Deep neck space infections

1. DISSERTATION PROTOCOL
TO STUDY CLINICAL PROFILE AND
OUTCOME OF HEAD AND NECK ABSCESSES
AT A TERTIARY HEALTH CARE CENTRE

2. DissertationProtocolSubmitted totheM.U.H.S.NashikInpartialfulfilmentoftherequirementsForthedegree
ofM.S.inOTORHINOLARYNGOLOGY
HEAD OF DEPARTMENT: DR. AJIT LOKARE
Department of OTORHINOLARYNGOLOGY,
R.C.S.M. Govt. Medical College & CPR hospital, Kolhapur.
PG GUIDE: Dr. VASANTI PATIL, Associate Professor,
Department of OTORHINOLARYNGOLOGY,
R.C.S.M. Govt. Medical College & CPR hospital Kolhapur.
PG STUDENT: Dr. Renu Gupta, Junior Resident,
Department of OTORHINOLARYNGOLOGY,
R.C.S.M. Govt. Medical College & CPR hospital Kolhapur.

3. Introduction
• Head and neck abscesses represent a significant clinical challenge, necessitating a thorough
investigation into their clinical profile and outcomes for effective management. The intricate
anatomy of the head and neck region, coupled with the diverse microbial flora present,
contributes to the complexity of these abscesses
• Head and neck abscesses include extracranial abscess like Bezold abscess, Peritonsillar
abscess, Parotid abscess, Septal abscess and Deep neck space abscesses (DNSA) like
Retropharyngeal abscess, Parapharyngeal, Submandibular abscess, Ludwig’s angina, etc.
• Combination of both conservative and surgical approach complements each other in
recovery of the case. Early diagnosis of head and neck abscesses with help of proper clinical
assessment and imaging, followed by prompt treatment is crucial for managing such
infections.
• In the present study, we aim to evaluate the clinical profile, etiology, microbiological profile,
complications and outcome of head and neck abscesses at a tertiary health care centre.
Understanding the treatment modalities and their efficacy is paramount for refining clinical
protocols. The findings of this study are anticipated to not only enhance the scientific
understanding of head and neck abscesses but also inform evidence-based clinical practices,
ultimately improving patient care in this challenging domain.

4. Review of Literature
In a study by Zain Sheikh et al (2022) (9), on the assessment and management of deep neck space infections in
adults: A systematic review and qualitative evidence synthesis, found that the assessment and management of
deep neck space infections in adults: A systematic review and qualitative evidence synthesis. They concluded that
there are limited methodologically rigorous studies investigating DNSIs. CT imaging was the most used imaging
modality. Surgical drainage was commonest treatment choice. Areas of further research on epidemiology,
reporting guidelines and management are required.
In a study by Preeti Dudhe et al (2022) (10), on Clinical Profile and Outcome of Head and Neck Abscesses in 68 Patients at a Tertiary Care Centre,
found that out of 68 cases, 43(63.23%) were males and 25(36.77%) were females. Around 57% of the cases were in the age group of 11 to 40 years.
36(52.94%) cases had abscesses in the neck region while 32(47.06%) cases had it in the head region. Majority of the cases were of submandibular
abscesses (18; 26.47%) followed by mastoid abscess 11;16.18%), Ludwig’s angina (9;13.24%) and others. Most common etiology was odontogenic in
origin (24; 35.29%) followed by otogenic (23; 33.82%). Pain and swelling (56; 82.35%) were the most common presenting features followed by fever
(32, 47.06%) and others. 25% cases had history of diabetes mallitus. Incision and drainage was the most common mode of treatment used. Majority
abscesses can be treated successfully by incision and drainage with the cover of antibiotics. Diabetic cases of abscesses can be managed successfully
without any complications or prolonged hospital stay with good sugar control.
In a study by Ashis Kumar Ghosh et al (2018) (16), on Clinical Presentation of Neck Space Abscess and its Management in a Rural Based Tertiary Care Centre,
found that among 46 patients 22 were male and rest 24 were female, mean age of our sample is 22.98 with SD 15.414. Patients mostly complain about neck
pain (76%) and swallowing difficulty (67%). 8.7% patients have diabetes mellitus as co-morbidity. The source of infection is unknown in most of the cases, but
dental caries and oropharyngeal infection (28.3% each) were found as source of infection in a significant number of patients. Abscess formation was found
mostly in submandibular space (28.3%) followed by parapharyngeal space (26.1%). 80% patients needed incision and drainage along with iv antibiotics whether
20% patients responded well to conservative treatment. One patient with compromised upper airway, underwent tracheostomy as a lifesaving procedure. They
concluded that patients of all age group may be presented with neck space infection. Patients with comorbidities present with more severe form of neck space
infection. In many cases of neck space infection, source of infection may present in nearby areas. As patient with neck space infection can progress to life
threatening conditions, prompt medical as well as surgical treatment is very important.

