Deep Neck Space Infections

§ 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)

§ relatedRelated Diseases