The document provides an overview of deep neck spaces and infections that can occur within these spaces. It discusses the layers of cervical fascia that divide the neck into various spaces. Some key spaces mentioned include the parapharyngeal, retropharyngeal, masticator, visceral, and carotid spaces. Common causes of deep neck space infections are discussed. Clinical features, investigations including imaging, and treatment approaches like antibiotics and surgical drainage are summarized. Maintaining a patent airway is emphasized as critical, and tracheostomy may be needed in some severe cases to protect the airway. Complications are also reviewed.
Fascial spaces are potential spaces that exist between the fasciae and underlying organs and other tissues.infection of orofacial & neck region, particularly those of odontogenic origin,have been one of the most common diseases in human being.
Space infection. by Dr. Amit T. Suryawanshi, Oral Surgeon, Pune All Good Things
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best.
Space infection. by Dr. Amit Suryawanshi .Oral & Maxillofacial Surgeon, Pun...All Good Things
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
Infratemporal fossa a systematic approachAugustine raj
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Neck space infections taken from PL. DHINGRA and other sources to cover all o...lordskywalker7878
This presentation covers the important ENT topics of neck space infections with their management and image illustrations. The source is mainly PL. DHINGRA however other sources have been mentioned in the presentation, especially on the images. It is divided into superficial and deep neck infections for clear distinction between the two categories. It is an extremely important topic especially if your goal is towards surgical side of ENT.
Fascial spaces are potential spaces that exist between the fasciae and underlying organs and other tissues.infection of orofacial & neck region, particularly those of odontogenic origin,have been one of the most common diseases in human being.
Space infection. by Dr. Amit T. Suryawanshi, Oral Surgeon, Pune All Good Things
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best.
Space infection. by Dr. Amit Suryawanshi .Oral & Maxillofacial Surgeon, Pun...All Good Things
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
Infratemporal fossa a systematic approachAugustine raj
infratemporal fossa is a irregular space with numerous neurovascular structures. an attempt has been made by me to decode all the boundaries and structures in a systematic way. sincere thanks to Dr. Viren Karia for his awesome video.
Neck space infections taken from PL. DHINGRA and other sources to cover all o...lordskywalker7878
This presentation covers the important ENT topics of neck space infections with their management and image illustrations. The source is mainly PL. DHINGRA however other sources have been mentioned in the presentation, especially on the images. It is divided into superficial and deep neck infections for clear distinction between the two categories. It is an extremely important topic especially if your goal is towards surgical side of ENT.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. INTRODUCTION
• The cervical fascia invests muscles and organs of the neck, limiting and
influencing the direction of spread of infection.
• The cervical fascia is divided into two layers: the superficial layer that
envelops platysma and the muscles of facial expression and the deep
layer, which, in turn, comprises superficial, middle and deep layers.
• Superficial (or investing) layer of deep cervical fascia
• attached superiorly to the superior nuchal line of the occipital bone, the
mastoid process, the zygomatic arch, the inferior border of the mandible,
the hyoid and the spinous processes of the cervical vertebrae.
• inferiorly to the manubrium, the clavicle and the acromium and spine of
the scapula
• forms the roof of the anterior and posterior triangles of the neck
• forms the most superficial fascial boundary of the deep neck spaces
• provides a robust barrier to the spread of infection, such that abscesses
tend to track deep to it into adjacent, deeper neck spaces, or even into the
mediastinum.
3. • Middle layer of deep cervical fascia (or pre-tracheal
fascia)
• limited to the anterior aspect of the neck limited to the anterior aspect of the
neck
• splits to invest the thyroid gland, trachea and oesophagus and blends with the
carotid fascia laterally
• descends into the superior mediastinum where it blends with the fibrous
pericardium.
• Consequently, it bounds a deep space which extends from the neck into the
mediastinum
• Deep layer of deep cervical fascia (prevertebral fascia)
• forms part of a fascial sleeve for the prevertebral muscles that surround the
vertebral column.
