What causes deep neck infections?

Updated: Apr 30, 2020
  • Author: Alan D Murray, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Before the widespread use of antibiotics, 70% of deep neck space infections were caused by spread from tonsillar and pharyngeal infections. Today, tonsillitis remains the most common etiology of deep neck space infections in children, whereas odontogenic origin is the most common etiology in adults. [6, 7, 8, 9] A study by Adoviča et al found that out of 263 patients hospitalized for deep neck space phlegmons and/or abscesses, 70.6% of the cases arose from dental infections. [10] Causes of deep neck infections include the following:

  • Tonsillar and pharyngeal infections

  • Dental infections or abscesses

  • Oral surgical procedures or removal of suspension wires

  • Salivary gland infection or obstruction [11]

  • Trauma to the oral cavity and pharynx (eg, gun shot wounds, pharynx injury caused by falls onto pencils or Popsicle sticks, esophageal lacerations from ingestion of fish bones or other sharp objects)

  • Instrumentation, particularly from esophagoscopy or bronchoscopy

  • Foreign body aspiration

  • Cervical lymphadenitis

  • Branchial cleft anomalies

  • Thyroglossal duct cysts

  • Thyroiditis

  • Mastoiditis with petrous apicitis and Bezold abscess

  • Laryngopyocele

  • IV drug use [12]

  • Necrosis and suppuration of a malignant cervical lymph node or mass

As many as 20-50% of deep neck infections have no identifiable source.

Other important considerations include patients who are immunosuppressed because of human immunodeficiency virus (HIV) infection, chemotherapy, or immunosuppressant drugs for transplantation. These patients may have increased frequency of deep neck infections and atypical organisms, and they may have more frequent complications.

A retrospective study by Alotaibi et al indicated that in patients with odontogenic infection, criteria for hospital admission based on a risk of deep neck space infection should include not just the well-known risk signs—fever, trismus, leukocytosis, swollen neck, dysphagia, dyspnea, and elevated C-reactive protein levels—but also the presence of mandibular (as opposed to maxillary) odontogenic infection and/or dental abscess. The study included a cohort of 97 patients. [13]

Systemic lupus erythematosus (SLE) may be another etiologic factor in deep neck space infection. A retrospective study by Chang et al indicated that individuals with SLE have an approximately five-fold greater risk of developing the condition. [14]

A retrospective study by Almutairi et al of 183 patients with deep neck space infection found that 93 (50.8%) had comorbidities, with diabetes and hypertension being the most prevalent (45.2% and 23.7% of comorbidities, respectively). [15]

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