Incision and Drainage of Deep Neck Space Infections

The incidence of deep neck space infections (DNSIs) has decreased since the discovery of antibiotics [1] and the improvement of dental hygiene. DNSI poses considerable challenges in diagnosis and treatment, and may potentially lead to life-threatening complications such as descending necrotizing mediastinitis, septic shock, pleural and pericardial effusion, cavernous sinus and internal jugular vein thrombosis, or carotid artery erosion [2]. DNSIs are categorized depending on the neck space involved. Those most frequently involved are the retropharyngeal, peritonsillar, masseteric, pterygopalatine, maxillary, parapharyngeal, sub-mandibular, and parotid, and abscesses of the floor of the mouth [3]. The management of DNSI includes control of the airway, effective antibiotic therapy, and surgical intervention when indicated. When a significant deep neck space abscess is diagnosed, incision and drainage (I + D) should be considered on an urgent basis in adults [4]. A different scenario is described for children, as conservative management may be effective for selected patients [5], but every case should be managed on its own clinical merits. The goals of surgery are to stop the progression of the infection, obtain a sample for microbiology and sensitivity, and create a drainage pathway.