Deep Neck Infections
Deep Neck Infections
Deep Neck Infections
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<strong>Deep</strong> <strong>Neck</strong> <strong>Infections</strong><br />
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1
1. Fasciae of the head and neck 1<br />
2. Potential spaces of the neck 4<br />
3. Etiology and pathogenesis of deep neck infection 8<br />
4. Clinical manifestation 10<br />
5. General work up 10<br />
6. Ludwigs angina 11<br />
7. Parapharyngeal space infection 15<br />
8. Retropharyngeal space infection<br />
9. References<br />
17<br />
2
deep neck infections ก<br />
<br />
ก<br />
ก<br />
<br />
กก<br />
ก<br />
<br />
<br />
<br />
deep neck infections ก<br />
<br />
<br />
กก deep neck infections กกก Mediastinitis ,<br />
airway obstruction, carotid artery hemorrhage septicemia <br />
source infection, signs and symptoms , microbiologic features ก<br />
laboratory radiologic workups กกก<br />
กกก<br />
deep neck infections กก<br />
fascial<br />
planes potential space กก<br />
กก<br />
drainage ก<br />
Fasciae of the head and neck<br />
2 1. Cervical spine musculature กก spine <br />
musculature ก<br />
support ก cervical portion spinal cord<br />
spine 2. Visceral segment <br />
viscera, vasculature, nerves <br />
lymphatics cervical fasciae <br />
visceral structures 2 <br />
superficial deep layer<br />
Superficial cervical fascia<br />
Superficial cervical fascia sheet fibrous connective tissue <br />
adherent ก deep fascia<br />
Superficial cervical fascia platysma muscle platysma muscle <br />
cervical branch fascial nerve marginal mandibular branch facial nerve<br />
<br />
superficial cervical fascia, Potential space superficial deep<br />
cervical fascia กก platysma muscle กก<br />
<br />
3
The deep cervical fascia<br />
<strong>Deep</strong> cervical fascia (<br />
1 2) กก spread<br />
cervical infections ก ก<br />
3 <br />
1. superficial or investing layer of the deep cervical fascia<br />
2. middle layer or vesceral fascia<br />
3. deep layer or prevertebral fascia<br />
various fascia กก<br />
potential space ก<br />
infections neck space <br />
<br />
1 Cross section of the neck<br />
Superficial layer of the deep cervical fascia<br />
ก skull chest ก<br />
mother of the cervical fasciae<br />
deep cervical fascia <br />
develop ก fascia <br />
4
superficial layer of the deep cervical fascia ก ligamentum nuchae,<br />
spine cervical vertebrae external occipital protuberance, mastoid process<br />
zygoma<br />
mandible hyoid bone<br />
scapula, clavicle manubrium กก sternum<br />
Superficial layer of the deep cervical fascia 1 ก<br />
2 <br />
ก<br />
trapezius ก<br />
sternocleidomastoid <br />
sternum<br />
1-3 . ก suprasternal space of Burns fascia กhyoid<br />
bone <br />
mandible ก submandibular space <br />
submental space <br />
anteromedial <br />
ก<br />
anterior belly of the digastric <br />
Superficial layer fascia กก<br />
capsule parotid gland ก<br />
ก parotidomasseteric fascia ก<br />
parotid gland masseter<br />
muscle parotidomasseteric fascia <br />
superiorly <br />
inferior border of<br />
zygoma ก<br />
fascia superiorly temporalis muscle fascia <br />
lateral orbital margin temporal line of skull The deeper layer <br />
pterygoid muscle mandible <br />
deep parotid gland ก 2 spaces <br />
parotid masticator spaces.<br />
Middle or Visceral fascia of the deep cervical fascia<br />
Fascia <br />
viscera pharynx , esophagus, larynx, trachea <br />
thyroid gland strap muscles fascia ก<br />
space <br />
กกก<br />
mouth, pharynx, esophagus, larynx trachea<br />
