title: Rational diagnostic and therapeutic management of deep neck infections: analysis of 233 consecutive cases.
abstract: OBJECTIVE
  Although deep neck infections are less common nowadays because of the widespread use of antibiotics, they continue to carry significant morbidity and mortality rates.
  
  
  METHODS
  Between 2000 and 2008, deep neck infections were treated in 233 patients at the University of Padova. Cases of peritonsillar abscess, superficial infections, infections due to external neck injuries, and infections in head and neck tumors were excluded. Clinical, radiologic, laboratory, and microbiological assessments were analyzed.
  
  
  RESULTS
  The site of origin was identified in 189 of the 233 cases (81.1%), and the most common cause of deep neck infection was dental infection (39.5%). Intravenous antibiotic therapy was given to 78 patients, and 155 required both medical and surgical procedures. The bacteria most often isolated were gram-positive anaerobic cocci. None of our patients died of the deep neck infection or its complications.
  
  
  CONCLUSIONS
  It is worth emphasizing that airway support is the priority in patients with deep neck infections. Empirical antibiotic treatments must cover gram-positive and gram-negative aerobic and anaerobic pathogens. Surgical exploration and drainage may be mandatory in selected cases at presentation or in cases that fail to respond to parenteral antibiotics within the first 24 to 48 hours. It is important to perform cultures during operation to establish the pathogen(s) involved and to obtain an antibiogram to tailor the antibiotic treatment.
authors.affiliation: Dept of Medical and Surgical Specialties, Otolaryngology Section, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Marioni
authors.forename: Alberto
authors.initials: A
authors.lastname: Staffieri
authors.forename: Saverio
authors.initials: S
authors.lastname: Parisi
authors.forename: Rosario
authors.initials: R
authors.lastname: Marchese-Ragona
authors.forename: Andrea
authors.initials: A
authors.lastname: Zuccon
authors.forename: Claudia
authors.initials: C
authors.lastname: Staffieri
authors.forename: Marianna
authors.initials: M
authors.lastname: Sari
authors.forename: Chiara
authors.initials: C
authors.lastname: Speranzoni
authors.forename: Cosimo
authors.initials: C
authors.lastname: de Filippis
authors.forename: Roberto
authors.initials: R
authors.lastname: Rinaldi
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001420:Bacteria, Aerobic / Q000302:isolation & purification; D003937:Diagnosis, Differential; D004322:Drainage / Q000379:methods*; D004724:Endoscopy; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009333:Neck; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents