RESUMEN
Deep neck infections are dangerous for its potential ease to fascial spread, sepsis, and upper airway obstruction. This article reviews 77 cases of deep cervical infection, focus on etiological, clinical and therapeutic aspects. The most frequent location was the submaxillary area (29%), followed by the parapharyngeal space (28%), floor of the mouth (27%) and retropharyngeal (14%) spaces. Etiology was dental in 32%; pharyngoamigdalar infection in 27%; foreign bodies in 13%. In 22% the cause is unknown. Two or more bacteria were isolated in 72%, with Streptococcus B haemolytic being the most frequent germ. All patients were treated with intravenous broad-spectrum antibiotics. Surgical drainage was needed in 54%, and tracheotomy in 18%. Four patients developed mediastinitis, and one died as a consequence of it. The incidence of deep neck infections has decreased after the itroduction of antibiotics but they still may be lethal especially when life-threatening complications occur. Early recognition and management are necessary.
Asunto(s)
Infecciones Bacterianas , Cuello , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/etiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/terapia , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Las infecciones cervicales profundas (ICP) pueden producir diseminación fascial, sepsis y compromiso de la vía aérea. Analizamos 77 pacientes con ICP, tratados entre 1990 y 2005 desde los puntos de vista etiológico, clínico y terapéutico. El 29% se localizó en el espacio submandibular, 28% en el espacio parafaríngeo, 27% en suelo de boca y 14% en el espacio retrofaríngeo. La causa fue dentaria en el 32%, infección faríngoamigdalar en el 27%; e impactación de cuerpo extraño esofágico en el 13%. En el 22% no se objetivó causa alguna. Se aislaron dos o más gérmenes en el material purulento, siendo del Streptococcus B- haemolytico el germen más frecuentemente aislado. Fue necesario el drenaje quirúrgico en el 54% de los casos, con traqueotomía en el 18% de los casos. Cuatro pacientes desarrollaron una mediastinitis, falleciendo uno de ellos. A pesar de la disminución de la incidencia de las infecciones cervicales profundas, estas todavía tienen gran importancia por su morbimortalidad, por lo que precisan de un diagnóstico y tratamiento precoz, dirigido a gérmenes de la cavidad oral fundamentalmente, pues es la patología dentaria la más frecuentemente implicada en las mismas
Deep neck infections are dangerous for its potential ease to fascial spread, sepsis, and upper airway obstruction. This article reviews 77 cases of deep cervical infection, focus on etiological, clinical and therapeutic aspects. The most frequent location was the submaxillary area (29%), followed by the parapharyngeal space (28%), floor of the mouth (27%) and retropharyngeal (14%) spaces. Etiology was dental in 32%; pharyngoamigdalar infection in 27%; foreign bodies in 13%. In 22% the cause is unknown. Two or more bacteria were isolated in 72%, with Streptococcus B haemolytic being the most frequent germ. All patients were treated with intravenous broad-spectrum antibiotics. Surgical drainage was needed in 54%, and tracheotomy in 18%. Four patients developed mediastinitis, and one died as a consequence of it. The incidence of deep neck infections has decreased after the itroduction of antibiotics but they still may be lethal especially when life-threatening complications occur. Early recognition and management are necessary