The visceral layer of deep cervical fascia 3 <br />
strap<br />
muscle, <br />
viscera carotid sheath<br />
cervical visceral fascia form capsule thyroid gland <br />
pharynx, esophagus, larynx trachea base of skull, superior constrictor<br />
muscle pharynx , pharyngeal aponeurosis, mandible pterygomandibular<br />
raphae<br />
The buccopharyngeal fascia <br />
fascia <br />
constrictor muscle<br />
buccinator muscle extending ก base of skull cricoid cartilage<br />
5
carotid sheath connective tissue carotid artery, vagus nerve,<br />
intenal jugular vein cervical sympathetic chain ก<br />
base of skull กก<br />
clavicle, carotid sheath กกก<br />
chest mediastinum <br />
<br />
<br />
2 Midsagittal section<br />
<strong>Deep</strong> cervical fascia or prevertebral fascia<br />
The prevertebral fascia (<br />
2) <br />
cervical vertebral bodies <br />
paraspinous muscle (musculus longus colli , musculus longus capitis, scalene muscle)<br />
lateral tip of transverse processes of cervical vertebrae<br />
6
Potential Spaces of the <strong>Neck</strong><br />
Potential space กก <br />
<br />
ก potential space <br />
<br />
The lateral pharyngeal or parapharyngeal space<br />
Parapharyngeal space ( 1,3) ก<br />
pharyngomaxillary space<br />
ก connective tissue <br />
space <br />
medial pterygoid muscle, mandible<br />
carotid sheath ก base of skull, กก<br />
hyoid <br />
posterolateral ก carotid sheath , Posteromedial ก retropharyngeal space, <br />
medial buccopharyngeal fascia <br />
constrictor muscle <br />
tonsillar fossa<br />
anterior inferior ก spaces floor of mouth<br />
<br />
3 Oblique cross section<br />
The submandibular space<br />
Submandibular space (<br />
4) 2 space mylohyoid muscle <br />
mylohyoid muscle ก submaxillary space submental<br />
space <br />
anterior belly of digastric muscle , mandible hyoid bone<br />
7
space <br />
mylohyoid muscle sublingual space<br />
submandibular space oral mucosa , tongue , mandible <br />
กก hyoid <br />
space <br />
most common กก<br />
กกก<br />
injury floor of<br />
month , กก sublingual submandibular gland , กก<br />
root of<br />
mandibular teeth<br />
ก<br />
submandibular space กก submaxillary<br />
sublingual space mylohyoid ก geniohyoid muscle ก<br />
mylohyoid cleft<br />
Whartons duct, lingual nerve, hypoglossal nerve , branch of facial artery<br />
multiple lymphatics mylohyoid cleft <br />
กก<br />
midline <br />
sublingual submaxillary <br />
Ludwigs angina ก<br />
cellulitis กก<br />
molar ก sublingual space ก<br />
2 tongue ก upward posteriorly ก severe airway<br />
obstruction กก<br />
posterior <br />
carotid sheath <br />
retropharyngeal space <br />
<br />
4 Coronal view<br />
8
The masticator space<br />
The masticator space (<br />
4) กกก fascia <br />
superficial layer of<br />
the deep cervical fascia mandible muscle of mastication 2 <br />
anterior ก masseter muscle, medial lateral pterygoid muscle, ramus<br />
Posterior ก body of mandible tendinous insertion temporalis<br />
muscle masticator space ก Zygoma, mandible , pterygoid<br />
muscle base of skull ก superomedially ก temporal space <br />
Zygomatic arch ก<br />
masticator space ก<br />
ก<br />
3<br />
The retropharyngeal space<br />
Retropharyngeal space (<br />
2 3) <br />
deep layer of the deep<br />
cervical fascia buccopharyngeal fascia <br />
constrictor muscles pharynx<br />
esophagus <br />
<br />
space <br />
alar layer<br />
alar layer deep layer of the deep cervical fascia ก<br />
base of<br />
skull Thoracic vertebra <br />
2 fascia ก<br />
sheath <br />
esophagus <br />
deep layer of the deep cervical fascia <br />
alar layer<br />
<br />
base of skull diaphragm ก<br />
prevertebra space<br />
ก<br />
danger space ก<br />
space <br />
กกก<br />
mediastinum <br />
Retropharyngeal space กกกก<br />
parapharyngeal space , masticator<br />
space parotid space ก retropharyngeal lymph node ก<br />
กก<br />
space กก<br />
endoscopy <br />
Parotid space<br />
Parotid space (<br />
3) <br />
superficial deep capsule porotid<br />
gland กกกก fascia <br />
superfical layer of the deep cervical fascia<br />
superficial capsule กก parotid gland <br />
deep capsule กก parapharyngeal space ก<br />
medial<br />
capsule ก lateral capsule parapharyngeal space ก<br />
parotid<br />
9
space กก<br />
parapharyngeal space <br />
retropharyngeal space <br />
carotid sheath mediastinum <br />
complication กก<br />
suppurative parotiditis (1)<br />
Etiology and pathogenosis of deep neek infections<br />
deep neck infections ก<br />
spaces spaces , ก<br />
antibiotic deep neck infections กกกก<br />
pharynx tonsil <br />
70% กก<br />
antibiotic กก<br />
กกก deep neck infections กก 50% source of<br />
infection (2) กกก deep neck infections <br />
1. กกกก<br />
sublingual submaxillary spaces ก Ludwigs angina , กก<br />
masticator space กก<br />
parapharyngeal space , infratemporal<br />
fossa pterygopalatine fossa กก carotid sheath retropharyngeal<br />
space ก mediastinitis กกMixed<br />
microbiologic flora<br />
<br />
alpha beta-streptococci, Staphylococcus, Peptostreptococcus, Fusobacterium<br />
nucleatum , Bacleroides melanogenicus, B. oralis, Veillonella, Actinomyces ,<br />
Spirochaeta <br />
2. กกก<br />
tonsillar peritonsillar กก antibiotic<br />
กกก deep neck infections Peritonsillar abscess <br />
cellulitis กก<br />
streptococcal ก<br />
retrograde thrombophlebitis parapharyngeal space กก<br />
Carotid sheath<br />
ก<br />
Mediastinum posterior parapharyngeal<br />
space fascia ก<br />
retropharyngeal กก<br />
retropharyngeal space <br />
3. Trauma aerodigestive tract blunt, penetrating <br />
iatrogenic <br />
deep neck infections กกก<br />
ก retropharyngeal space parapharyngeal space <br />
<br />
10
4. Retropharyngeal lymph nodes drain ก nose paranasal sinuses,<br />
pharynx , middle ear , eustachian tube , muscle bone <br />
lymph nodes<br />
กกกกกกกก<br />
retropharyngeal abscess <br />
compromised immune system<br />
<br />
Streptococcus pyogenes, Staphylococcus oralis anaerobic<br />
bacteria ก<br />
retropharyngeal space alar layer <br />
prevertebral space<br />
mediastinum <br />
5. Prevetebral space กกก<br />
cervical vertebral body infection <br />
necrosis กกก Potts disease ก<br />
tuberculosis<br />
6. Sialadenitis กกก<br />
Staphylococcus Streptococcus ก<br />
submandibular gland กก<br />
submandibular space ก<br />
parapharyngeal space ก parotitis ก<br />
masticator space <br />
parapharyngeal space fascia <br />
posteroinferior deep lobe<br />
parotid gland <br />
7. Temporal bone กก<br />
parapharyngeal space <br />
Bezolds abscess ก<br />
mastoid air cell ก tip กก mastoid<br />
ก<br />
parapharyngeal space ก<br />
8. ก<br />
congenital cyst fistulas ก deep neck infections<br />
กกก<br />
fascial compartment ก foregut anomalies, bronchogenic<br />
cysts, thyroid cysts , laryngoceles , thyroglossal duct cysts, branchial arch<br />
anomalies source deep neck infections <br />
9. report deep neck infections กก (3) ก<br />
กก<br />
supraclavicular ก<br />
carotid sheath <br />
mediastinum <br />
Staphylococcus aureus beta-hemolytic<br />
streptococci<br />
ก injury carotid artery innominate artery ก<br />
pseudoaneurysm formation <br />
11
Clinical manifestations<br />
Clinical presentation deep neck infections ก<br />
space ก<br />
ก<br />
specific deep neck infections ก<br />
pain , fever,<br />
limitation mandibular neck motion<br />
Pain ก<br />
primary source infection ก<br />
กกกกกก<br />
abscess retropharyngeal space กกกก<br />
<br />
Fever deep neck infections spiking temperatures<br />
ก<br />
septicemia กก<br />
thrombophlebitis internal jugular vein<br />
<br />
mediastinum<br />
Trismus and limitation neck motion ก deep neck infections ก<br />
กกก<br />
pitting edema ก<br />
deep neck infections กก fluctuance<br />
ก<br />
<br />
progressive dysphagia odynophagia , change in<br />
voice dyspnea<br />
Change in voice กกกก<br />
retropharyngeal space <br />
parapharyngeal space ก Hot potato voice<br />
Dysnea กกกก airway <br />
Ludwigs angina <br />
pharyngeal swelling ก parapharyngeal space retropharyngeal space<br />
abscess, dyspnea ก mediastinal<br />
extension กก chest pain, severe dyspnea radiographic evidence <br />
mediastinum กก<br />
General work up<br />
กกกก<br />
work up <br />
deep neck infections initial laboratory examination <br />
complete blood count<br />
with differential , erythrocyte sedimentation rate , serum electrolyte level, calcium level ,<br />
coagulation parameters blood cultures sepsis ก cultures with gram<br />
strain กก<br />
radiographic examination film lateral neck <br />
ก airway ก<br />
floor of mouth (Ludwigs angina) <br />
12
etropharyngeal abscess air <br />
ก<br />
retropharyngeal space กก<br />
retropharyngeal space <br />
Non invasive techniques CT scan ก localize <br />
infection ก spread infection กก<br />
<br />
cellulitis abscess กก<br />
(4) arteriography <br />
<br />
deep neck infections กก ก<br />
pseudoaneurysm ก injury innominate artery carotid artery<br />
Specific deep neck infections<br />
Ludwigs Angina<br />
.1836 Wilhelm Friedrich von Ludwig <br />
5 <br />
soft tissue<br />
infection submandibular space floor of month <br />
ก acute airway obstruction กก<br />
submandibular<br />
space <br />
Ludwigs angina<br />
<br />
5 Mylohyoid line as view medially<br />
Anatomy<br />
Ludwings angina (<br />
4 5) ก<br />
submandibular space <br />
submandibular space ก 2 spaces submandibular space submaxillary<br />
space <br />
2 spaces กกก<br />
mylohyoid muscle ก<br />
mylohyoid cleft ก submandibular gland , Whartons duct , lingual nerve,<br />
hypoglossal nerve lymphatics , arteries vein ก<br />
13
Submandibular space superficial layer of the deep cervical fascia <br />
กกก<br />
hyoid mandible กก midline <br />
submaxillary<br />
sublingual space<br />
ก<br />
Ludwigs angina กก<br />
submaxillary<br />
space ก<br />
sublingual space ก<br />
anterior teeth first molar <br />
mylohyoid line กกก<br />
sublingual space second <br />
third molar ก<br />
mylohyoid ridge ก<br />
lingual surface <br />
<br />
submaxillary space <br />
Definition<br />
Pseudo-Ludwigs angina ก<br />
sublingual space , submandibular<br />
lymph nodes, submandibular gland submental space Ludwigs angina <br />
1. Spreding cellulitis abscess<br />
2. Involvement <br />
submaxillary sublingual spaces ก bilateral<br />
3. Spred fascial planes lymphatics<br />
4. Involvement of muscle fascia submandibular gland lymph<br />
nodes<br />
5. ก<br />
submaxillary space ก<br />
sublingual space<br />
Etiology<br />
Ludwigs angina most common young adults ก<br />
กกก second third molar ก submaxillary space <br />
mylohyoid ridge ก<br />
cellulitis<br />
กกกก 75-80% <br />
<br />
<br />
ก injury floor of mouth ก stab wound , gunshot wound <br />
ก<br />
molar กก<br />
Ludwigs angina<br />
