Which physical findings are characteristic of deep neck infections?

Updated: Apr 30, 2020
  • Author: Alan D Murray, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Physical examination should focus on determining the location of the infection, the deep neck spaces involved, and any potential functional compromise or complications that may be developing. A comprehensive head and neck examination should be performed, including examination of the dentition and tonsils. The most consistent signs of a deep neck space infection are fever, elevated WBC count, and tenderness. Other signs and symptoms largely depend on the particular spaces involved and include the following:

  • Asymmetry of the neck and associated neck masses or lymphadenopathy, which is present in almost 70% of pediatric retropharyngeal abscesses according to a study by Thompson and colleagues

  • Medial displacement of the lateral pharyngeal wall and tonsil caused by parapharyngeal space involvement

  • Trismus caused by inflammation of the pterygoid muscles

  • Torticollis and decreased range of motion of the neck caused by inflammation of the paraspinal muscles

  • Fluctuance that may not be palpable because of the deep location and the extensive overlying soft tissue and muscles (eg, sternocleidomastoid muscle)

  • Possible neural deficits, particularly of the cranial nerves (eg, hoarseness from true vocal cord paralysis with carotid sheath and vagal involvement), and Horner syndrome from involvement of the cervical sympathetic chain

  • Regularly spiking fevers (may suggest internal jugular vein thrombophlebitis and septic embolization)

  • Tachypnea and shortness of breath (may suggest pulmonary complications and warn of impending airway obstruction)

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