AtlasInfectionsDeep Neck Space Infections

Maxillofacial Infections

Deep Neck Space Infections

aka Fascial Space Infections

Odontogenic infection can spread along fascial planes into potential spaces of the head and neck, threatening the airway, mediastinum and great vessels.

Source
Odontogenic (molar)
Imaging
Contrast CT
Rx
Airway + I&D + IV abx

§ overviewOverview

Infections that spread from the tooth/jaw into the potential spaces bounded by the deep cervical fascia, following predictable anatomical routes.

§ etiologyEtiology

  • 01Odontogenic (>60%) — most often mandibular molars
  • 02Tonsillar, salivary, traumatic, iatrogenic

§ clinicalClinical Features

  • 01Swelling, pain, trismus, dysphagia, drooling
  • 02Airway compromise (retro-/parapharyngeal)
  • 03Fever, malaise, elevated WCC/CRP
  • 04Torticollis (deep spread)

§ investigationsInvestigations

  • 01Contrast-enhanced CT head-neck (gold standard)
  • 02Aspirate for culture
  • 03FBC, CRP, glucose, coagulation
  • 04Chest imaging to exclude mediastinitis

§ classificationClassification

  • 01Primary spaces adjacent to tooth: buccal, canine, sublingual, submandibular, submental
  • 02Secondary/deep spaces: masticator (masseteric, pterygomandibular, temporal), lateral pharyngeal (parapharyngeal), retropharyngeal, prevertebral, danger space (space 4 of Grodinsky-Holyoke)

§ treatmentTreatment

  • 01Airway assessment — secure early (awake fibre-optic if compromised)
  • 02IV empirical antibiotics: amoxicillin-clavulanate or ampicillin-sulbactam + metronidazole; add clindamycin/vancomycin if MRSA suspected
  • 03Surgical: extract source tooth + incision & drainage of involved spaces via appropriate approaches, dependent drainage, corrugated/Penrose drain
  • 04ICU support if septic
  • 05Reassess and re-image if no improvement in 48–72 h

§ complicationsComplications

  • 01Airway obstruction
  • 02Descending necrotising mediastinitis (via retropharyngeal/danger space)
  • 03Cavernous sinus thrombosis (via canine space and pterygoid plexus)
  • 04Lemierre syndrome (internal jugular thrombophlebitis)
  • 05Septic shock

§ prognosisPrognosis

Good with early surgical drainage and antibiotics; delayed presentation carries high morbidity/mortality.

§ examKey Examination Points

  • 01Trismus + dysphagia = deep space involvement until proven otherwise
  • 02Airway is priority
  • 03Follow the fascial routes on CT

§ revisionQuick Revision Summary

  • 01Odontogenic source · early I&D + antibiotics · watch for mediastinitis

§ vivaBDS Viva Questions

  • 01Boundaries of pterygomandibular space?
  • 02Danger space?
  • 03Cavernous sinus thrombosis route?

§ mcqsMCQs — Assessment (3)

Question 1

Danger space extends to:

Question 2

Trismus most suggests involvement of:

Question 3

First priority:

References

  1. Peterson LJ. Principles of OMFS 3e

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.