Download - Pyogenic-Infections-of-the-Deep-Neck-Spaces.pptx

8/10/2019 Pyogenic-Infections-of-the-Deep-Neck-Spaces.pptx

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PROLOGUE: A MYSTERY

CASE


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CASE: HPI

BV. 14year old F Remote tonsillectomy and ESS x2

In the ED with 9 d h/o sore throat andodynophagia. Antecedent head cold 4 d prior

has since resol!ed with conser!ati!e meas"res. De!eloped intenseL otalgia# d a$o. %reated with

amo&icillin 'or p"tati!e A() * no impro!ement.

+ast ni$ht spi,ed 'e!ers to 1-1. F. ad emesis.

0ot toleratin$ (.

2o"rtesy o' 32) Dept. (%(0S. 5rand Ro"nds Archi!es. 16 Sept

#-1-


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CASE: PHYSICAL

7I%A+S8 % 1-#. 3 1:;/66 R 116 R #4 Sp(# 9


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CASE: LABS and STUDIES

2328 32 #1--- with ;= )0s 1= >and 'orms 3)8 0a 149 B .1 2r 1.4 3@08 :-

Rapid Strep8 0onreacti!e

A 0ec, Film8 @nremar,a>le

2R8 @nremar,a>le


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CommonInfections of teDee! "ec# S!aces: An

O$e%$ie&

7ictor %sen$ )S:(%(0S S">rotation


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DEEP "EC' SPACES: Eleven anatomic orpotential compartments created >y

inter'ascial planes within the nec,

DEEP "EC' I"(ECTIO"8 A s"pperati!e

G"s"ally >acterialH in'ection within the deepnec, spaces o' the deep cer!ical 'ascia

DE(I"ITIO"S


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A)IAL A"ATOMY


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SAGITTAL A"ATOMY


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SAGITTAL A"ATOMY


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RADIOLOGIC A"ATOMY

HEAD A"D "EC' A)IALMRI (LYTHROUGH *

LI"'+
http://www.imaios.com/en/e-Anatomy/Head-and-Neck/Face-and-neck-MRIhttp://www.imaios.com/en/e-Anatomy/Head-and-Neck/Face-and-neck-MRI


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A ME"U O( SPACES: PEARLSSUPRAHYOID

PARAPHARY"GEAL *PP+: A major nexus o' conti$"o"s spread. %ransmits thecarotid sheath. Isolated in!ol!ement is "ncommon.

SUBMA"DIBULAR *SM+: In'ection may lead to "pper airway o>str"ction

MASTICATOR: )ost closely associated with trism"s. Almost e&cl"si!elysecondary to odonto$enic ca"ses.

PAROTID: )ost li,ely seen in dehydrated and decrepit patients with poordentition

TEMPORAL: 3etween temporalis 'ascia and temporal >one periosti"m

PERITO"SILLAR *PTS+: )ost common site o!erall >"t not a,nowled$ed as atr"e D0I since it is not deCned >y 'ascial apposition

I"(RAHYOID RETROPHARY"GEAL *RPA+8 E&tends 'rom s,"ll >ase to le!el o' carina G%#H.

Does not comm"nicate with the ple"ral space.

DA"GER8 In'ection easily escapes into the mediastin"m and ple"ral space

PREVERTEBRAL *PV+8 E&tends to coccy& and may de!elop into psoas a>sess.

CAROTID: Associated with I7DA and septic throm>oem>olism

PRETRACHEAL *PT+: Associated with anterior per'oration o' the esopha$eal wall


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HOO(BEATS: COMMO"S

PERITO"SILLAR *49=+

RETROPHARY"GEALG##= 4:= non%SH )ost common D0I across alla$e $ro"ps

3"t it is predominantly a pediatricin'ection

SUBMA"DIBULARG14= #


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RETROPHARY"GEAL ABSCESS *RPA+ EPIDEMIOLOGY

ial. A!era$e nJ micro>es isolated 'rom

c"lt"re.

