Pediatric deep space neck infections: a review

Abstract

Pediatric deep neck infections (DNI) are a relatively uncommon yet potentially dangerous entity that must be diagnosed promptly. These infections have a slight male predominance and may occur at any age, although peritonsillar abscesses are most commonly seen in adolescents. Depending on the location of infection, the presenting symptoms are variable but usually include fever, sore throat, odynophagia, and/or neck pain/swelling. In very young patients, fever may be the sole presenting symptom, making diagnosis challenging. Laboratory tests and imaging may be helpful in establishing a diagnosis. Computed tomography (CT) is the gold standard for diagnosing and characterizing DNI, although recently there has been increased interest in the use of ultrasound, as it is cost-effective and avoids radiation. Comorbidities, including immunologic disease and craniofacial syndromes in particular, portend an increased risk of infection and subsequent complications. The most commonly reported complications arising from DNI include airway obstruction and locoregional extension of infection. Pediatric DNI can be caused by a wide variety of bacteria, and empiric broad-spectrum antibiotic regimens typically include a beta-lactam penicillin derivative or a third-generation cephalosporin. The development of potent antibiotic medications has facilitated medical management of select pediatric DNI, but debate persists regarding appropriate indications for surgical management versus medical therapy alone. In general, otherwise healthy, clinically stable patients who have small- to medium-sized infections with favorable imaging characteristics may safely undergo a trial of medical management. Based on the size and severity of the infection, there is a wide range of procedural options, which, in select cases, may safely be performed in the Emergency Department. The last decade has seen a nationwide increase in hospital charges incurred in the management of DNI. With increasing scrutiny towards healthcare costs and utilization, appropriate management plans must be implemented to optimize both patient safety and cost efficiency.