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Infections of the Head and Neck

Smith, Lorraine M.; Osborne, Ryan F.
Topics in Emergency Medicine. 25(2):106-116, April 2003.
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Abstract
Abstract:

The anatomy of the head and neck is complex with many contiguous spaces. As a result,
infections in one anatomical region may easily spread to involve other anatomical regions,
including the pharynx, eye, and brain. This may lead to devastating results, including airway
obstruction, blindness, and altered mental status with cranial neuropathies. We present some
of the serious infections that affect patients in this confined space with a discussion of
etiologies and treatments.
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Acute Neck Infections: Prospective Comparison Between CT and MRI in 47 Patients
Muoz, Alberto; Castillo, Mauricio; Melchor, Miguel A.; Gutirrez, Ramn
Journal of Computer Assisted Tomography. 25(5):733-741, September/October 2001.
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Abstract
Abstract:

Purpose: The purpose of this work was to assess the advantages and disadvantages of MRI
versus CT in the initial evaluation of acute infections involving the neck.
Method: We prospectively evaluated 47 patients with neck infections. All patients underwent
CT and MRI with contrast of the area of interest using similar slice thickness. Final diagnosis
was achieved by percutaneous aspiration, surgical exploration and drainage, or follow-up
after successful antibiotic therapy in all patients. Two radiologists reviewed all imaging
studies with special attention to lesion conspicuity, location, extension, bone involvement,
source of infection (odontogenic versus nonodontogenic), and presence of gas and/or calcium
in the lesions. A 3 point scale was used to grade these parameters, and statistical comparison
was done using paired t test.

Results: As used in our population, MRI was superior to CT in regard to lesion conspicuity,
number of anatomic spaces involved, extension, and source. Additionally, although not
statistically significantly, MRI detected a greater number of abscess collections. CT was
superior to MRI in the detection of intralesional gas and calcium and showed fewer motion
artifacts. These advantages of CT were, however, not significantly better than those of MRI.
Conclusion: As used in our study, MRI was considered superior to CT in the initial evaluation
of neck infections. Our findings suggest that MRI may be used as the first and perhaps the
only modality to initially evaluate patients with neck infections when clinically feasible.
(C) 2001 Lippincott Williams & Wilkins, Inc.
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Conservative Treatment of Retropharyngeal and Parapharyngeal Abscess in Children
Pelaz, Andrs Coca; Allende, Ana Vivanco; Llorente Pends, Jose Luis; Nieto, Carlos Surez
Journal of Craniofacial Surgery. 20(4):1178-1181, July 2009.
doi: 10.1097/SCS.0b013e3181acdc45
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Abstract
Abstract:

Parapharyngeal and retropharyngeal infections, which can potentially cause life-threatening

complications, could be treated conservatively with no need for surgical drainage. A
retrospective analysis of all patients diagnosed with retropharyngeal and parapharyngeal
infections was performed. Information regarding age, sex, presenting symptoms, physical
examination, laboratory and imaging evaluations, management, duration of hospital stay, and
complications were reviewed. Seven children were identified, 4 with retropharyngeal abscess
and 3 with parapharyngeal abscess. All but 1 patient were under 7 years old, and all were
treated with intravenous amoxicilin/clavulanic acid and corticosteroids. Torticollis and fever
were present in all the patients. The mean length of hospital stay was 7 days. There were no
complications associated. We demonstrate that retropharyngeal and parapharyngeal abscesses
can be treated medically, reserving the surgical drainage for complicated cases. Treatment
with intravenous antibiotics and corticosteroids is a safe option, reducing the durations of
symptoms and the length of hospital stay.
(C) 2009 Mutaz B. Habal, MD