Constantinidis J, Steinhart H, Zenk J, Iro H
Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätskliniken des Saarlandes, Homburg.
Laryngorhinootologie. 1998 Oct;77(10):551-6. doi: 10.1055/s-2007-997025.
The incidence of deep neck space infections has been significantly reduced by modern antibiotic therapy. These infections are relatively rare and yet the life-threatening complications merit special consideration by head and neck surgeons.
Seven cases of deep neck space infections as a consequence of purulent pharyngitis (3), peritonsillar abscess (2), retropharyngeal (1), and odontogenic (1) abscess are presented. Despite antibiotic therapy according to antibiogram all patients showed an increase in complaints with persisting febrile temperatures and rising inflammation parameters. Surgical intervention became necessary. In two cases the infection spread into the mediastinum.
All patients were completely cured by means of early surgical intervention including extensive drainage of the primary focus, deep neck spaces and mediastinum, accompanied by intravenous antibiotic therapy. Tracheotomy was performed on one patient with increasing dyspnea. All patients had an uneventful recovery without major postoperative complications.
The clinical course of the disease must be observed particularly closely even after starting antibiotic therapy and identification of the infectious focus. Antibiotic therapy may in some cases cover clinical symptoms. However, in the presence of abscess formation or necrotizing infections, antibiotics can prove to be ineffective. The optimum time for surgery is difficult to determine. Complete drainage of the neck spaces down to the mediastinum is a safe procedure to save the patients' life. This shortens the duration of the disease and prevents complications. The most common problems in the management of deep neck space infections are discussed.
现代抗生素治疗已使颈部深部间隙感染的发病率显著降低。这些感染相对罕见，但危及生命的并发症值得头颈外科医生特别关注。
本文报告了7例颈部深部间隙感染病例，病因分别为化脓性咽炎（3例）、扁桃体周围脓肿（2例）、咽后脓肿（1例）和牙源性脓肿（1例）。尽管根据药敏试验使用了抗生素治疗，但所有患者的症状均加重，持续发热，炎症指标上升。因此有必要进行手术干预。2例患者的感染蔓延至纵隔。
所有患者均通过早期手术干预得以完全治愈，包括对原发病灶、颈部深部间隙和纵隔进行广泛引流，并辅以静脉抗生素治疗。1例呼吸困难加重的患者接受了气管切开术。所有患者均顺利康复，无严重术后并发症。
即使在开始抗生素治疗并确定感染灶后，也必须特别密切地观察疾病的临床进程。在某些情况下，抗生素治疗可能会掩盖临床症状。然而，在存在脓肿形成或坏死性感染时，抗生素可能无效。手术的最佳时机难以确定。对颈部间隙直至纵隔进行彻底引流是挽救患者生命的安全措施。这可缩短病程并预防并发症。文中还讨论了颈部深部间隙感染治疗中最常见的问题。
