Ling Jin,1,* Yongjun Chang,1,* Yihua Zhao,2,* Kai Fan,1,* Jiawei Lu,1 Yang Wang,1 Shaoqing Yu1 

1Department of Otolaryngology, Head and Neck Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People’s Republic of China; 2Department of Otolaryngology, Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Jinan, 250200, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Shaoqing Yu, Department of Otolaryngology, Head and Neck Surgery, Tongji Hospital, 389 Xincun Road, Putuo District, Shanghai City, 200065, People’s Republic of China, Email yu_shaoqing@163.com

Background: Deep neck space infection (DNSI) is an acute and severe condition, with severe cases being relatively rare but considerably more critical. Consequently, in clinical practice, there is a limited understanding and lack of comprehensive reviews on severe DNSI.
Methods: We conducted a retrospective analysis of the diagnosis and treatment of five cases of severe DNSI admitted to our department.
Results: All five patients were diagnosed via neck CT and surgical exploration. Bacterial cultures predominantly revealed mixed infections of Klebsiella and other gram-negative bacilli, along with anaerobic bacteria. Three patients had diabetes, two presented with diabetic ketoacidosis, and three had mediastinal involvement. Three patients underwent tracheotomy, while two required tracheal intubation. All patients were treated with neck incision, drainage, regular dressing changes, and targeted antibiotic therapy. They had an average hospital stay of 35.8 days, and all were discharged fully recovered.
Conclusion: Severe DNSI tends to occur in patients with diabetes and other underlying systemic conditions. Infections involving multiple deep neck spaces, such as the parapharyngeal, pretracheal, and prevertebral spaces, leading to high-risk complications like airway obstruction, cervical necrotizing fasciitis, mediastinitis, and sepsis, are considered severe DNSI. Early diagnosis, timely surgical exploration, drainage to maintain airway patency, and targeted antibiotic therapy are crucial to effective management.

Keywords: deep neck space infection, severe infections, diagnosis, therapeutics, comorbidity