Microbiologic features<br />
กกกก<br />
<br />
bacterial cultures <br />
ก<br />
oral flora <br />
Mixed flora <br />
aerobes anaerobes most<br />
common reported aerobes alpha-hemolytic streptococci Staphylococcus<br />
14
anaerobes Peptostreptococcus, Peptococcus, Fusobacterium nucleatum,<br />
Bacteroides melanogenicus, B.oralis , Veillonella, Spirochaeta <br />
Mixed flora <br />
synergistic effect ก endotoxins collagenase, hyaluronidase <br />
proteases ก tissue necrosis, local thrombophlebitis, putrid odor gas<br />
formation<br />
Clinical features<br />
<br />
Ludwigs angina กก<br />
ก<br />
unilateral ก bilateral ก<br />
external perimandibular region floor of mouth , Soft tissue floor of mouth <br />
ก ก<br />
posterior superior<br />
ก<br />
neck rigidity, trismus, odynophagia drooling , <br />
100 o -120 o F 104 o F กกกก<br />
airway Dyspnea stridor กกก<br />
airway<br />
obstruction<br />
กกก endotracheal intubation<br />
ก airway obstruction <br />
ก tracheostomy ก<br />
ก onset กก respiratory obstruction 12-24 .<br />
Physical examination<br />
ก -Fever<br />
-Trachycardia<br />
-Variable degree respiratory obstruction<br />
-Dysphagia<br />
-Drooling<br />
-Submandibular and submental region tense, swollen <br />
tender<br />
-Floor of mouth tense indurated mucosa <br />
Fluctuance ก ก<br />
superior marked trismus<br />
15
ก Indirect laryngoscope ก ก fiberopticscope base<br />
of tongue ก epiglottis posterior supraglottis endolarynx <br />
ก<br />
Laboratory and radiologic examination<br />
ก Ludwigs angina ก<br />
clinical parameter laboratory <br />
radiologic studies <br />
white blood cell count <br />
กก 15,000 20,000 mark shift to the left <br />
X-ray studies soft tissue gas ก<br />
posterior <br />
airway ก<br />
กกกก<br />
<br />
panoramic<br />
tomography ก origin of infection กกก<br />
Treatment<br />
กกก<br />
Stage ก<br />
periapical<br />
abscess mild cellulitis massive sepsis airway obstruction early stages<br />
Ludwigs angina <br />
unilateral ก ก intravenous antibiotic<br />
and supportive กกกก<br />
<br />
ก<br />
dysphagia bilateral, drooling ก airway<br />
compromise ก control airway กก<br />
กก <br />
control airway ก drainage กก<br />
กก airway nasotracheal intubation ก acute obstruction<br />
ก tracheostomy ก ก<br />
tracheostomy <br />
<br />
กกก<br />
airway cricothyroidotomy <br />
กdrainage<br />
ก decompression suprahyoid region <br />
horizontal incision 3-4 finger breadths mandibular region ก<br />
incision ก<br />
ก submandibular region 2 mylohyoid muscle ก<br />
ก midline drainage <br />
medial lateral ก Gross purulence <br />
ก ก woody induration, watery edema กก<br />
กก antibiotic ก High-dose penicillin (12-16 million units/day) <br />
drug of choice chloramphenicol clindamycin ก<br />
penicillin <br />
16
antibiotic <br />
gram negative penicillin-resistant staphylococci ก<br />
<br />
immunocompromised host<br />
ก 70% controlled conservative medical<br />
management <br />
81% กกก (5)<br />
Complications<br />
ก Ludwigs angina acute airway obstruction ก<br />
tracheostomy กก airway obstruction <br />
ก<br />
ก<br />
<br />
carotid sheath retropharyngeal space ก<br />
mediastinum <br />
กmediastinitis ก<br />
chest x-ray film mediastinum ก<br />
,<br />
pericardial air , pulmonary infiltrates extrapleural fluid<br />
ก<br />
Ludwigs angina ก pus ก<br />
ก<br />
ก CT scan neck with contrast media กก<br />
pockets ก drainage<br />
mortality rate กกกกก<br />
<br />
10% <br />
(5,6)<br />
Parapharyngeal spaces infections<br />
parapharyngeal spaces (<br />
3) กก <br />
<br />
petrous portion กก temporal <br />
