Deep neck space infections in adults – clinical aspects

Czech version

Authors: V. Vejmelka ^1,2 ; P. Urbánková ^1,2 ; B. Gál ^1,2
Authors‘ workplace: Lékařská fakulta Masarykovy Univerzity, Brno ¹; Klinika otorinolaryngologie a chirurgie hlavy a krku, FN u sv. Anny v Brně ²
Published in: Otorinolaryngol Foniatr, 75, 2026, No. 1, pp. 60-66.
Category: Original Article
doi: https://doi.org/10.48095/ccorl202660

Overview

Deep neck space infections (DNSI) represent acute, rapidly progressing, and potentially life-threatening conditions requiring immediate diagnosis and comprehensive management. In untreated or late-diagnosed cases, severe complications may develop, including descending mediastinitis, sepsis, or multi-organ failure. The clinical presentation can be highly variable, particularly in patients with prior antibiotic therapy or in individuals with immune disorders, which increases the risk of diagnostic delay. Key steps in management include early utilization of imaging modalities (CT or MRI), urgent surgical drainage of the focus, early and aggressive administration of broad-spectrum antibiotics, and provision of comprehensive intensive care. This article provides an otorhinolaryngologist perspective on the issue and presents the experience of the Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne’s University Hospital Brno, based on a retrospective study of 80 patients treated for DNSI between 2018 and 2023.

Keywords:

Neck – Soft tissue infections – Retrospective studies – adult – mediastinitis

Sources

1. Krtičková J, Haviger J, Ryšková L et al. Hluboké krční záněty jako komplikace zánětu hltanu (retrospektivní studie). Otorinolaryngol Foniatr 2017; 66 : 7–11.

2. Klail P, Hlaváč L, Šafránek J et al. Hluboké krční infekce –⁠ základní fakta a naše zkušenosti. Rozhl Chir 2024; 103 (11–12): 494–501. Doi: 10.48095/ccrvch2024494.

3. Komínek P, Astl J, Plzák J et al. Záněty hltanu. Havlíčkův Brod: Tobiáš 2016.

4. Lau AS, Upile NS, Wilkie MD et al. The rising rate of admissions for tonsillitis and neck space abscesses in England, 1991–2011. Ann R Coll Surg Engl 2014; 96 (4): 307–310. Doi: 10.1308/003588414x13946184900363.

5. Hurley RH, Douglas CM, Montgomery J et al. The hidden cost of deep neck space infections. Ann R Coll Surg Engl 2018; 100 (2): 129–134. Doi: 10.1308/rcsann.2017.0193.

6. Isankova O, Safronovs J, Berke K et al. Deep Neck Infections. Review of 111 cases. Otolaryngol Pol 2025; 79 (1): 1–5. Doi: 10.5604/01.3001.0054.8465.

7. Gao W, Lin Y, Yue H et al. Bacteriological analysis based on disease severity and clinical characteristics in patients with deep neck space abscess. BMC Infect Dis 2022; 22 (1): 280. Doi: 10.1186/s12879-022-07259-9.

8. Sheikh Z, Yu B, Heywood E et al. The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis. Clin Otolaryngol 2023; 48 (4): 540–562. Doi: 10.1111/coa.14064.

9. Srba A. FP, Kovář D., Astl J. Hluboké krční záněty –⁠ diagnostika a terapie. Otorinolaryngol Foniatr 2017; 66 (2): 86–91.

10. Yang SW, Lee MH, See LC et al. Deep neck abscess: an analysis of microbial etiology and the effectiveness of antibiotics. Infect Drug Resist 2008; 1 : 1–8. Doi: 10.2147/idr.s3554.

11. Čelakovský P, Kalfeřt D, Tuček L et al. Deep neck infections: risk factors for mediastinal extension. Eur Arch Otorhinolaryngol 2014; 271 (6): 1679–1683. Doi: 10.1007/s00405-013-2651-5.

12. Boscolo-Rizzo P, Stellin M, Muzzi E et al. Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol 2012; 269 (4): 1241–1249. Doi: 10.1007/s00405-011-1761-1.

13. Liao TI, Ho CY, Chin SC et al. Sequential Impact of Diabetes Mellitus on Deep Neck Infections: Comparison of the Clinical Characteristics of Patients with and without Diabetes Mellitus. Healthcare (Basel) 2024; 12 (14). Doi: 10.3390/healthcare12141383.

14. Loperfido A, Stasolla A, Giorgione C et al. Management of Deep Neck Space Infections: A Large Tertiary Center Experience. Cureus 2023; 15 (2): e34974. Doi: 10.7759/cureus.34974.

15. Almutairi DM, Alqahtani RM, Alshareef N et al. Deep Neck Space Infections: A Retrospective Study of 183 Cases at a Tertiary Hospital. Cureus 2020; 12 (2): e6841. Doi: 10.7759/cureus.6841.

