subdural empyema Sphenoid sinuses Sup orbital fissure, cavernous sinus Sx of increased intracranial pressure

OTOLOGIC COMPLICATIONS: 

OTOLOGIC COMPLICATIONS Involve middle or posterior fossa Epidural abscess>meningitis>brain abscess Warning signs early - malodorous discharge, fever, HA late - facial paralysis., vertigo Multiple complications are common Malignant otitis externa