ENT: Deep Neck Space Infections
High-Yield Clinical Summaries for Board Review & PG Entrance Examinations
| Condition | Primary Etiology/Source | Clinical Hallmarks | Critical Complication |
|---|---|---|---|
| Ludwig Angina | Odontogenic (usually 2nd/3rd mandibular molar) | Bilateral submandibular space cellulitis; “Bull neck” appearance; “Woody” floor of mouth; tongue elevation/protrusion. | Airway obstruction (ASPHYXIA) |
| Retropharyngeal Abscess | Suppurative adenitis (in children <5 years) or trauma (in adults) | “Cri du chat” (cat-like cry); dysphagia; neck stiffness; retropharyngeal bulging on exam/XR. | Mediastinitis; asphyxia |
| Quinsy (Peritonsillar Abscess) | Acute tonsillitis (superior pole involvement) | “Hot Potato” voice; severe trismus; uvula deviated to the opposite side. | Airway obstruction; rupture & aspiration |
| Parapharyngeal Abscess | Tonsillitis, dental, or parotid infections | Bulging of the lateral pharyngeal wall and tonsil; neck mass below the angle of the mandible. | Internal Jugular Vein Thrombosis; Carotid artery erosion |
High-Yield Clinical Pearls
- Ludwig Angina Treatment: Focus on AIRWAY PROTECTION. Often requires emergent tracheostomy or fiberoptic-guided intubation. Surgical decompression (incision and drainage) via a submental/submandibular approach is mandatory if there is no improvement on IV antibiotics.
- Retropharyngeal Abscess Imaging: Lateral neck X-ray (neck in extension) is the initial screening test. Prevertebral soft tissue space width is >7mm at C2 and >14mm at C6 in children (indicates pathology).
- Quinsy Management: Needle aspiration or incision and drainage (I&D) under local anesthesia. “Quinsy tonsillectomy” (immediate tonsillectomy) is an alternative in recurrent cases to avoid future recurrence.
- Parapharyngeal Space: Divided by the styloid process into anterior (pre-styloid) and posterior (post-styloid) compartments. The post-styloid compartment contains the Carotid sheath (Carotid artery, IJV, CN IX, X, XI, XII), making it the most dangerous space for infection spread.