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Deep neck space infections

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Deep neck space infections

  1. 1. Clinical importance: Various spaces in the neck 18 spaces: suprahyoid and infrahyoid Clinically important Intercommunication infection spreads rapidly: cranial cavity, mediastinum
  2. 2. Clinical importance cont.: If not tackle:- Life threatening conditions Acute laryngeal oedema Upper airway compression Involvement of great vessels, cranial nerves Severe odynophagia
  3. 3. Important Deep Neck Spaces: 1. Peritonsillar space 2. Submaxillary space: sublingual space submandibular space 3. Retropharyngeal space 4. Parapharyngeal space 5. Parotid space 6. Masseteric space 7. Pre-epiglottic & para-glottic space.
  4. 4. Peritonsillar space: Boundary: laterally : superior constrictor medially : tonsillar capsule Infection: peritonsillitis-> Abscess (quinsy) Pathology : as an complication & : de novo
  5. 5. Peritonsillar space cont.: s/s: Pain more severe & unilateral Muffled sound (hot potatoes sound) Trismus Drooling of saliva Inflamed soft palate Buried tonsils Enlarged and tender JD node
  6. 6. Management of peritonsillitis: Diagnosis: clinically, aspiration of abscess Treatment: I/V Ampicillin + cloxacillin & metronidazole Anti-inflammatory: Ibuprofen & paracetamol Locally antiseptic mouth wash If abscess: I & D of abscess (site of drainage) If second attack: tonsillectomy.
  7. 7. Submaxillary space: Boundary: Superior : mucosa of floor of mouth Inferior : deep fascia of neck Divided by myelohyoid muscle Content: submandibular and sublingual salivary glands, lymph nodes.
  8. 8. Sub maxillary space cont: Ludwigs angina (inflammation of floor of mouth):- Browny Induration Pathology: Dental origin(80%) Inflammation of submandibular salivary gland Lymphadenitis Trauma floor of mouth
  9. 9. Ludwig’s Angina
  10. 10. Submaxillary space cont.: S/S: pain Swelling of floor of mouth Submandibular & submental region Trismus Diagnosis: clinically Treatment: Conservative : Antibiotics : Anti-inflammatory : local antiseptic mouth wash
  11. 11. Submaxillary space cont.: Surgical treatment: Incision and drainage: wide incision Greety sensation No pus: usually inflammatory fluid & necrotic tissue NB: always pierce myelohyoid muscle.
  12. 12. Retropharyngeal space: Boundary: Superior : base of skull Inferior : posterior mediastinum Posterior : pre-vertebral fascia Anterior : bucopharyngeal fascia Content: Lymph nodes, loose aerolar tissues. Pathology:suppuration RP lymph node (Rouviere) :Koch’s spine :Pharyngeal trauma :From other neck spaces
  13. 13. Retropharyngeal space cont: S/S: Pain, fever Odynophagia Drooling of saliva Stertor: respiratory obstruction o/e: bulging of posterior pharyngeal wall X-ray soft tissues neck lateral view: increase prevertebral soft tissue density.
  14. 14. Retropharyngeal space cont: Treatment: Conservative: Antibiotics Anti-inflammatory+ supportive therapy Surgical: I&D of most bulging area through trans-oral route Anaesthesia: blanket anaesthesia Position: head down and lateral position
  15. 15. Parapharyngeal space: Boundary: Superior : base of skull Inferior : Hyoid bone Medial : pharynx Lateral : mandible content: great vessels, last 4 cranial nerves, lymph nodes, deep lobe of parotid.
  16. 16. Parapharyngeal space cont: S/S:  Pain, fever, odynophagia Drooling of saliva Stertor - respiratory obstruction O/E: lateral neck swelling bulging of lateral pharyngeal wall pseudo enlargement of tonsils
  17. 17. Parapharyngeal space cont: Treatment: Conservative: Antibiotics Anti-inflammatory + supportive therapy Surgical: I&D of most bulging area lateral side of neck (external route) Anaesthesia: LA or GA Position: head turn and lateral position