Deep neck abscesses represent an emergency otolaryngological disease. We analyzed 25 patients with deep neck abscesses treated in our hospital between 1998 and 2009. The mean age of the patients was 58.9 years. We investigated the age, primary focus, extension of the abscess, treatment, causative bacteria and prognosis.
The cause of the deep neck abscesses was pharyngeal infection in 9 cases (36%), odontogenic infection in 5 cases (20%), peritonsillar abscess in 3 cases (12%), and a foreign body (fish bones) in 3 cases (12%). Each case of deep neck abscess was classified according to the degree of extent of infection diagnosed with CT imaging. The abscesses were localized in the upper neck space above the hyoid bone in 10 cases, extended to the lower hyoid bone in 8cases, and extended to the mediastinum in 7 cases.
As regards causative bacteria, there was a mixture of aerobic and anaerobic bacteria-related infection in 11 cases (44%). Severe single aerobic infection was seen in 9 cases(36%), and Streptococcus pyogenes (S. pyogenes) was seen in 4 cases (16%). Progression to the mediastinal space occurred in 4 cases of the mixed infection type and in 3 cases of S. pyogenes infection.
As for the sensitivity of the causative bacteria to antibacterial drugs, the anaerobic bacteria demonstrated 89% resistance to penicillin. It was thought that anaerobic bacteria produced β lactamase.
Our treatment principle for deep neck abscesses is hospitalization, followed by incision and drainage of the abscess and intravenous administration of a wide spectrum antibacterial agent.
Though there serious cases have been reported such as descending necrotizing mediastinitis and/or necrotizing fasciitis, all 25 cases we treated were successfully cured without any severe complication.
