Deep neck abscess: A retrospective review of 210 cases

This study was performed to review our experience with deep neck abscesses (DNAs) and compare it to the experiences in the available literature, and t o study changing trends within our patient population. We retrospectively s tudied 210 patients who had DNAs between 1981 and 1998. Peritonsillar absce sses and limited intraoral abscesses were excluded. Demographics, presentat ion, etiology, site of abscess, associated systemic diseases, bacteriology, radiology, treatment, airway management, and outcome were reviewed. We com pared the entire group to those in the available literature and studied cha nging trends within this patient population. Dental infection (43%) was the most common cause, followed by intravenous drug abuse (12%) and pharyngoto nsillitis (6%). The incidences of intravenous drug abuse and mandibular fra ctures as causes of DNA were 19% and 8%, respectively, during the period 19 81 to 1990, but were only 1% each during the period 1991 to 1998. Streptoco ccus viridans was the most common pathogen (39% of positive cultures), foll owed by Staphylococcus epidermidis (22%) and Staphylococcus aureus (22%). L ateral pharyngeal space abscess was the most common DNA (43%), followed by submandibular space abscess, Ludwig's angina, and retropharyngeal space abs cess (28%, 17%. and 12%, respectively). Seventy-five percent of patients wi th true Ludwig's angina underwent tracheotomy. Nondental infections are no longer a significant etiologic factor in DNA. Streptococcus viridans has re placed S aureus and beta -hemolytic streptococci as the most common pathoge n. Lateral pharyngeal space abscess was the most common DNA; however, its i ncidence has progressively decreased over the past decade. Intravenous drug abuse and mandibular fractures are no longer major etiologic factors. Trac heotomy is indicated in patients with Ludwig's angina.