Deep neck abscess: a retrospective review of 210 cases

This study was performed to review our experience with deep neck abscesses (DNAs) and compare it to the experiences in the available literature, and to study changing trends within our patient population. We retrospectively studied 210 patients who had DNAs between 1981 and 1998. Peritonsillar abscesses and limited intraoral abscesses were excluded. Demographics, presentation, etiology, site of abscess, associated systemic diseases, bacteriology, radiology, treatment, airway management, and outcome were reviewed. We compared the entire group to those in the available literature and studied changing trends within this patient population. Dental infection (43%) was the most common cause, followed by intravenous drug abuse (12%) and pharyngotonsillitis (6%). The incidences of intravenous drug abuse and mandibular fractures as causes of DNA were 19% and 8%, respectively, during the period 1981 to 1990, but were only 1% each during the period 1991 to 1998. Streptococcus viridans was the most common pathogen (39% of positive cultures), followed by Staphylococcus epidermidis (22%) and Staphylococcus aureus (22%). Lateral pharyngeal space abscess was the most common DNA (43%), followed by submandibular space abscess, Ludwig's angina, and retropharyngeal space abscess (28%, 17%, and 12%, respectively). Seventy-five percent of patients with true Ludwig's angina underwent tracheotomy. Nondental infections are no longer a significant etiologic factor in DNA. Streptococcus viridans has replaced S aureus and beta-hemolytic streptococci as the most common pathogen. Lateral pharyngeal space abscess was the most common DNA; however, its incidence has progressively decreased over the past decade. Intravenous drug abuse and mandibular fractures are no longer major etiologic factors. Tracheotomy is indicated in patients with Ludwig's angina.