16. Olejniczak I, Bojanowska-Poźniak K, Pietruszewska W. Deep neck infections –⁠ still important diagnostic and therapeutic problem. Otolaryngol Pol 2016; 70 (2): 25–30. Doi: 10.5604/00306657.1200650.

17. Chow AW. Life-Threatening Infections of the Head, Neck, and Upper Respiratory Tract. In: Principles of Critical Care, 4e. edn. Edited by Hall JB, Schmidt GA, Kress JP. New York, NY: McGraw-Hill Education 2015.

18. Hagelberg J, Pape B, Heikkinen J et al. Diagnostic accuracy of contrast-e–nhanced CT for neck abscesses: A systematic review and meta-analysis of positive predictive value. PLOS ONE 2022; 17 (10): e0276544. Doi: 10.1371/journal.pone.0276544.

19. Nurminen J, Velhonoja J, Heikkinen J et al. Emergency neck MRI: feasibility and diagnostic accuracy in cases of neck infection. Acta Radiol 2021; 62 (6): 735–742. Doi: 10.1177/0284 185120940242.

20. Muñoz A, Castillo M, Melchor MA et al. Acute neck infections: prospective comparison between CT and MRI in 47 patients. J Comput Assist Tomogr 2001; 25 (5): 733–741. Doi: 10.1097/00004728-200109000-00011.

21. Prado-Calleros HM, Jiménez-Fuentes E, Jiménez-Escobar I. Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description. Head Neck 2016; 38 Suppl 1: E2275–E2283. Doi: 10.1002/hed.24183.

22. Kauffmann P, Cordesmeyer R, Tröltzsch M et al. Deep neck infections: A single-center analysis of 63 cases. Med Oral Patol Oral Cir Bucal 2017; 22 (5): e536–e541. Doi: 10.4317/medoral.21799.

23. Daryabor G, Atashzar MR, Kabelitz D et al. The Effects of Type 2 Diabetes Mellitus on Organ Metabolism and the Immune System. Front Immunol 2020; 11 : 1582. Doi: 10.3389/fimmu.2020.01582.

24. Barber BR, Dziegielewski PT, Biron VL et al. Factors associated with severe deep neck space infections: targeting multiple fronts. J Otolaryngol Head Neck Surg 2014; 43 (1): 35. Doi: 10.1186/s40463-014-0035-5.

25. Maroldi R, Farina D, Ravanelli M et al. Emergency imaging assessment of deep neck space infections. Semin Ultrasound CT MR 2012; 33 (5): 432–442. Doi: 10.1053/j.sult.2012.06.008.

26. Koç RH, Abakay MA, Sayın İ. Determining the prognostic value of CRP and neutrophil lymphocyte ratio in patients hospitalized for deep neck infection. Braz J Otorhinolaryngol 2024; 90 (6): 101492. Doi: 10.1016/j.bjorl.2024.101492.

27. Staffieri C, Fasanaro E, Favaretto N et al. Multivariate approach to investigating prognostic factors in deep neck infections. European Archives of Oto-Rhino-Laryngology 2014; 271 (7): 2061-2067. Doi: 10.1007/s00405-014-2926-5.

28. Kameshwar PR, Worawat & Tangjaturonrasme. Serum Procalcitonin as Outcome Predictors in Deep Neck Infections. Biomed J Sci & Tech 2019; 22. Doi: 10.26717/BJSTR.2019.22.003729.

29. Kostlivý T, Slouka D, Chrobok V et al. Hluboké krční infekce: příručka pro praxi. Praha: ČSOCHHK ČLS JEP 2023.

30. Kocher GJ, Hoksch B, Caversaccio M et al. Diffuse descending necrotizing mediastinitis: surgical therapy and outcome in a single-centre series. Eur J Cardiothorac Surg 2012; 42 (4): e66–e72. Doi: 10.1093/ejcts/ezs385.

31. Cho SY, Woo JH, Kim YJ et al. Airway management in patients with deep neck infections: A retrospective analysis. Medicine (Baltimore) 2016; 95 (27): e4125. Doi: 10.1097/md.000 0000000004125.

32. Joynt G. Airway management and acute upper-airway obstruction. Oh‘s Intensive Care Manual 2009 : 327–341.

33. Tseng KL, Shieh JM, Cheng KC et al. Tracheostomy versus endotracheal intubation prior to admission to a respiratory care center: a retrospective analysis. Int J Gerontol 2015; 9 (3): 151–155. Doi: 10.1016/j.ijge.2014. 04.004.

34. Park MJ, Kim JW, Kim Y et al. Initial Nutritional Status and Clinical Outcomes in Patients with Deep Neck Infection. Clin Exp Otorhinolaryngol 2018; 11 (4): 293–300. Doi: 10.21053/ceo. 2018.00108.

35. Velhonoja J, Lääveri M, Soukka T et al. Deep neck space infections: an upward trend and changing characteristics. Eur Arch Otorhinolaryngol 2020; 277 (3): 863–872. Doi: 10.1007/ s00405-019-05742-9.