This study was performed to review our experience with deep neck
abscesses (DNAs) and compare it to the experiences in the available literature, and to study changing trends within our patient population. We retrospectively studied 210 patients who had DNAs between 1981 and 1998.
Peritonsillar abscesses and limited intraoral
abscesses were excluded. Demographics, presentation, etiology, site of
abscess, associated systemic diseases, bacteriology, radiology, treatment,
airway management, and outcome were reviewed. We compared the entire group to those in the available literature and studied changing trends within this patient population. Dental
infection (43%) was the most common cause, followed by
intravenous drug abuse (12%) and pharyngotonsillitis (6%). The incidences of
intravenous drug abuse and
mandibular fractures as causes of
DNA were 19% and 8%, respectively, during the period 1981 to 1990, but were only 1% each during the period 1991 to 1998. Streptococcus viridans was the most common pathogen (39% of positive cultures), followed by Staphylococcus epidermidis (22%) and Staphylococcus aureus (22%). Lateral pharyngeal space
abscess was the most common
DNA (43%), followed by submandibular space
abscess,
Ludwig's angina, and retropharyngeal space
abscess (28%, 17%, and 12%, respectively). Seventy-five percent of patients with true
Ludwig's angina underwent
tracheotomy. Nondental
infections are no longer a significant etiologic factor in
DNA. Streptococcus viridans has replaced S aureus and beta-hemolytic streptococci as the most common pathogen. Lateral pharyngeal space
abscess was the most common
DNA; however, its incidence has progressively decreased over the past decade.
Intravenous drug abuse and
mandibular fractures are no longer major etiologic factors.
Tracheotomy is indicated in patients with
Ludwig's angina.