| What medical imaging techniques are abbreviated as CT and MRI? | CT – Computerized tomography MRI – Magnetic resonance imaging | REFERENCES 1. Smith II JL, Hsu JM, Chang J (2006) Predicting deep neck space abscess using computed tomography. Am J Otolaryngol 27: 244-247. 2. Mayor GP, Millán JMS, Martínez VA (2001) Is conservative treatment of deep neck space infections appropriate? Head And Neck 23: 126-133. 3. Bottin R, Marioni G, Rinaldi R, Boninsegna M, Salvadori L, et al. (2003) Deep neck infection: A present day complication. A retrospective review of 83 cases. Eur Arch Otorhinolaryngol 260: 576-579. CT – Computerized tomography MRI – Magnetic resonance imaging Rapidly progressive bacterial infections which spread along facial planes and spaces of head and neck region. They may be fatal unless emergently treated. Most of these infections are secondary to dental infection. | 483 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952350_ent_neck_space_infection.pdf | Eur Arch Otorhinolaryngol 260: 576-579. CT – Computerized tomography MRI – Magnetic resonance imaging Rapidly progressive bacterial infections which spread along facial planes and spaces of head and neck region. | 1 | page=1,block=3 | 0.700 | valid |
| What condition is associated with difficulty in breathing or risk of breathing obstruction? | Airway compromise or impending airway compromise | • Necrotizing fibrofascitis • Abscess formation • No response to antibiotics over 48-72 hours • Deterioration despite antibiotics over 24 hours • Airway compromise or impending airway compromise • Mediastinal spread • Vascular complication like venous thrombosis | 146 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952350_ent_neck_space_infection.pdf | • Necrotizing fibrofascitis • Abscess formation • No response to antibiotics over 48-72 hours • Deterioration despite antibiotics over 24 hours • Airway compromise or impending airway compromise • Mediastinal spread • Vascular complication like venous thrombosis | 1 | page=1,block=37 | 0.700 | valid |
| What is the goal of follow-up services for neck space infections? | Complete resolution of infection and follow up to ensure no recurrence | 1. Contrast enhanced CT scan of head and neck is the standard in evaluation of neck space infections. If CT Scan facility is not available, following should be done:- a. Lateral x-ray neck: Prevertebral soft tissue thickening >7 mm at the level of C2 or > 2/3rd of the width of the vertebral body at C6 is highly suggestive of retropharyngeal abscess. It may also demonstrate foreign bodies, subcutaneous air, air fluid levels and erosion of vertebrae. b. Ultrasound neck can suggest abscess and guide aspiration attempts. 2. Blood: Total and differential leukocyte count, blood sugar, urea 3. Abscess Cultures with Gram stain to direct antimicrobial therapy. Anaerobic culture, when available. QUALITY ASSESSMENT PARAMETERS FOLLOW UP SERVICES Complete resolution of infection and follow up to ensure no recurrence; treatment of initial cause of infection in tooth or tonsil. | 744 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952350_ent_neck_space_infection.pdf | QUALITY ASSESSMENT PARAMETERS FOLLOW UP SERVICES Complete resolution of infection and follow up to ensure no recurrence; treatment of initial cause of infection in tooth or tonsil. |
| How does a tubercular cold abscess differ from other deep neck space infections? | would not display inflammatory signs or rapid progression | They usually present as • Ludwig’s angina (submandibular space infection) • Peritonsillar abscess • Parapharyngeal abscess • Retropharyngeal abscess The typical presentation is with acute onset of pain and swelling in the neck with fever, malaise, trismus and dysphagia. Extension along spaces to involve multiple deep neck spaces is frequent and may extend to parotid space, masticator space, temporal space, visceral vascular (carotid) space. Cervical space infection may spread inferiorly to the anterior mediastinum and posteriorly along prevertebral space. Tubercular cold abscess involves the same anatomical spaces but would not display inflammatory signs or rapid progression. | 626 | comparison | 0.920 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952350_ent_neck_space_infection.pdf | Tubercular cold abscess involves the same anatomical spaces but would not display inflammatory signs or rapid progression. | 1 | page=1,block=7 | 0.700 | valid |
| How does the disease course differ in immunocompromised patients with deep neck space infections? | Signs of inflammation may be less marked and disease course may be more rapidly progressive | Screen for diabetes mellitus, HIV infection, agranulocytosis and immunosuppressive therapy or chemotherapy. Signs of inflammation may be less marked and disease course may be more rapidly progressive in immunocompromised patients. | 108 | comparison | 0.920 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952350_ent_neck_space_infection.pdf | Screen for diabetes mellitus, HIV infection, agranulocytosis and immunosuppressive therapy or chemotherapy. Signs of inflammation may be less marked and disease course may be more rapidly progressive in immunocompromised patients. | 1 | page=1,block=17 | 0.700 | valid |
