Is conservative treatment of deep neck space infections appropriate?

BACKGROUND: A 31-patient prospective series on deep neck infections, managed at Hospital Ramón y Cajal in Madrid, Spain, is presented.

METHODS: A prospective study was conducted from January 1994 to December 1997, including all parapharyngeal or retropharyngeal infections. Clinical and radiologic findings and length of stay in the hospital were registered. Medical treatment was instituted with broad-spectrum antibiotics, and surgery was reserved for those patients not responding to medical treatment.

RESULTS: Twenty-four patients (77.42%) had parapharyngeal, 3 (9.68%) retropharyngeal and 4 (12.90%) mixed infections. On the basis of clinical and CT findings, 19 cases (61.29%) were considered abscesses and 12 (38.71%) cellulitis. Medical treatment was successful in all but 3 cases (90.32%), with no major complications. All the patients were discharged from the hospital within 20 days after admission (mean, 8.09 days).

CONCLUSIONS: Despite the wide use of antibiotics, deep neck space infections are commonly seen. Although most reports are based on surgical treatment followed by antibiotics, medical treatment could be as successful as open surgical drainage in most cases.