This article explores the approach to managing patients with deep space neck infections. Clearly, an understanding of the fascial planes within the neck is required which then provides an understanding of the route of spread in these cases. The authors remind the reader of the normal anatomy of the parapharyngeal space (PPS) and retropharyngeal space (RPS) including radiological images. Structures of importance in the PPS include cranial nerves IX-XII, ICA and IJV. Although the RPS does not contain any structures of note, the significance here is that just posterior to the space is the ‘danger space’ as it has a direct communication with the mediastinum. The RPS itself has direct communications with the lateral pharyngeal space, sublingual space, carotid space and the PPS. The authors then describe the potential aetiologies of these infections and what to determine from the patient with respect to history and examination findings. Flexible laryngoscopy, where possible is advised to determine the effect of the infection upon the airway and guide management thereafter. CT or MRI is imperative in these patients and the authors describe medically managing those with abscesses <2cm diameter with 48 hours of antibiotics, especially paediatric patients. If deterioration occurs or plateau, then a reassessment is made. Surgical approaches are also discussed in terms of their relevant steps. The main factor for determining the approach is where the collection is with respect to the great vessels – if medial, the transoral approach is preferred and if lateral, then transcervical. The authors complement their descriptions well with multiple line drawings, CT slices and nasoendoscopy images reflecting the variety of presentations, from the mild to the severe. An informative read.

Management of parapharyngeal and retropharyngeal space infections.
Martinez Bigcas JL, Jain KS.
Share This
Suzanne Jervis

FRCS (ORL HNS), Shrewsbury and Telford Hospitals, NHS Trust, UK.

View Full Profile