-= o' isolates $row anero>es

S. pyogenes S. aureus > oropharyn$eal anaero>es H. infuenzae PATHOPHYSIOLOGY

s"pperati!e lymphadenitis * or$anied phle$mon * mat"re a>scess

)or>idty and mortality is d"e to de!elopment o' complications


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RETROPHARY"GEAL ABSCESS *RPA+ CLI"ICAL PRESE"TATIO"

Ad"lts8 Sore %hroat Fe!er Dyspha$ia (dynopha$ia 0"chalain Dyspnea oarseness

2hildren8 Sore %hroa G;4=H Fe!er G64=H (dynopha$ia G=H 2o"$h

In'ants8 0ec, F"llness G9


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RETROPHARY"GEAL ABSCESS *RPA+ PHYSICAL (I"DI"GS

Ad"lts8 pharyn$eal edema cer!ical +AD n"chal ri$idity droolin$ stridor

2hildren8 'e!er and n"chal ri$idity G64=H retropharyn$eal >"l$e andnec, mass G=H a$itation or lethar$y droolin$ G##=H respiratorydistress or stridor

(ther8 dystonic reactions GtorticollisH dysphonia Ghot potato !oiceH

trism"s In a droolin$ or stridoro"s patient >e minimally in!asi!e when e&aminin$

the pharyn&

LABORATORY 2328 #-= o' cases may not show le",ocytosis or relati!e le't shi't Standard 5AS rapid throat swa> and c"lt"re

3lood c"lt"res8 rarelyret"rn positi!e $rowth o"nd c"lt"re8 91= sensiti!ity 'or polymicro>ial in'ection 2R and ESR to 'ollow >aseline. 2R is act"ally pro$nostic o'

hospitaliation le$nth. reoperati!e la>s in anticipation o' s"r$ical inter!ention Gcoa$"lation

panel meta>olic panel type and crossH


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RETROPHARY"GEAL ABSCESS *RPA+ IMAGI"G

+ateral 0ec, Film8 loo, 'or widened A diameter o'retropharyn$eal tiss"e. )a&imal reported sensiti!ity o' ;;=.

2% 0ec, with 2ontrast )ost important ima$in$ test to consider ypodense lesion o' retropharyn$eal space with rim enhancement A>sol"te Indications8 e?"i!ocal +0F ne$ati!e +0F with hi$h clinical

s"spicion Sensiti!ity scess d"rin$ hospitaliation. Some anatomic

insi$ht into s"rro"ndin$ !asc"lar str"ct"res. roo' o' concept. 0o data to s"pport ro"tine "se.

)RI8 0ot recommended 'or initial e!al"ation d"e to "ntimeliness

Fle&i>le Endoscopy8 not recommended


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RETROPHARY"GEAL ABSCESS *RPA+


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RETROPHARY"GEAL ABSCESS *RPA+MEDICAL MA"AGEME"T

ARE0%ERA+ A0%I3I(%I2 %ERAM is $"ided >y s"spected so"rce o' in'ectionN

)"st ha!e MRSA co$e%a.e i' strain is endemic poor clinical

response to clindamycin or in patients with !ery se!ere disease

SUSPECTEDSOURCE

(IRST/LI"E THERAPY ALTER"ATIVE

(donto$enic AmpicillinS"l>actam : $ I7 ?6h

enicillin 5 #4 )@ I7 ?46h O)etronidaole -- m$ I7 ?6;h

2lindamycin 6-- m$ I7 ?6;h

Imipenem -- m$ I7 ?6h

)eropenem 1 $ I7 ?;h

Rhino$enic and(to$enic

Ampicillins"l>actam : $ I7 ?6h

2e'tria&one 1 $ I7 ?#4h O)etronidaole -- m$ I7 ?6;h

2iproPo&acin 4-- m$ ?1#h O

2lindamycin 6-- m$ I7 ?6;h

As a>o!e

Imm"ncompromised 2eCpime # $ I7 ?1#h O)etronidaoole -- $ I7 ?6h

iperacillin%ao>actam 4. $ I7?6h

As a>o!e


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RETROPHARY"GEAL ABSCESS *RPA+ SURGICAL I"DICATIO"S

Important8 -= o' patients with "ncomplicated RA achie!espontaneo"s resol"tion with medical therapy alone

Respiratory distress

@r$ent complication o' RA Ge.$. mediastinitisempeyema septic throm>ophle>itisH

Diameter o' a>scess # cm on 2% 0ec,

0o response to A3& therapy at 4; hrs

SURGICAL APPROACH @/S $"ided F0A8 pre'erred in hemodynamically "nsta>le

patients or those with small and accessi>le loc"lations

I/D8 @s"ally re?"ires transcer!ical entry. Small a>scesses may>e drained !ia transoral aspiration.


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0UESTIO"S

Download - Pyogenic-Infections-of-the-Deep-Neck-Spaces.pptx

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