5. AIM – To evaluate clinical profile and outcome of
head and neck abscess at tertiary care center
Objectives:
• To evaluate clinical presentation and etiology of patients with head and
neck abscesses in our hospital
• To study microbiological profile of head and neck abscesses
• To analyze the associated systemic diseases and comorbidities with
respect to its impact on head and neck abscesses
• Understanding the treatment modalities and their efficacy
• To study the complications and the final outcome of the neck abscesses

6. Material and Methods:
Dept.ofEarNoseandThroat(ENT), Tertiaryhealthcarecenter
STUDYSETTING:
Prospectiveobservationalstudy
STUDYDESIGN:
50casesofheadandneck abscesses admittedatdepartmentofEarNose
andThroat(ENT),Tertiaryhealthcarecenterwillbeincluded inthestudy
STUDYSUBJECTS:
2years
STUDYDURATION:
50cases
SAMPLESIZE:

7. INCLUSION AND EXCLUSION CRITERIA
INCLUSION
Patients of all age
groups
Patients with
extracranial abscesses
Patients with neck
abscesses
EXCLUSION
Cases of superficial skin infections.
Cases of biopsy proven head and neck
cancers
Patients with intracranial abscesses
Patients not willing to participate in the
study and refused to give consent
Patients willing to
participate in the study

8. METHODOLOGY
The study will be started after getting approval from Institutional Ethical
Committee.
50 cases of head and neck abscesses admitted to the department of ENT,
during course of the study, will be included in the study.
Detailed data regarding sociodemographic variables such as age, gender,
etiology, associated systemic disease will be collected.
The confirmation of the abscess will be done by USG scan. Different head
and neck spaces involved with abscess will be confirmed by CT scan.
The exact location of the head and neck space abscess will be identified by
imaging or surgical findings.

9. The culture and sensitivity of the pus from the abscess will be documented.
. The medical and surgical treatment of each patient will be analyzed.
Patients’ outcome will be analyzed based on the resolution of the abscess, hospital stay period,
complications, and requirement of further surgical procedure.

10. Informed Consent Form
•Date .........................
•TITLE: TO STUDY CLINICAL PROFILE AND OUTCOME OF HEAD AND NECK ABSCESSES AT A TERTIARY HEALTH CARE CENTRE
I ..................................................................... age ...................
•Without any pressure and desire, I allowed to participate in this project voluntarily.
•Doctor has given me satisfactory information about this project and I am happy. After my participation in this project, I am ready to inspect and examine.
• I am free to separate from the project at any time and the doctor has made me realize this right.
• It has been explained to me that the medical and all information and documents obtained from me will be kept secret.
• I will cooperate fully with the investigative doctor and will inform the doctor about any negative results during the project.
• I have full permission to publish any findings in this project in the Medical Magazine.
• Whatever the cost of this project, will be prepared by Doctor self (Principle Investigator).
•Consent ................................................
•Details of this project, has been explained. Patient's signature
•Name: - Address: -
•Signature of an neutral witness Name: -
•Address: -

11. •समती पत्र
•मी . श्री /सौ/ क
ु _________________________राहणार, ……………… ……… सहीनिशी माझी
•“CLINICAL PROFILE AND OUTCOME OF HEAD AND NECK ABSCESSES AT A TERTIARY HEALTH CARE CENTRE” या संशोध ात्मक अभ्यासात
सहभागी होण्याची संपणणू सहमती देत आहे.
•मला साम्जान्यात सोप्या सलभु भाषेमध्ये मी सहभागी होत असणाया संशोध कयाणबदल डॉक्टरांधीीी संपणणू माहहती हदलेली आहे.
•मी या संशोध कायाणत सहभागी होण्ययाची संपणणू सहमती देत आहे. तसेच, या माझ्यावरील सरुी
ु असलेल्या संशोध ात्मक अब्यासाधतू मला वाटेल त्यावळे ीी माघार घेण्याचा
माझा अ कार सरधितु ठे वत आहे
•माधीधीीीय महोदय,
• एय्छिक सहभाग आणी माघार :- तम्हीी
ु संशो ाधीीात सहभागी होण्यास व माघार घेण्यास
•पणणपणेू मक्तु आहात
•शंका िेरासण:- क
ृ पया क
ु टलीही बाबतात समजली धीसल्यास त्या शंक
े चे धिरसण करण्याचा तम्हालाी
ु संपणणू अ कार आहे. क
ृ पया सही करण्यापवीी
ू सपंणणू माहहती
व्यावास्थीत जाधणू घ्या. गप्तताुु : या संशोध ादरम्याधी तम्हीी
ु परववलेलीी
ु माहहती पणणपणेू गवपतु ठे वण्यात येईल. तमच्याी
ु ललखित परवाधीगी लशवाय ही माहहती कोणालाही
परववण्यातू येणार धीीाही. वैज्ञाधिक संभाषणाकरीता प्रत्यक
े व्यककतस एक साक
ं ी
े ितक क्रमाक
ं देणयात येईल. मला/ आम्हाला डॉक्टराधीी
ं ीी हदलेली वररल माहहती
पणणतू : समजली अधसू मी / आम्ही यांत सहभागी होण्यास तयार आहे. व कररता सही करत आहोत.
•सही/ आंगठा
• नुुाव:____________________
•वरील सही करणाच्या व्यककतस मी ओधळत अधसू त्याधीी
े क
ु ठल्याही दबावाधीीाली धी येता व संपणणू माहहती साखम्जू घेधिच संबं त सही क
े लेली आहे. करीता साधी देत

