Aim: Since the development of penicillin, the head and neck space infections have become relatively uncommon, although the morbidity remains high. The delayed diagnosis and treatment can cause serious complications as airway obstruction, mediastinitis, sepsis and death. Controversy still exists about choice of antibiotic therapy, diagnosis, and clinical or surgical treatment. The aim of this prospective study is analyze the etiology (associated factors, site of origin and bacteriology), clinical presentation (symptoms, origin, primary and secondary involved spaces and the routes of propagation of the infection), treatment (antimicrobial therapy, corticosteroid, surgical drainage) and complications. Study design: Prospective clinical. Material and method: This prospective series included 58 patients that need hospitalization due to deep neck infection in a two-year period, from December 1997 to December 1999. In all cases there was confirmation of the diagnosis by cervical ultrasound and/or CT scanning. The management consisted of maintenance of an adequate airway and systemic antibiotics. Surgical drainage was performed promptly as required. Bacteriological cultures were done when purulent material was found in spontaneous drainage and during surgical procedures. Results: Thirty patients were males and 28 females. The mean age was 33,4 years. The most common site of infection was the submandibular (46,6%), followed by pterygomandibular (31%), sublingual (29,3%) and parapharyngeal space (20,7%). Thirty-two patients had infection in more than one site. The etiology was odontogenic (40%), suppurative adenitis (13,8%), salivary gland infection (10,3%). Surgical drainage was performed in 72,4% of patients. The association of penicillin and metronidazole was used in 55.2% of cases and clindamicin in 13.8%. The cultures were negative in 38.1%. S. viridans, S. aureus, S. pyogenes, H. influenzae and Peptostreptococcus were isolated. Recovery occurred in 57 patients. One patient died due to mediastinal spread of infection. Two patients had dehiscence of the suture and one had infection recurrence. Conclusion: Deep neck space infections are potential severe disease and a challenging problem in the care of children and adults. An accurate diagnosis based in image studies is related with less complications and sequels. Odontogenic infections are the most prevalent etiology. The association of penicillin and metronidazole still is a cheap and effective treatment to the most cases. The early and wide drainage is the key to infection control, and is related to quickly recuperation and hospital discharge.
deep neck space; necrotizing fasciitis; neck space infections
