What is included in airway management of patients with deep neck infections?

Updated: Apr 30, 2020
  • Author: Alan D Murray, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The airway is the first priority of treatment. [1]  Addressing the airway may involve observation, endotracheal or nasotracheal intubation, tracheostomy, or cricothyroidotomy for emergent situations. [2]

Even in experienced hands, attempted oral or nasal endotracheal intubation in a patient with a deep neck space infection or abscess may be extremely difficult. The larynx and vocal cords may be difficult to visualize because of swollen pharyngeal walls and laryngeal displacement. Instrumentation can cause additional swelling. The potential exists for abscess rupture with intubation leading to aspiration, acute airway obstruction, or death. Other factors (eg, tracheal deviation, external airway compression, trismus, cervical spine rigidity) can produce difficulty with intubation.

Patients presenting with impending respiratory distress should undergo a tracheostomy while under local anesthesia to secure a safe airway. A tracheostomy is safer, more conservative, and preferable to the development of respiratory compromise. Tracheostomy should be performed before any attempts at surgical drainage in these patients.

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