| What complication involves the spread of infection to the chest cavity? | Mediastinal spread | • Necrotizing fibrofascitis • Abscess formation • No response to antibiotics over 48-72 hours • Deterioration despite antibiotics over 24 hours • Airway compromise or impending airway compromise • Mediastinal spread • Vascular complication like venous thrombosis | 197 | relationship | 0.890 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952350_ent_neck_space_infection.pdf | • Necrotizing fibrofascitis • Abscess formation • No response to antibiotics over 48-72 hours • Deterioration despite antibiotics over 24 hours • Airway compromise or impending airway compromise • Mediastinal spread • Vascular complication like venous thrombosis | 1 | page=1,block=37 | 0.700 | valid |
| What are some common presentations of deep neck space infections? | Ludwig’s angina (submandibular space infection) • Peritonsillar abscess • Parapharyngeal abscess • Retropharyngeal abscess | They usually present as • Ludwig’s angina (submandibular space infection) • Peritonsillar abscess • Parapharyngeal abscess • Retropharyngeal abscess The typical presentation is with acute onset of pain and swelling in the neck with fever, malaise, trismus and dysphagia. Extension along spaces to involve multiple deep neck spaces is frequent and may extend to parotid space, masticator space, temporal space, visceral vascular (carotid) space. Cervical space infection may spread inferiorly to the anterior mediastinum and posteriorly along prevertebral space. Tubercular cold abscess involves the same anatomical spaces but would not display inflammatory signs or rapid progression. | 26 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952350_ent_neck_space_infection.pdf | They usually present as • Ludwig’s angina (submandibular space infection) • Peritonsillar abscess • Parapharyngeal abscess • Retropharyngeal abscess The typical presentation is with acute onset of pain and swelling in the neck with fever, malaise, trismus and dysphagia. | 1 |
| What can a lateral x-ray neck demonstrate in addition to retropharyngeal abscess? | foreign bodies, subcutaneous air, air fluid levels and erosion of vertebrae | 1. Contrast enhanced CT scan of head and neck is the standard in evaluation of neck space infections. If CT Scan facility is not available, following should be done:- a. Lateral x-ray neck: Prevertebral soft tissue thickening >7 mm at the level of C2 or > 2/3rd of the width of the vertebral body at C6 is highly suggestive of retropharyngeal abscess. It may also demonstrate foreign bodies, subcutaneous air, air fluid levels and erosion of vertebrae. b. Ultrasound neck can suggest abscess and guide aspiration attempts. 2. Blood: Total and differential leukocyte count, blood sugar, urea 3. Abscess Cultures with Gram stain to direct antimicrobial therapy. Anaerobic culture, when available. QUALITY ASSESSMENT PARAMETERS FOLLOW UP SERVICES Complete resolution of infection and follow up to ensure no recurrence; treatment of initial cause of infection in tooth or tonsil. | 376 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952350_ent_neck_space_infection.pdf | It may also demonstrate foreign bodies, subcutaneous air, air fluid levels and erosion of vertebrae. | 1 |
| What combination of antibiotics is preferred for aggressive IV therapy in progressive neck infections? | Crystalline Penicillin, Aminoglycoside and Metronidazole or Clindamycin | DISTRICT HOSPITAL PHC/PRIMARY LEVEL 1. Hospitalization: As an emergency for close watch and intensive management. 2. Airway management: In progressive disease, in view of impending airway compromise, consider securing the airway early. During acute respiratory difficulty, tracheostomy should be done if intubation is difficult 3. Correction of fluid and electrolyte imbalance 4. Antibiotics: Early and aggressive IV antibiotic therapy with a combination of Crystalline Penicillin, Aminoglycoside and Metronidazole or Clindamycin is preferred. 5. Incision and drainage: Peritonsillar abscess is drained intraorally. All other abscesses are drained via an external approach 1. Cautiously assess the airway. If found compromised, do endotracheal intubation/ consider tracheotomy 2. Immediately gain an IV access for hydration, broad spectrum antibiotics and pain killers. 3. | 458 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952350_ent_neck_space_infection.pdf | Antibiotics: Early and aggressive IV antibiotic therapy with a combination of Crystalline Penicillin, Aminoglycoside and Metronidazole or Clindamycin is preferred. |
| What conditions should be screened for in patients with deep neck space infections? | diabetes mellitus, HIV infection, agranulocytosis and immunosuppressive therapy or chemotherapy | Screen for diabetes mellitus, HIV infection, agranulocytosis and immunosuppressive therapy or chemotherapy. Signs of inflammation may be less marked and disease course may be more rapidly progressive in immunocompromised patients. | 11 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952350_ent_neck_space_infection.pdf | Screen for diabetes mellitus, HIV infection, agranulocytosis and immunosuppressive therapy or chemotherapy. | 1 | page=1,block=17 | 0.700 | valid |