Abstract
Background
Deep neck infections (DNIs) are medical emergencies that can result in severe complications and even death. Prompt and accurate diagnosis, coupled with appropriate management, can mitigate the severity of these infections.
Methods
We conducted a retrospective cohort study of patients over 15 years old diagnosed with DNIs at a community-based hospital in Thailand from January 2017 to December 2021. The study aimed to evaluate the epidemiology, clinical features, and risk factors associated with complications in patients diagnosed with DNIs.
Results
A total of 226 patients were included, with 135 (59.7%) males and a median age of 39.5 years (IQR 29–58). Comorbidities were present in 87 patients (38.5%), with hypertension (20.4%) and diabetes mellitus (19.0%) being the most common. Odontogenic infections were the leading cause of DNIs (54.9%), and the primary presenting symptoms were neck pain and swelling (67.7%). The buccal space was the most frequent infection site (22.6%), followed by the peritonsillar space (20.4%) and the submandibular space (19.9%). Klebsiella pneumoniae was the most identified pathogen (20%), followed by Staphylococcus spp. and Viridans streptococcus (each 6.2%). Among the patients, 44.6% underwent incision and drainage, 12.4% underwent simple aspiration, and 42.9% received conservative treatment with intravenous antibiotics. Complications were observed in 16.4% of the patients, with airway obstruction being the most common (7.1%), followed by sepsis (4.9%). Multiple logistic regression analysis revealed significant risk factors for complications: involvement of the parapharyngeal space (odds ratio 43.3, p = 0.006), multiple space involvement (odds ratio 7.98, p < 0.001), and involvement of the submental space (odds ratio 5.5, p = 0.017). Additionally, presenting symptoms such as fever (odds ratio 6.1, p = 0.008), anemia (odds ratio 37.4, p = 0.024), and neck pain and swelling (odds ratio 0.2, p = 0.045) were associated with higher complication rates.
Conclusions
Odontogenic infections are the most common cause of DNIs. Complications are significantly associated with infections involving the parapharyngeal, submental, and multiple spaces. Early diagnosis and prompt management, especially in patients with identified risk factors, are crucial in reducing life-threatening complications.