[Surgical complications of the deep infections of the neck]

The aim of the present report is to review the complications of the deep neck infections and their surgical treatment in the Institute for the last 5 years. From 1999 to 2003 29 patients with deep cervical infections were treated surgically. Twelve of the patients had submandibular abscess, 10 cases were with parapharyngeal abscess, 3 with Ludwig's angina, 1 with mastoiditis with exteriorization in the neck and 3 with neck phlegmonas. The infections were most frequently oftonsillar and dental origin. The following complications were observed: 6 cases with acute obstruction of the upper airways treated with tracheostomy; 2 cases with sepsis; 2 with descending mediastinitis; and 1 with acute hemorrhage of stress ulcers of the stomach. Three cases of deep cervical infections, complicated with mediastinitis, sepsis, VII and XI cranial nerves paresis, hemorrhages from the gastrointestinal tract are cited. The third case is interesting with the multiple complications including hemorrhage from stress ulcers of the stomach, which could not be managed endoscopically because of the compression due to hypopharingeal edema leading to laparotomy, gastrotomy and suture of 3 stress ulcers. Later, the development of mechanical ileus based on adhesions was treated with ileostomy and laparostomy. The great importance of the early surgical treatment of neck infections, the use of antibiotics covering both aerobic and anaerobic bacterial spectrum and the good coordination between otolaryngologists, surgeons, anestesists and microbiologists is stressed in conclusion.