Head and neck cellulitis in hospitalized adults

Our purpose was to review the clinical features of head and neck cellulitis in hospitalized patients.

A retrospective review was undertaken of 147 cases of head and neck cellulitis seen over a 15-year period at a community Hawaiian hospital.

Otologic cellulitis was mainly related to otitis externa, caused by Pseudomonas aeruginosa, although some cases had infected pierced ears or ear cysts. Cervical cellulitis was associated with malignancy, dental infection, or lymphadenitis; these patients often had positive blood cultures. Facial cellulitis was almost always caused by Staphylococci and Streptococci, usually preceded by dental infections, traumatic abscesses, or sinusitis. All study patients recovered completely, except for one patient who developed cavernous vein thrombosis and oculomotor palsy. Seventy-five percent of the patients recovered with parenteral antibiotics alone; the other patients required abscess drainage and/or other surgical procedures, especially if neck infection was present.

Although head and neck cellulitis cases have grave potential consequences, most patients do very well with proper antibiotics and appropriate surgical drainage.