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Images of deep neck space infection and the clinical significance
Bing Wang1, Bu-Lang Gao2, Guo-Ping Xu3
1Department of Neurology, Henan Provincial People's Hospital of Zhengzhou University, PR China.
Background:
Deep neck infection is not difficult to diagnose clinically, but correct localization of the involved space for timely incision and drainage is not easy without assistance of imaging.
Purpose:
To investigate the images of deep neck space infection of phlegmon and abscess and the role of imaging examination in correct localization and treatment.
Material And Methods:
Between June 2004 and June 2010, 28 patients were diagnosed with deep neck infection (14 men, 14 women; age range, 17-72 years; mean age, 46 years). Clinical presentations included neck swelling, pain, dysphagia, fever, and elevated white blood cell count. Of the 28 cases, 20 had computed tomography (CT) scans, 18 had magnetic resonance imaging (MRI) examinations, and 10 had both CT and MRI.
Results:
All 28 patients were confirmed by CT and/or MRI to have deep neck infection, with 11 cases in the retropharyngeal space, five in the parapharyngeal space, four in the masseteric space, and eight in multiple spaces. Thirteen cases had abscesses that were successfully treated with incision and drainage under CT guidance in combination with large doses of antibiotics, and 15 had phlegmon managed with large doses of antibiotics. Followed up for 5-20 months, all patients recovered completely. Two patients were confirmed by imaging examination to have retropharyngeal infection spreading to the superior mediastinum with abscess formation and another two patients had multiple space infection because inappropriate puncture or incision for drainage without imaging guidance in these patients caused the spread of infection. Clinical diagnosis was not accurate with only 12 patients (42.9%) being correctly diagnosed of the exact deep neck space involved before imaging confirmation. CT and/or MRI made the correct diagnosis in all 28 patients. CT and/or MRI also directly changed the treatment plan in seven patients and contributed to the recovery of these patients.
Conclusion:
CT and MRI play a crucial role in both the diagnosis and correct puncture and incision for drainage of the deep neck space infection.
Insights
Imaging is crucial for diagnosing deep neck infections. Computed tomography (CT) and magnetic resonance imaging (MRI) accurately localize infections, guiding effective treatment and improving patient outcomes.
Area of Science:
- Radiology
- Otolaryngology
- Infectious Diseases
Background:
- Deep neck infections are clinically recognizable, but precise localization of the affected space for surgical intervention is challenging without imaging.
- Accurate localization is critical for timely and effective incision and drainage procedures.
Purpose of the Study:
- To analyze imaging characteristics of deep neck space infections (phlegmon and abscess).
- To evaluate the role of imaging examinations in accurate localization and treatment of deep neck infections.
Main Methods:
- A retrospective study of 28 patients (mean age 46 years) with deep neck infection from June 2004 to June 2010.
- Utilized computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis and localization, with 20 patients undergoing CT, 18 MRI, and 10 both.
Main Results:
- Imaging (CT/MRI) correctly diagnosed all 28 cases, identifying infection locations including retropharyngeal (11), parapharyngeal (5), masseteric (4), and multiple spaces (8).
- Clinical diagnosis accuracy for exact space involvement was only 42.9% before imaging.
- Imaging guided successful incision and drainage in 13 abscess cases and altered treatment plans in seven patients, contributing to complete recovery in all cases.
Conclusions:
- Computed tomography (CT) and magnetic resonance imaging (MRI) are essential for accurate diagnosis of deep neck space infections.
- Imaging plays a vital role in guiding precise surgical interventions, such as puncture and incision for drainage.
- The use of imaging significantly improves treatment planning and patient outcomes in deep neck infection management.
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