Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes, middle ear, or sinuses. These deep cervical space infections have become relatively uncommon in the postantibiotic era. Consequently, many clinicians are unfamiliar with these conditions. In addition, with widespread use of antibiotics and/or profound immunosuppression, the classic manifestations of these infections, such as high fever, systemic toxicity, and local signs of erythema, edema, and fluctuance, may be absent.
Deep neck space infections often have a rapid onset and can progress to life-threatening complications . Thus, clinicians must be aware of such infections and should not underestimate their potential extent or severity.
The relevant anatomy, microbial etiology, clinical manifestations, diagnosis, and treatment of deep neck space infections will be reviewed here. Peritonsillar abscesses and submandibular space infections (Ludwig's angina), suppurative parotitis, and odontogenic, middle ear, and sinus infections are discussed in detail separately. (See "Peritonsillar cellulitis and abscess" and "Submandibular space infections (Ludwig's angina)" and "Suppurative parotitis in adults" and "Epidemiology, pathogenesis, and clinical manifestations of odontogenic infections" and "Acute otitis media in children: Epidemiology, microbiology, clinical manifestations, and complications" and "Acute otitis media in adults (suppurative and serous)" and "Acute sinusitis and rhinosinusitis in adults: Clinical manifestations and diagnosis" and "Acute sinusitis and rhinosinusitis in adults: Treatment".)
Knowledge of the cervical compartments and interfascial spaces is essential for understanding the pathogenesis, clinical manifestations, and potential routes of spread of infections involving these spaces.
Cervical fascia — The muscles, vessels, and visceral structures of the neck are enveloped by the cervical fascia, which has a superficial and deep component (figure 1 and figure 2). The superficial cervical fascia consists of the subcutaneous tissues of the neck, which completely enclose the head and neck and is continuous with the platysma anteriorly.