Deep Neck Space Infections: Scope, Dangers and Predictors of Outcome in an Emerging Economy

Abstract

Objective: Study the scope, dangers and predictors of outcome of deep neck space infections in our setting. Study Design: Retrospective cohort. Setting: Public Academic Tertiary Hospital. Method: Case files retrieved utilizing ICD-10 version 10 codes that met the inclusion criteria for deep neck space infections (DNSI) from January 1, 2012- June 30, 2016 were analyzed. Results: Thirty-three cases of DNSI with a M:F = 1.75:1 were studied. Age range was 6 months - 82years with mean = 35.3 years ± 26.0 Figure 1. In this, 60.6% presented early (≤ 7days) while 39.4% late ( that is after 7 days). The submandibular space predominated (n = 20, 60.6%) then the Space of Gilette (n = 5,15.2%) Figure 2. Major source was odontogenic (n = 19,57.6%) with 57.9%, 26.3% and 15.8% for the 1st, 2nd and 3rd mandibular molars, respectively, which tend to be extensive. We recorded a case that extended to the coccyx. Almost half had causally-associated co-morbidity (n = 15, 45.5%); predominantly anemia (n = 8, 24.2%) Figure 3. Parenteral Ceftriazone/Augmentin with Metronidazole for 24-48 hours before surgical intervention of which 36.4% were delayed interventions. All had ICU management which improved outcome. Morbidity and mortality rates were 24.2% and 15.2% respectively with the latter often following upper airway obstruction from Ludwig’s angina in 80% of which three-fifth expired before surgical intervention from late presentation. Conclusion: Extensive deep neck space infections with their attendant morbidity and mortality remain frequent in our environment. Early diagnosis and early identification of predictors of outcome with prompt intervention are key to satisfactory results.