[Complications of the deep infections of the neck]

Deep infections of the neck are potentially life-threatening for their descending spread along cervical fascia planes towards the mediastinum and development of sepsis after thrombophlebitis of the internal jugular vein. The aim of the present report is to review the complications of the deep neck infections and their surgical treatment for the period of 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 of tonsillar 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 ulcer of the stomach treated with laparotomy and laparostomy. Combined surgical and massive antibiotic treatment according to the bacteriological findings was carried out. Cervical incisions, jugulotomy and thoracotomy were performed in cases with descending mrdiastinitis. Permanent suction drainage and lavage of the abscess cavities were used. In cervical phlegmonas the surgical wounds were left open against anaerobic infection. 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 of the deep neck infection--stress ulcer of the stomach, which could not be managed endoscopically because of the compression due to hypopharingeal edema, sepsis, tracheal stenosis. All the patients but one recovered after the treatment. One of them with cervical phlegmona died out of heart arrest in the operating theater after urgent intubation and tracheotomy for airway obstruction. 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, reanimators and microbiologists is stressed in conclusion.