Management of deep neck space infections - an Australian otolaryngology experience

Deep neck space infections (DNSI) are common, potentially life-threatening presentations in otolaryngology. Treatment is often based on the severity of presenting symptoms and surgeon preference. This study aims to evaluate the presentation and predictors of complications in patients presenting with DNSI at an Australian Otolaryngology referral centre.

A retrospective review was conducted for all patients admitted under the Otolaryngology Unit with a DNSI between 2015 and 2020. Patient demographics, presentation, treatment and outcomes were recorded. Factors predictive of surgical intervention and complications were evaluated using univariate and multivariate analyses.

A total of 422 patients were identified. The majority were peritonsillar abscesses (n = 323, 76.5%). The most common management was incision and drainage under local anaesthetic (n = 272, 64.4%). A non-surgical approach was generally less successful for multispace and parapharyngeal abscesses. A median age of 48 years was significantly associated with a complication at presentation in both the peritonsillar abscess and non-peritonsillar abscess group on multivariate analysis (P = <0.001) and P = 0.048, respectively. In the non-peritonsillar abscess group, an elevated CRP at a median of 196 and 180 mg/L were predictive of a complication at admission and following initial treatment, respectively. Patients with multispace abscesses and presenting with dysphagia are more likely to experience a complication after initial treatment, P < 0.00001 and P = 0.031, respectively.

Understanding predictors of complications in patients presenting with DNSI will ensure timely, aggressive treatment upfront to minimize potential morbidity and mortality. Surgeons should maintain a close index of suspicion for complications in those with multispace abscesses.