• extends from the skull base to the third thoracic vertebra where it fuses with
the anterior longitudinal ligament in the posterior mediastinum
• extends laterally as the axillary sheath.
• Alar fascia
• component of the deep layer of deep cervical fascia although it is described
separately from it as it lies between the deep and middle layers of deep
cervical fascia
4.
5. NECK SPACES
• Parapharyngeal space (lateral pharyngeal space, pharyngomaxillary
space)
• forms an inverted cone, base bounded by the petrous portion of the
temporal bone, apex at the level of the hyoid.
• crossed by the styloid process and attachments thus dividing the space
into pre and post-styloid compartments.
• The pre-styloid compartment (anterior to the styloid complex) contains
fat, connective tissue, the maxillary artery, the inferior alveolar nerve, the
lingual nerve and the auriculotemporal nerve.
• the post-styloid (posterior) compartment contains the carotid sheath and
its contents, the glossopharyngeal and hypoglossal nerves, the
sympathetic chain and associated lymph nodes.
• can become infected either primarily or as a consequence of direct spread
of infection from the submandibular and/or the retropharyngeal spaces.
• A recent study of DNSIs of this space in particular demonstrated different
clinical features depending on whether the anterior or posterior
parapharyngeal space (APPS and PPPS respectively) is infected.
6. • The APPS contains fat which in the presence of infection may liquefy,
develop into pus and hence abscess formation.
• The PPPS is rich in lymph nodes and vessels. Infection in this space causes
lymphadenitis, but less likely to develop into abscess formation.
• more conservative approach possible in PPPS and aggressive surgical
drainage of pus required for APPS.
7. Retropharyngeal space
• contains lymph nodes.
• Bounded anteriorly by the middle layer of deep cervical fascia and posteriorly
by the alar fascia.
• Extends craniocaudally from the skull base to the tracheal bifurcation.
• Midline raphe is formed by the attachment of the superior constrictor muscles
to the alar fascia.
• Retropharyngeal space abscess
• Usually in adults by penetrating trauma through the posterior mucosal wall of
the pharynx or cervical esophagus.
• in children, secondary to suppuration of retropharyngeal lymph nodes
following an upper respiratory tract infection, although retropharyngeal lymph
nodes tend to regress after the age of 5 years.
• a significant cause of airway compromise, and as a consequence surgical
tracheostomy is not commonly required.
• Once the airway has been appropriately secured the abscess can be drained in
a controlled fashion.
• The incision is made at the most inferior aspect of the collection such that
further accumulation of pus will drain through gravity into the pharynx.
8.
9. So-called ‘danger space’
• The so-called ‘danger space’ is a potential space between the alar fascia
anteriorly and the deep layer of deep cervical fascia (prevertebral fascia)
posteriorly, which extends craniocaudally from the skull base to the
diaphragm.
10. Submandibular space
• Cranially by floor of mouth mucosa
• Laterally by Mandible
• Anteroinferiorly by the anterior belly of digastric
• Posteroinferiorly by the posterior belly of digastric
• The mylohyoid muscle lies anteriorly and the stylomandibular ligament
posteriorly.
• The space is divided by the mylohyoid muscle into sublingual and
submandibular compartments
• These compartments are continuous around the posterior free edge of the
mylohyoid muscle and the submandibular gland lies within both as it straddles
this free edge.
• Ludwig’s Angina
• Acute infection of bilateral sublingual and submandibular spaces, and the
submental space.
• occurs most commonly as a consequence of anterior dental infection.
• Gross oedema of the floor of mouth and of the anterior tongue, such that the
tongue becomes grossly swollen, protuberant and immobile.
• The result is significant risk of life-threatening airway obstruction
• Emergency tracheostomy, a primary treatment option.
11.
12.
13. Masticator space
• lies inferior to the skull base
• Bounded by the pharyngeal mucosa medially and the medial surface of
the ramus of the mandible laterally.
• The lateral pterygoid plate, superior constrictor, tensor and levator palatini
muscles constitute the posteromedial border and can be subdivided into
superficial temporal space superolaterally, deep temporal space
superomedially, pterygoid space inferomedially and masseteric space
inferolaterally.
