Current knowledge and interdisciplinary approach to deep neck infections

Dear Editor,

We would like to contribute to the discussion on the diagnosis and management of deep neck infections, the central topic of this issue of Otorinolaryngologie a foniatrie.

Deep neck infections are acute, potentially life-threatening conditions requiring prompt diagnosis and multidisciplinary care. They involve inflammatory processes –⁠ phlegmons or abscesses –within cervical fascial spaces, with possible mediastinal extension and then mortality rates of 20–50%.

The etiology is predominantly odontogenic, with pharyngeal or tonsillar origins less common. These infections are usually polymicrobial, involving both aerobic (e. g., Streptococcus pyogenes, Staphylococcus aureus, Haemophilus influenzae) and anaerobic bacteria (Bacteroides, Prevotella, Fusobacterium spp.).

Diagnosis relies on clinical assessment, laboratory tests, and imaging. Relevant history includes recent dental infections, pharyngeal inflammation, or risk factors such as diabetes, poor oral hygiene, renal insufficiency, and low socioeconomic status. Common symptoms are fever, odynophagia, swelling, trismus, and antalgic head posture. Evaluation must include airway and hemodynamic stability. Laboratory findings typically show leukocytosis and elevated CRP or procalcitonin; blood cultures are recommended in febrile cases. Microbiological sampling of abscess or phlegmon material is essential. Contrast-enhanced CT from the skull base to the diaphragm is the imaging method of choice; MRI is reserved for patients with contraindications to CT. Differential diag -⁠ nosis includes odontogenic infections, peritonsillar abscess, and, rarely, neoplasms or vascular lesions.

Empiric antibiotic therapy should begin immediately at maximum dosage, with subsequent adjustment based on microbiological results and clinical response. The choice of therapy should follow established recommendations (Tab. 1), and treatment usually continues for 2–3 weeks depending on clinical progress.

Surgical drainage is indicated for abscesses or progressive phlegmons unresponsive to conservative therapy within 48 hours, combined with elimination of the primary focus. In cases where the airway is compromised, early intubation or tracheostomy is required. Intensive monitoring, sepsis management, and control of metabolic balance are essential supportive measures.

Effective management depends on close interdisciplinary collaboration among otorhinolaryngologists, anesthesiologists, thoracic and maxillofacial surgeons, microbiologists, and infectious disease specialists. Despite advances in diagnosis and treatment, early recognition and coordinated care remain critical to improving outcomes.

Sincerely,

Assoc. Prof. David Slouka, MD, PhD, MBA

invited editor

Conflict of interest statement

The author declares that, in connection with the topic, creation, and publication of this article, there is no conflict of interest, and neither the creation nor the publication of the article was supported by any pharmaceutical company.