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Sepsis in the Head and Neck
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
The fascial layers of the neck – the superficial and deep cervical fascia – are distributed so as to create a number of potential spaces where abscesses can collect and expand (Figures 5.1 and 5.2) and deep neck space (DNS) infections can develop. Infection in the oropharynx, especially the tonsil, can easily spread to cause suppuration in the parapharyngeal space, the peritonsillar space or, in very young children, the retropharyngeal lymph nodes. Dental infections can spread to the submental and submandibular space. The flora are mainly the pyogenic (pus-producing) organisms – Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae – but anaerobes and unusual organisms may be implicated.
Anatomy and Embryology of the Mouth and Dentition
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Because of the potential of inflammation associated with the tissues surrounding partially erupted, impacted third molars (pericoronitis), the spaces associated with this region are particularly important and, as they are interconnected, inflammation can spread to involve the tissue spaces of the neck. The submental and submandibular tissue spaces are located below the inferior border of the mandible, beneath the mylohyoid muscle, in the suprahyoid region of the neck. The submental space lies beneath the chin in the midline, between the mylohyoid muscles and the investing layer of deep cervical fascia. It is bounded laterally by the two anterior bellies of the digastric muscles. The submental space communicates posteriorly with the two submandibular spaces. The submandibular space is situated between the anterior and posterior bellies of the digastric muscle. It communicates with the sublingual space around the posterior free border of the mylohyoid muscle.
Ultrasound imaging, including ultrasound-guided biopsy
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
The normal submandibular glands are homogeneous echogenic (bright) structures lying infero-lateral to the mylohyoid muscle in the submandibular space. Intraglandular ducts are visible as short defined hyper-echoic lines but Wharton’s duct is only usually visualized when it is dilated. Lymph nodes in the submandibular space are exclusively extra-glandular.
Lymphatic malformation in larynx masquerading as respiratory papillomatosis
Published in Acta Oto-Laryngologica Case Reports, 2021
Contrast-Enhanced MRI was suggestive of the mixed cystic type of common (cystic) LM which demonstrated an ill-defined cystic mass in the region of the posterior wall of the hypopharynx measuring 3.8 × 2.5 cm. Mass was infiltrating the bilateral vallecula, epiglottis, and bilateral aryepiglottic folds. Bilateral pyriform fossa sinus was obliterated with severe narrowing of the supraglottic airway. The cystic mass was extending along the left lateral pharyngeal wall of the oropharynx, hypopharynx, left submandibular spaces displacing and encasing the gland. Inferiorly, it was extending along with the left anterior strap muscles into the thoracic inlet. Another 2.6 × 1.4 cm ill-defined cystic area was also noted in the left paratracheal region with mass effect and right lateral displacement of the trachea (Figures 3 and 4).
The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections
Published in Drug Metabolism Reviews, 2019
Paul Andrei Tent, Raluca Iulia Juncar, Florin Onisor, Simion Bran, Antonia Harangus, Mihai Juncar
In the case of head and neck infections, regardless of the number of fascial spaces involved, the submandibular space is the most frequently affected. The most frequently isolated aerobic bacterial species is Streptoccocus viridans, while Prevotella intermedia, Bacteroides fragilis and Fusobacterium nucleatum are the most frequently isolated anaerobic bacteria. Currently, empirical administration of amoxicillin + clavulanic acid and moxifloxacin in penicillin-allergic patients is recommended in the case of odontogenic head and neck space infections. However, we are aware of the fact that pathogenic microflora is continuously adapting to the administered antibiotics and that acquisition of antibiotic resistance is an unavoidable evolution. The clinician should undoubtedly take in consideration the normal conditions of oral cavity and head and neck soft tissue in order to completely understand the role of bacterial metabolic adaptations involved in the development of multidrug resistance. Knowing the exact relationship between external environment, nutrients and bacterial genetic or metabolic antibiotic resistance acquisition, will prevent the appearance of antibiotic resistance mechanisms in the future. In this context, we believe that antibiotic development methods, as well as the study of resistance mechanisms and bacterial metabolism behavior should be continuous and constant. The target of central metabolism in bacterial pathological agents should be taken in consideration in the future development of antibacterial drugs.
Are panels of clinical, laboratory, radiological, and microbiological variables of prognostic value in deep neck infections? An analysis of 301 consecutive cases
Published in Acta Oto-Laryngologica, 2019
Gino Marioni, Elena Fasanaro, Niccolò Favaretto, Giacomo Trento, Luciano Giacomelli, Roberto Stramare, Giancarlo Ottaviano, Cosimo de Filippis
Oral cavity exploration, complete otorhinolaryngological evaluation, upper aero-digestive tract endoscopy, and contrast-enhanced CT were routinely implemented. Orthopantomography of the lower jaw was performed in 114 cases (37.9%), ultrasound of the neck in 102 (33.9%), and MRI of the neck in 10 (3.3%). Infection was diagnosed in the submandibular space in 194 cases (64.5%), in the parapharyngeal space in 127 (42.2%), and in the retropharyngeal space in 22 (7.0%); more than one neck space was infected in 47 patients (15.6%). The site from which the DNI had originated was identified in 255 of the 301 patients (84.7%). In the present series, the DNIs were most often caused by dental infections, which were diagnosed in 115 cases (38.2%). The pharyngo-tonsillar structures were the second most common site of origin (54 cases; 17.9%), followed by the salivary glands (48 cases; 15.9%). For 46 of the 301 patients (15.3%), the source of the DNI remained unknown. Laboratory tests revealed high leukocyte counts (reference range, 4.5–11.0 cells × l09/L) in 172 (57.1%) of the 301 cases.