กก hyoid Carotid sheath posterior inferior <br />
กก<br />
inferior <br />
mediastinum <br />
Parapharyngeal space anterior Posterior compartments <br />
styloid process, Posterior compartment ก internal carotid artery, internal<br />
jugular vein, cranial nerves 9, 10 12 , cervical sympathetic trunk. Parotid ,<br />
masticator, submandibular retropharyngeal spaces ก<br />
parapharyngeal<br />
spaces ก<br />
parapharyngeal spaces ก<br />
กก peritonsillar infection <br />
polymicrobial<br />
<br />
oropharyngeal flora <br />
Immunocompromised host ก<br />
<br />
ก<br />
17
ก กก<br />
fever, trismus perimandibular edema <br />
parotid submandibular region ก marked pain limitation of<br />
neck motion ก<br />
Trismus ก<br />
Intraoral examination ก lateral pharyngeal wall <br />
posterior tonsillar pillar tonsil ก anterior medial, <br />
ก cranial nerves 9,10 12 , Horners syndrome กก<br />
<br />
cervical sympathetic chain <br />
parapharyngeal<br />
abscess กก <br />
rare กก hematoma skull<br />
base กก<br />
fissure of Santorini ก<br />
<br />
ligation of carotid artery <br />
<br />
parapharyngeal spaces infections ก uncommon ก CT scan<br />
กก<br />
(7)<br />
กก<br />
parapharyngeal spaces infections antibiotic<br />
high-dose penicillin ก<br />
ก<br />
antibiotic <br />
<br />
aminoglycoside กก<br />
กกกกก<br />
<br />
10-15% <br />
กก กก<br />
hemorrhage,<br />
subcutaneous emphysema, neurological deficit, skin necrosis <br />
cellulitis,<br />
dyspnea, severe sepsis ก<br />
internal jugular vein thrombosis abscess<br />
formation ก CT scan MRI กกก<br />
ก<br />
24-48 . ก<br />
<br />
antibiotic <br />
กกก<br />
กก<br />
intraoral external intraoral approaches กก<br />
peritonsillar abscesses ก<br />
parapharyngeal space abscesses <br />
ก inadequate exposure ก severe bleeding ก<br />
External approach parapharyngeal space ก transverse<br />
submandibular incision 2 ½ fingerbreadths mandibular margin <br />
anterior limits <br />
submandibular gland angle of mandibular ก incision<br />
superficial layer of the deep cervical fascia <br />
submandibular gland free<br />
inferior posterior <br />
parapharyngeal space dissect tail <br />
submandibular gland ก<br />
sternocleidomastoid, <br />
medial <br />
18
mandible medial ก<br />
internal pterygoid ก<br />
approach <br />
base of skull <br />
.. 1929 , Mosher T-shaped incision submandibular<br />
fossa approach <br />
parapharynx carotid sheath T<br />
ก<br />
sternocleidomastoid ก<br />
submandibular transverse incision <br />
ก<br />
carotid sheath visceral space <br />
Complication parapharyngeal space infections <br />
Airway<br />
compromise กก pharynx<br />
Internal jugular vein thrombosis กกก septic emboli with pulmonary emboli,<br />
pneumonia, emphysema, bacterial endocarditis uncontrolled septicemia <br />
ก ligation of internal jugular vein<br />
Mediastinitis กกก<br />
carotid sheath <br />
high<br />
mortality rate<br />
the most frequent fatal complication parapharyngeal space infections<br />
carotid artery hemorrhage กก<br />
necrosis artery wall <br />
abscess<br />
cavity<br />
Bleeding most common ก oropharyngeal location ก involves internal<br />
carotid artery <br />
oropharyngeal bleeding กกก tranoral drainage <br />
<br />
peritonsillar abscess<br />
ก bleeding <br />
carotid sheath <br />
common carotid artery <br />
controlled bleeding<br />
Retropharyngeal space infection<br />
Retropharyngeal space abscess (<br />
1-3) กกกก<br />
abscessed lymph nodes <br />
draining กก,<br />
ก กก<br />
กก<br />
trauma กก,<br />
ก endotracheal tube ก<br />
endoscopic ก tracheostomy ก (8)<br />
