What is the role of incision and drainage in the treatment 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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Answer

Incision and drainage is the cornerstone of therapy for the treatment of deep neck space abscesses. Establish a secure airway before initiating any surgical procedure.

Perform incision and drainage for any frank abscess in patients with impending complications because of abscess formation and in patients with no improvement after 48-72 hours of IV antibiotics.

Most deep neck spaces require a transcervical approach to facilitate adequate exposure of the abscess and for protection of the surrounding neurovascular structures. [26] A study by Cable et al describes the successful use of image-guided surgical drainage of medial parapharyngeal space abscesses in the pediatric population to help localize infections in areas that are otherwise difficult to reach. [27]  A study by Dabirmoghaddam et al indicated that ultrasonographically guided drainage of deep neck space abscesses leads to shorter hospital stays than does incision and drainage, with the mean hospital stay for the ultrasonography patients in the study being 5.47 days, compared with 9.70 days for those who were treated with incision and drainage. [28]

Approach retropharyngeal abscesses by a transoral route when the abscess is small and focal. This approach requires attention to the airway to prevent aspiration of pus once the abscess cavity is entered.

Quinsy tonsillectomy or tonsillectomy performed with infection in the peritonsillar space is controversial treatment for peritonsillar abscesses. Historically, tonsillectomy during acute infection was avoided because of concern about increased risk of postoperative hemorrhage. Several recent studies, such as those by Ungkanont et al and Dodds and Maniglia, suggest no increased morbidity from this procedure. [16, 29]

Many approaches are possible to the deep neck spaces. Description of the surgical incisions and technique of drainage is beyond the scope of this article. Every approach used must ensure adequate exposure and access to allow drainage without compromising surrounding structures. Abscess cavities should be copiously irrigated, débrided, and left open with a drain or packing to prevent reaccumulation. Once an abscess has been entered, cultures should be obtained to help direct antimicrobial therapy.


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