Evaluation of clinicopathological profile of deep neck space infections in western part of Nepal, a descriptive study

Abstract

Introduction: Deep neck space infections are the infections involving the deeper neck spaces compartmentalized by various layers of deep fascia of the neck. Patients with deep neck infections can easily land up in complication if prompt diagnosis and treatment is unavailable. This study aimed to assess the status of deep neck infections, the patient demography, their clinical presentations, bacteriology, mode of diagnosis, treatment and complications in a tertiary health centre of western region of Nepal.

Methods: This is a prospective study done in the department of ENT and head and neck surgery from July 2022 to June 2023 enrolling all the patients diagnosed with deep space neck infections. Data investigated age, sex, occupation and economic status, signs and symptoms, predisposing factors, spaces of neck involved, comorbidities, blood and radiological investigations, method of drainage of the abscess, pus culture and sensitivity, duration of hospital stay of the patients and complications if any.

Results: Out of total 53 patients, 34 were males and 19 females,age ranging from seven months to 64 years with the mean age of 32.38 years. The average duration of hospital stay was 6.8 days. Majority (39.62%) belonged to the lower middleclass status. Eighty-five percentof patients had history of prior use of medications before encountering the hospital. Submandibular space (32%) was the commonest space involved while peritonsillar space (30%) was the second. Sixteen patients had comorbidities including anemia, diabetes mellitus, HIV positive status, congenital fistula and malignancy. Thirty five patients underwent surgical incision and drainage for frank abscesses, four underwent needle aspiration, two underwent USG-guided needle aspiration and rest of them were medically managed. The microorganisms were isolated in only five cases with E.Coli, Citrobacter freundii, Kleibsella pneumoniae, Streptococcus pyogenes as isolates. Three cases suffered from complications such as upper airway obstruction, pharyngocutaneous fistula and death.

Conclusion: Increased self-administration of antibiotics have led to increase in absence of growth of microorganisms in culture media and increase in bacterial resistance of the common antibiotics. Deep neck infections if treated early can avoid undesirable complications.