Clinical presentation retropharyngeal abscess กกก<br />
กก irritability , poor appetite fever กก<br />
ก<br />
neck rigidity tenderness ก<br />
<br />
posterior<br />
19
pharyngeal swelling กกกก muffled cry, drooling <br />
respiratory compromise<br />
กก<br />
fever, sorethroat, odynophagia, neck tenderness<br />
Dyspnea กก abscesses กก<br />
lateral<br />
<br />
midline ก<br />
midline กก alar fascia prevertebral fascia <br />
กก Potts abscess nontuberculous prevertebral abscesses กmidline<br />
Radiographic examination ก lateral x-ray film neck most<br />
important study soft tissue retropharyngeal space กก 7 . ก<br />
<br />
Soft tissue retrotracheal space กก 14 . ก 22 .<br />
<br />
x-ray fluoroscopy cycle ก<br />
ก<br />
<br />
loss of lordosis curvature , CT scan, <br />
กกกก Cellulitis ก abscess , film<br />
lateral neck specific ก<br />
air sign (9)<br />
กก antibiotic fluid replacement <br />
oropharyngeal flora <br />
high-dose penicillin drug of choice <br />
ก abscess กก<br />
<br />
intraoral external <br />
respiratory obstruction ก drainage transoral posterior pharyngeal wall<br />
under general anaesthesia (10) <br />
(Rose position) ก<br />
aspiration <br />
airway obstruction กinferior<br />
<br />
external drainage anterior cervical approach ก<br />
sternocleidomastoid กก<br />
hyoid cricoid cartilage<br />
ก incision superficial layer of the deep cervical fascia retract<br />
lateral carotid sheath retract posterior medial <br />
carotid sheath lateral trachea ก drainage drain <br />
กก mediastinum ก<br />
thoracic surgery<br />
กก tracheostomy <br />
ก<br />
endotracheal tube ก rupture abscess กก<br />
rupture abscess ก lung abscess pneumonia กก aspiration<br />
Retropharyngeal space infections ก posterior alar fascia <br />
danger space ก mediastinum <br />
----------------------------------<br />
20
References<br />
1. Shumrick KA, Sheft SA. <strong>Deep</strong> <strong>Neck</strong> <strong>Infections</strong>. In : paparella MM, Shumrick DA,<br />
Gluckman JL, Meyerhoff WL, eds. Otolaryngology. 3 rd ed. Philadelphia; W.B.<br />
Saunders, 1991:2545-63<br />
2. Ballenger JJ. Diseases of the Oropharynx. In : Ballenger JJ, Snow JB, eds.<br />
Otorhinolaryngology: HEAD AND NECK SURGERY. 15 th ed. Baltimore; A Lea &<br />
Febiger Book , 1996:236-44<br />
3. Schondorf J,Jungehulsing M, Brochhagen HG, et al. Infection of deep soft tissues of<br />
the neck in intravenous drug abuse. Laryngorhinootologie 2000 Mar; 79 (3) : 171-3<br />
4. Johnson JT. <strong>Deep</strong> <strong>Neck</strong> Infection. In : Gates GA, ed. Current Therapy in<br />
Otolaryngology Head and <strong>Neck</strong> Surgery. 15 th ed. St. louis; Mosby-Year Book,<br />
1994, 315-17<br />
5. Kurien M, Mathew J, Job A, et al. Ludwigs angina. Clin Otolaryngol 1997 Jun; 22(3):<br />
263-5<br />
6. De Bast Y, Appoloni O, Firket C, et al. Ludwigs angina. Rev Med Brux 2000 Jun; 21<br />
(3) : 137-41<br />
7. Sichel JY, Gomori JM, Saah D, et al. Parapharyngeal abscess in children: the role of<br />
CT for diagnosis and treatment. Int J Pediatr Otorhinolaryngol 1996 May: 35 (3) :<br />
213-22<br />
8. Stein S, David AS. Retropharyngeal abscess : an unusual complication of tracheal<br />
intubation. Eur J Anaesthesiol 1999 Feb; 16 (2) : 133-6<br />
9. Boucher C, Dorion D, Fisch C. Retropharyngeal abscesses: a clinical and radiologic<br />
correlation. J Otolaryngol 1999 Jun; 28 (3) : 134-7<br />
10. Ameh EA. Acute retropharyngeal abscess in children. Ann Trop Paediatr 1999 Mar;<br />
19 (1) : 109-12<br />
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