• Communication with the pterygopalatine fossa exists via the
pterygomaxillary fissure
• The muscles of mastication and the mandibular division of the trigeminal
nerve are contained within it.
• Masticator Space Infection
• usually arises secondary to odontogenic infection
• Less commonly as spread from infection from the parotid space,
submandibular space or peritonsillar space.
• Trismus due to oedema of the adjacent pterygoid muscles.
14.
15. Visceral space
• formed anteriorly by the middle layer of deep cervical fascia
• Posteriorly by the deep layer of deep cervical fascia
• contains the larynx, hypopharynx, cervical oesophagus, proximal trachea,
thyroid and parathyroid glands.
• Suppurative Thyroiditis
• due to abnormal development of the 4th branchial pouch
• results in a communicating sinus between pharynx and thyroid bed
• in some cases, a proximal orifice may be identified as a defect in the
mucosa of the piriform fossa.
• Barium swallow examination and/ or cross-sectional imaging with
contrast-enhanced CT or MRI may demonstrate the sinus tract, and the
orifice will usually be identifiable by careful inspection of the piriform
fossa mucosa under anaesthetic using direct pharyngoscopy.
• Preponderance for the left side of the hypopharynx.
• Treatment:- excision of the sinus tract including the ipsilateral hemithyroid
• Alternatively, obliteration of the sinus opening in the hypopharynx using
monopolar diathermy.
16. Carotid space
• Formed by the carotid sheath
• Carotid Sheath formed from all three layers of deep cervical fascia
blending together.
• contains the common carotid artery, the internal jugular vein (IJV) and the
vagus nerve
17. Parotid space
• formed by the superficial layer of deep cervical fascia
• splits to invest the parotid gland
• therefore also contains the facial nerve, the retromandibular vein, the
external carotid artery and its terminal branches.
18. Peritonsillar space
• lies lateral to the pharyngeal tonsil
• Medial to the superior constrictor muscle.
• contains loose connective tissue
• Site of accumulation of pus in peritonsillar abscess, or quinsy.
• direct communication exists between the posterior aspect of the
parapharyngeal space and the retropharyngeal space, as well as the
anterior parapharyngeal space and the submandibular space.
• peritonsillar space abscess can directly spread to the parapharyngeal
space by direct extension, via lymph and/or blood vessels which traverse
the superior constrictor muscle.
19.
20. Aetiology of DNSI
• odontogenic infection most common aetiological factor causing 31–49% of
DNSIs.
• Peritonsillitis in approximately 7–20% of cases
• Whilst in 17– 57% of cases, the primary source of infection is not clinically
apparent
• Ingestion of foreign body, coexisting Diabetes Mellitus (DM), Human
Immunodeficiency Virus (HIV) infection and intravenous (IV) drug abuse
• Mycobacterial infection, mandibular fracture, sialolithiasis, parotitis and
thyroid infection
21. • Pain, pre-eminent symptom in most patients
• Pain, at the neck space harbouring the infection, but can also be referred
to the ear, cause odynophagia, trismus or torticollis.
• Other symptoms:- dysphonia, dysphagia, sialorrhoea or cough.
• swelling in the neck, pyrexia and trismus.
• Skin fistulae, medial or anterior displacement of the lateral or posterior
pharyngeal wall and gingival swelling.
• Sex:- male to female ratio is 1.6:1
• Age:- 20-40 years
• Coexistent diseases:- dental caries, DM, IV drug abuse and HIV infection.
Clinical Features
22. Clinical Assessment and Investigations
• full clinical history, a thorough examination including fibre-optic
nasoendoscopy to assess the upper aerodigestive tract mucosa and airway
patency simultaneously.
• Due to the potential for DNSIs to cause significant airway compromise it is
essential that the initial assessment of patients is performed with high
priority.
• Pulse rate, blood pressure, temperature. sPO2, respiratory rate
• urea, creatinine and electrolytes assays, blood count, including differential
white cell count, C-reactive protein and erythrocyte sedimentation rate.
