Clinicopathological Profile of Deep Neck Space Infections in a Rural Tertiary Care Center: A Prospective Study

Introduction: Deep neck space infection (DNSI) is defined as an infection involving the potential spaces and fascial planes of the neck.It is a commonly encountered entity in routine ear, nose and throat (ENT) clinics.Due to the complex anatomy of the neck, it is quite a challenging entity.Deep neck space infection originates from the upper aerodigestive tract and involves the deep neck spaces.They are polymicrobial infections, mainly bacterial in origin.Dental infections are considered the most common underlying cause of DNSI.The other common primary sources are tonsils, salivary glands, foreign bodies, trauma to the head and neck, and malignancies.This study was carried out to acknowledge the experience in terms of clinical presentation, neck spaces involved, management, complications, and outcomes.Materials and methods: A prospective study, including 45 patients having DNSI presenting to the ENT department in a rural setup at a tertiary care center.Patients having DNSI were assessed based on their history, any addictions, clinical examination, immunocompromised status, and routine investigations.Appropriate radiological investigations [ultrasonography (USG) neck, computed tomography (CT)/ magnetic resonance imaging (MRI) neck] and a swab for culture and sensitivity were taken.The patients of all age-groups of both sexes were part of this study. Observations and results:The present study included 45 patients, with males (n = 22) and females (n = 23).The most common age-group involved was 1st decade of life, followed by 3rd decade of life.The commonest etiological factor seen was dental infection; out of 45 cases, 21 had dental infection, and 20 cases had a previous history of sore throat and upper respiratory tract infection (URTI).The most common associated comorbidity in these patients was anemia, followed by diabetes mellitus.In the present study, the symptom duration ranged from 5 days to 8 weeks.The majority of the patients, i.e., 24 out of 45, presented during 1st week of disease, 14 in 2nd week, 4 in 3rd week, 1 patient presented in 4th week, and 2 patients presented very late with more than 1 month duration of symptoms.The most common lymph nodes involved were level 1 (35/45), followed by level 2 (22/45).Level 3 and level 5 were also seen in a few of the cases.Parotid space was involved in 88.8% cases, followed by the submandibular space in 66.6% cases.Sublingual space was involved in 55.5% of cases.A total of 55.5% of cases improved with conservative management alone, while 35.5% of cases required surgical management.A total of 41 cases out of 45 improved by getting treatment.Conclusion: Deep neck space infections are a commonly encountered entity in the ENT outpatient department.They can present with severe and fatal complications.Dental infection is the commonest etiological factor associated with children being the most affected.The disease should not be ignored, and patients should be counseled regarding the same.The majority of cases improve with conservative management.In cases of collection or pus formation, surgical drainage should be done as soon as possible along with intravenous antibiotics.