Deep Neck Space Infections

Anatomically, within the deep neck are 11 spaces created by planes of greater and lesser resistance between the fascial layers. These include the submandibular space, parapharyngeal space (PPS), retropharyngeal space, peritonsillar space, danger space, prevertebral space, pretracheal space, carotid space, masticator space, temporal space, and the parotid space. Deep neck space infections (DNSIs) most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes (LNs), middle ear, or sinuses. These DNSIs often have a rapid onset and can progress to life-threatening complications. They present a challenging problem because of the difficult localization of infection, the risk of surgical injury to the intervening neurovascular and soft tissue structures, and the possible complicated sequelae of inflammatory involvement of the vital surrounding tissues such as neural dysfunction, vascular erosion, thrombosis, and osteomyelitis. This chapter focuses on the etiology, clinical presentation, diagnosis, management, and prognosis of certain inflammatory lesions such as Ludwig’s angina, peritonsillar abscess (PTA), parapharyngeal abscess, and retropharyngeal abscess (RPA).