• Pustulating skin fistulae and obviously infected dental sockets or roots
may be swabbed for microbial cultures but routine pharyngeal
microbiology swabs must not be taken to avoid precipitating an airway
crisis as a consequence of triggering the gag reflex.
23. • Contrast-enhanced CT:- gold-standard imaging modality
• Due to potential communication of the visceral, retropharyngeal, danger
and prevertebral spaces with the mediastinum it is imperative to include
the mediastinum in the CT scan field.
• Where there is clinical concern of septic emboli spreading to the brain,
lungs or liver these organs are required to be imaged also.
• Abscesses:- characteristic rim enhancement on CT imaging
• Cellulitis:- fluid and fat stranding in the subcutaneous tissues and along
fascial planes
• Myositis:- enlargement and hyperenhancement of the adjacent
musculature
• Ultrasound:- whether an abscess has sufficiently liquified to be drained,
targeting attempted drainage.
• Orthopantomogram:- infection of dental origin
24. Microbiology and Pharmacology
• Peptostreptococcus spp., Viridans Group Streptococci,
Staphylococcus aureus, Staphylococcus epidermidis
and Klebsiella pneumoniae
• Typically, broad-spectrum antibiotics are commenced
prior to receipt of microbiological results,
• Polymicrobial cultures are commonly seen.
• amoxicillin/clavulanate, or 2nd or 3rd generation
cephalosporins with metronidazole
• Clindamycin and vancomycin are commonly used as
second-line agents, or potential first-line agents when
drug allergy or sensitivity restrict choice.
25. Surgical Treatment
• Neck space infection:- life threatening infection
• Crude mortality rates of up to 2%.
• Ensure protection of the airway primarily, consider surgical drainage of
pus secondarily.
• conservative management wherever possible
• Without impending airway compromise, surgical intervention follows a
period of conservative management of 24–48 hours
• Conventional surgical drainage procedures:- incise the skin over the area
of maximal fluctuance or induration
• Following evacuation of the abscess contents, the abscess wall is curetted,
and any loculations or boundaries between adjacent and communicating
neck spaces (e.g. retropharyngeal, parapharyngeal and submandibular)
are broken down – often with digital dissection
• In classical Ludwig`s angina:- multiple transcutaneous stab incisions
26. • Drains are secured to permit further drainage of pus
• The underlying dental infection should be dealt with during the same
general anaesthetic
• ultrasound-guided aspiration of pus.
27. Airway Management
• Maintaining a patent and safe airway is the pre-eminent step
• Mortality due to asphyxiation, hypoxia, delayed septic complications
• The widespread use of antibiotics has reduced the morbidity and mortality
from pharyngeal oedema, permits a watch and wait policy in selected
cases.
• large abscesses causing a precarious airway:- secure the airway prior to
surgical drainage, maintain the airway post-operatively.
• Conventional endotracheal intubation is not always possible due to
trismus, reduced neck extension, laryngopharyngeal oedema, mass effect
from the abscess and the friable nature of the mucosa
• Airway secured via Tracheostomy.
28. Complications
• Tracheostomy, either planned or ‘crash’, is reported as necessary in 3–22%
of patients
• patients with Ludwig’s and retropharyngeal abscess:- higher risk of airway
obstruction than those presenting with lateralized abscesses
• Other complications:- pneumonia, IJV thrombosis, carotid artery
aneurysm and rupture, necrotizing fasciitis, skin fistulae and defects, vocal
cord and facial palsies, descending mediastinitis, upper gastrointestinal
bleeding, iatrogenic bleeding following tracheostomy insertion, septic
emboli from IJV thrombosis, sepsis, multi-organ failure and death.
• Patients with pre-existing comorbidities are more likely to suffer from
complications, as are patients that have infection in more than two neck
spaces
29. Paediatric Neck Space Infections
• more often results from an upper respiratory tract infection than from
odontogenic aetiologies
• methicillin-resistant Staphylococcus aureus (MRSA) is more frequently
isolated from pus samples
• The management is the same as that in adults.