Beema Salim, S F (2022) A Comprehensive study on the Clinical Spectrum, Bacteriological Profile, Diagnosis and Management of Deep Neck Space Infection: Our Experience. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Deep neck infection refers to an infection in the potential spaces and fascial planes of the neck, either with abscess formation or cellulitis. They are diseases of great importance due to their relative frequency, challenging nature and potential for serious complications.They are potentially lethal disease condition and constitute a medical and surgical emergency. AIMS OF THE STUDY: 1. To evaluate the clinical presentation and etiology of patients with deep neck space infections in our hospital. 2. To analyze the associated systemic diseases/ comorbidities with respect to its impact on deep neck space infections. MATERIALS AND METHODS: STUDY PLACE: Upgraded Institute of Otorhinolaryngology, RGGGH & MMC, Chennai. STUDY PERIOD: June 2020 to September 2021. DESIGN OF THE STUDY: Prospective study. SAMPLE SIZE: 40. Case details of patients admitted with deep neck space infections in the Department of Upgraded institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital from June 2020 to September 2021 were studied. ● A total of 40 patients admitted with complaints suggestive of deep neck space infections were included and studied. ● All patients underwent thorough history taking with emphasis on associated systemic illness and detailed physical examination. ● Appropriate laboratory investigations including complete hemogram, glycemic values, liver and renal function tests and electrolyte panel are done. ● Radiological investigations including CT neck with/ without contrast, X-ray neck, chest and USG neck were done to determine the extent, spread of the infection and to find out of complications if present. ● All patients were initially started on empirical intravenous antibiotics. ● Based on the severity of infection and the condition of the patient, conservative management or surgical intervention in the form of needle aspiration or incision and drainage were done and pus drained was sent for culture and sensitivity analysis. ● The antibiotics were later on modified according to culture sensitivity reports and clinical responsiveness. ● Supportive therapy with intravenous fluid, analgesics, antipyretics, mouth washes were given to improve the general condition of the patient. ● The presentation and the course of the disease, the impact of associated systemic illness, the bacteriological profile and antibiotic sensitivity study, the modality of treatment chosen, the complications encountered and the final outcome of the patient studied. ● Results are presented in numbers and percentage. INCLUSION CRITERIA : 1. Patients of age group 12 years to 80 years who are willing for admission and complete treatment and follow up 2. Patients who are willing for the study, able to understand the protocol and able to give informed consent 3. All patients with history and symptoms suggestive of deep neck space infections. EXCLUSION CRITERIA: 1. Patients of age less than 12 years, pregnant females, uncooperative patients. 2. Patients with superficial cellulitis/abscess and infections of external neck wounds both surgical and traumatic. 3. Patients not willing to complete treatment. 4. Patients not willing for the study. 5. Patients with associated head and neck malignancies. CONCLUSION: Deep neck space infections are potentially harmful, life endangering condition of the head and neck. Early diagnosis and management with appropriate intravenous antibiotics along with the treatment of the underlying aetiology is essential for the complete recovery of the patient. In our study of 40 patients of deep neck space infections, the following conclusions are made. ❖ Patients in the third to fifth decade are the most commonly affected by deep neck space infection. There is no gender predilection in the incidence of deep neck space infection. ❖ Diabetic mellitus is the commonest and most important risk factor for the occurrence of the disease. Uncontrolled diabetic patients are significantly seen to have multiple space involvement, prolonged hospital stay and complications of the disease. Attaining stable glycemic control boosts healing and favours good outcome. ❖ Odontogenic infection is the most common etiology responsible for the disease. Making the population aware about the importance of periodic dental checkup with maintenance of good oral hygiene is highly crucial for the prevention of the infection. ❖ Reduced polymorphonuclear leukocyte function plays a key role in the deterioration of gingival and periodontal health. This happens in diabetic patients and hence the control of blood glucose level plays a crucial role in the prevention as well as management of the infection. ❖ Klebsiella pneumonia is the most common organism isolated from the culture study of the infection. The antibiotic sensitivity study showed maximum response to piperacillin tazobactam, amikacin and ciprofloxacin. Hence, empirical regime must be started with these drugs to yield good results. ❖ In patients with diabetes, piperacillin tazobactam, amikacin or ciprofloxacin should be added to the regime, as there is a higher incidence of infection by Klebsiella pneumonia. ❖ Computed tomography of the neck with contrast is the single best investigation for deep neck space infection to see the extent, airway patency and complications. ❖ The first and foremost step of treating deep neck space infection is the assessment of airway. Securing a patent and stable airway is of prime importance. ❖ For patients with risk factors it is advisable to do an early surgical intervention to avoid complications and to improve prognosis and reducing the overall hospital stay. ❖ Treating deep neck space infection requires a multidisciplinary team of doctors including ENT surgeon, radiologist, diabetologist, anaesthetist, dentist, vascular and plastic surgeon. 3. To demonstrate the aerobic and anaerobic microbiology of the deep neck space infection and to analyze its sensitivity to antibiotics. 4. To study the different diagnostic modalities, management, complications and the final outcome of the condition.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221914008 |
| Uncontrolled Keywords: | Clinical Spectrum, Bacteriological Profile, Diagnosis, Management, Deep Neck Space Infection. |
| Subjects: | MEDICAL > Otolaryngology > MEDICAL > Otolaryngology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2022 13:38 |
| Last Modified: | 17 Dec 2023 05:09 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19365 |
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