A case of airway emergency due to deep neck infection treated by oral intubation without tracheostomy：Is tracheostomy essential in the treatment of deep neck abscesses?

抄録

Tracheostomy is a common procedure performed in cases of cervical abscess at risk of airway obstruction. However, tracheostomy may increase the risk of descending necrotizing mediastinitis in deep cervical infections extending caudally. We report a case of a deep cervical abscess that was successfully treated using oral tracheal intubation without tracheostomy. A 74- year-old man was referred to our hospital with fever, sore throat, progressive swelling, and pain in the right neck area starting 4 days prior. Contrast-enhanced computed tomography (CT) revealed an abscess with gas production behind the right side of the thyroid cartilage. The right neck was incised, and debridement of the necrotic tissue and drainage of the abscess were performed under general anesthesia. Because the abscess cavity might have extended caudally behind the cricoid cartilage during surgery, the patient was returned to the intensive care unit under oral intubation without tracheostomy：tracheostomy would have increased the risk of descending mediastinitis. The patient recovered well and was discharged 1 month postoperatively. The routine use of tracheostomy is controversial because of the possibility of increased risk of mediastinal contamination due to wound infection from the tracheostomy site.