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The Evolution of Deep Neck Space Infections; Change in Practice or Pathology of Pathophysiology.
Thomson B. J.1, Gane S.2, Coates M.2, Goh T.2, Stevenson D. S.1, Guidera A. K.1.
1) Department of Otolaryngology, Christchurch Hospital
2) Department of Radiology, Christchurch Hospital
Introduction:
Despite increased use of antibiotics, recent literature suggests an increase in the incidence of deep space neck infections (DSNI’s), changes in causative pathogens and anatomical site of infection. Standard use of radiological examination allows accurate location of infection site and the standard is now to classify according to this. However, because of complex cervical anatomy and confusing nomenclature there is potential for misinterpretation.
Aim:
To review DSNI’s presenting to Christchurch Hospital and establish whether an increase in incidence is occurring, also to determine whether there has been a recent change in the site, source of infection or microbiology that would require change in guidelines.
Method:
Retrospective review of notes of patients admitted to Christchurch Hospital between 1st April 2005 and 31 March 2015. Location of infection on imaging was independently reviewed by an Otolaryngologist and Radiology registrar using defined definitions1. Those for reclassification were reviewed with a consultant Radiologist.
Results:
57 patients were admitted with DSNI’s (29.8% female, 70.2% male). 61.4% required surgical drainage, 31.6% were admitted to the Intensive Care Unit, 3.5% mortality rate. 42% of infections were reclassified following review of imaging. There was a non-significant increasing trend in number of admissions over the study period. Prior to radiological review there was a significant increase in the number of retropharyngeal DNSI, a trend not found after review. There was no significant change of pathogen incidence.
Conclusions:
Apparent changes in pathophysiology in our population were related to a change in practice of radiological reporting rather than a change in site of infection.
We recommend audit and clinical review to confirm characteristics of the local population before committing to any standardised treatment protocols.
(1) Guidera AK, Dawes PJ, Fong A, Stringer MD. (2014) Head and Neck Fascia and Compartments: No Space for Spaces. Head Neck 36:1058-1068
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