12. Case record form (Confidential Data)
TITLE: TO STUDY CLINICAL PROFILE AND OUTCOME OF HEAD AND NECK ABSCESSES AT A TERTIARY HEALTH CARE CENTRE
Name: Age/Sex: IP. No:
Address: -
Presenting Complaints: -
Past History: -
Personal History: -
General Physical Examination: -
Local Examination:
Investigations:
CBC
Pus culture and sensitivity
USG/CT/MRI
Diagnosis:
Management:
Outcome:
Signature of the evaluator:

13. References
Shriram BM (2016) SRB’s manual of surgery, 5th edn. Jaypee brother’s medical publisher; (P)ltd, London, p 40
Brożek-Mądryz E, Waniewska-Łęczycka M, Robert B, Krzeski A (2018) Head and neck abscesses in complicated acute otitis media-pathways and classification.
•Otolaryngol (Sunnyvale) 8:345.
Nathoo N, Nadvi SS, Narotam PK, Van Dellen JR (2011) Brain abscess: management and outcome analysis of a computed tomography era experience with
•973 patients. World Neurosurg 75:716–726
Mathisen GE, Johnson JP (1997) Brain abscess. Clin Infect Dis 25:763–779
Menon S, Bharadwaj R, Chowdhary A, Kaundinya DV, Palande DA (2008) Current epidemiology of intracranial abscesses: a prospective 5 year study. J Med Microbiol 57:1259–12689. Vieira F, Allen SM, Stocks RSM, Thompson JW
(2008) Deep neck infections. Otolaryngol Clin N Am 12:459–483
Vieira F, Allen SM, Stocks RSM, Thompson JW (2008) Deep neck infections. Otolaryngol Clin N Am 12:459–483
Bakir S, Tanriverdi MH, Gun R, Yorgancilar AE, Yildirim M, Tekbas G et al (2012)
•Deep neck space infections: a retrospective review of 173 cases. Am J Otolaryngol
•33(1):56–63
Boscolo RP, Stellin M, Muzzi E, Mantovani M, Fuson R, Lupato V et al (2012) Deep neck space infections: a study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol 269(4):1241–
1249
Sheikh Z, Yu B, Heywood E, Quraishi N, Quraishi S. The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis. Clinical Otolaryngology. 2023 May 6.
Dudhe P, Burse K, Kulkarni S, Bhardwaj C, Patel R. Clinical Profile and Outcome of Head and Neck Abscesses in 68 Patients at a Tertiary Care Centre. Indian Journal of Otolaryngology and Head & Neck Surgery. 2023
Jun;75(2):668-74.
Swain SK, Lenka S, Jena PP. Deep neck abscess: Our experiences at a tertiary care teaching Hospital of Eastern India. Matrix Sci Med 2022;6:18-22.
Gao W, Lin Y, Yue H, Chen W, Liu T, Ye J, Cai Q, Ye F, He L, Xie X, Xiong G. Bacteriological analysis based on disease severity and clinical characteristics in patients with deep neck space abscess. BMC Infectious Diseases. 2022
Mar 23;22(1):280.
Chatterjee A, Ray A, Chakraborty B, Biswas D. A study of etiopathology and Outcomes in cases of neck abscesses And treatment modalities in a tertiary Care centre. Paripex - Indian Journal of Research. 2021;10(12):24-8.
Verma R, Angral S, Singh U. Clinical profile of patients with deep neck space infections: a review of 62 patients from a tertiary care hospital of North India. Int J Otorhinolaryngol Head Neck Surg 2019;5:1656-61.
Brożek-Mądryz E, Waniewska-Łęczycka M, Robert B, Krzeski A (2018) Head and Neck Abscesses in Complicated Acute Otitis Media-Pathways and Classification. Otolaryngol (Sunnyvale) 8: 345.
Ghosh AK, Saha J, Kundu S, Panchadhyayee S. Clinical Presentation of Neck Space Abscess and its Management in a Rural Based Tertiary Care Centre. JMSCR.
•2018;6(3):628-31.
Brito TP, Hazboun IM, Fernandes FL, Bento LR, Zappelini CE, Chone CT, et al. Deep neck abscesses: study of101 cases. Braz J Otorhinolaryngol. 2017;83:341---8.
Santhosh GS, Yadev I, Arun TP, et al. Clinical profile of deep neck space infections in a tertiary care hospital in Kerala. J. Evolution Med. Dent. Sci. 2017;6(3):219-226.
Kalsotra P, Gupta R, Nazir T, Gupta N, Prakash O, Singh KP. Deep neck space infections: a profile of fifty nine cases. JK SCIENCE. 2014:16(2):57-61.

14. THANK YOU