DEEP NECK ABSCESSES - CHANGING TRENDS

A retrospective review was conducted of 64 patients with deep neck abs cesses. Based on clinical and operative findings, these abscesses were categorized as retropharyngeal abscess (29 patients), parapharyngeal abscess (10 patients), Ludwig's angina (19 patients), or necrotizing c ervical fasciitis (six patients). Regional trauma from an ingested for eign body was the cause for 59 per cent of the patients with a retroph aryngeal abscess. In 90 per cent of subjects with Ludwig's angina, an odontogenic cause was established; however, in the majority of cases o f parapharyngeal abscess (80 per cent) and necrotizing fasciitis of th e neck (85 per cent), aetiology was unknown. Fifty-five patients (86 p er cent) required open neck drainage. In the remaining nine (14 per ce nt) endoscopic drainage of the abscess was possible. Eight patients (1 2 per cent) needed a tracheotomy for airway control. The overall morta lity was eight per cent despite aggressive anti-microbial therapy and early surgical intervention. Thirty-four cultures grew aerobic organis ms. Seventy-six per cent of these were gram-negative microorganisms. T he bacteriological pattern of deep neck abscesses is changing and may be responsible for the considerable mortality rate with which the absc esses are still associated despite anti-microbial therapy.