DOCSLIB.ORG

Acute Neck Infections Blair A

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Acute Neck Infections Blair A Acute Neck Infections Blair A. Winegar1, Wayne S. Kubal2 We present an overview of the imaging of acute neck infections mucosal space and may spread to the deep spaces of the neck if with a focus on contrast-enhanced CT. The emphasis of this chap- not appropriately treated. Infections that involve the pharyngeal ter is to enable the emergency radiologist to accurately diagnose mucosal space include pharyngitis, tonsillitis, peritonsillar ab- neck infections, to effectively communicate imaging findings with scess, and epiglottis. emergency physicians, and to function as part of a team offering In patients with acute tonsillitis, the affected tonsillar tissue is the best care to patients. enlarged and enhances after contrast material administration. The tonsils may display a striated enhancement pattern (tiger-stripe Patients with many types of head and neck infections may pres- appearance), reflecting inflamed enhancing mucosa with underly- ent in the emergency department. The causes of these disorders ing edematous submucosa. Uvulitis, enlargement and inflamma- include dental infection, penetrating trauma, and upper respiratory tion involving the uvula may be an associated finding (Fig. 2A). infections. Neck infections continue to portend significant morbid- Uncomplicated tonsillitis will not have a localized region of in- ity and mortality despite widespread access to antibiotics. Poten- ternal hypoattenuation. As the infection progresses, an ill-defined tially life-threatening complications may occur in approximately region of hypoattenuation without a well-defined enhancing wall 10–20% of acute neck infections, including airway obstruction, representing cellulitis or phlegmon may develop within the tonsil. septic thrombophlebitis with septic emboli, arterial pseudoaneu- This process may continue to evolve to abscess formation, defined rysm, and mediastinitis [1]. As more and more patients use emer- by a low-density collection with attenuation similar to CSF sur- gency departments for initial healthcare, emergency department rounded by an enhancing wall. These abscesses may uncommonly physicians will increasingly encounter acute neoplastic and non- remain within the tonsillar tissue, a true intratonsillar abscess. The neoplastic conditions in the head and neck [2]. In this setting, CT majority of these abscesses will penetrate the fibrous capsule of is the preferred imaging modality [2]. the tonsil to involve the potential space located between the supe- Although acute neck infections are easily diagnosed by clini- rior constrictor muscle and tonsillar capsule, termed a peritonsillar cal examination, correct localization may be problematic without abscess [2] (Fig. 2B). cross-sectional imaging. The extent of deep space involvement is Because treatment of peritonsillar abscess differs from acute particularly difficult to detect by clinical evaluation, with accu- tonsillitis and cellulitis or phlegmon, accurate characterization rate localization of infection in only 42.9% of cases in one series is paramount. The detection of a peritonsillar abscess requires [3]. In another series, the extent of deep neck space infection was incision and drainage or aspiration of the drainable fluid collec- underestimated in 70% of cases [4]. The anatomy of the cervical tion in addition to antibiotic therapy. Clinical assessment has low fascia affects the presentation, spread, and management of neck specificity for differentiating tonsillar cellulitis from peritonsillar infection [5]. Therefore, radiologists must be familiar with the abscess. Even when strict imaging criteria are applied, accurate anatomy of the deep cervical fascia and the spaces bounded by detection of drainable fluid collections on contrast-enhanced CT these fascial planes. Because the layers of the deep cervical fascia ranges from 63% to 77% in both adult and pediatric populations are not well seen on contrast-enhanced CT, knowledge of their [7, 8]. An irregular or scalloped morphology of the enhancing wall normal internal contents and expected boundaries is critical [6]. of a fluid collection increases the specificity for abscess and sug- gests a more mature abscess [9] (Fig. 2C). The Pharyngeal Mucosal Space Epiglottitis and supraglottitis are inflammation of the epiglot- The pharyngeal mucosal space is bounded by the middle layer tis and adjacent supraglottic larynx, respectively, that is typically of the deep cervical fascia and contains the mucosa of the upper caused by bacteria. Historically, this condition was more frequent aerodigestive tract and lymphoid tissue of the Waldeyer ring, in- in children infected with Haemophilus influenzae type b (HIB). cluding the palatine tonsils, lingual tonsils, and adenoids (Fig. 1). However, since widespread childhood vaccination to HIB was Upper aerodigestive tract infections begin within the pharyngeal introduced in the 1990s, acute epiglottitis is now more frequent 1Both authors: Department of Medical Imaging, University of Arizona, 1501 Campbell Ave, PO Box 245067, Tucson, AZ 85724. Address correspondence to W. S. Kubal ([email protected]). Imaging in the ED 61 Winegar and Kubal in adults and is caused by a variety of bac- compromise, and hoarseness. Definitive Historically, lateral radiographs have terial pathogens, including Streptococcus diagnosis is made by direct visualization, been used as a first-line imaging modal- species and Staphylococcus aureus [10]. which may require laryngoscopy. Treat- ity for the detection of epiglottitis. Find- Symptoms include sore throat, fever, muf- ment includes maintaining a patent airway, ings include thickening of the epiglottis fled voice, drooling, stridor or respiratory corticosteroids, and IV antibiotics. (“thumb” sign), obliteration of the val- leculae (“vallecula” sign), thickening of the aryepiglottic folds, and dilatation of the hypopharynx. Contrast-enhanced CT is useful in diagnosis of epiglottis when direct visualization is not feasible. CT can differentiate epiglottitis from other causes of fever and sore throat (e.g., tonsillar ab- scess, retropharyngeal abscess) and allows characterization of complicating features (e.g., abscess formation, soft-tissue gas, airway compromise). The CT findings of epiglottitis include swelling of the epiglot- tis and supraglottic structures (e.g., aryepi- glottic folds, false vocal cords), inflamma- tory stranding of the preepiglottic fat, and thickening of the platysma and preverte- bral fascia (Fig. 3) [11]. The Retropharyngeal Space A B The retropharyngeal space is a small Fig. 1—Spaces of neck. (Reprinted from Radiol Clin North Am Vol. 53, Kubal WS, Face and neck space containing predominantly fat situ- infections: what the emergency radiologist needs to know, 827–846, Copyright 2015, with permission from Elsevier) ated between the posterior aspect of the A, Axial contrast-enhanced CT image shows pharyngeal mucosal space (yellow), retropharyngeal pharyngeal mucosal space and cervical space (orange), masticator space (light green), parotid space (magenta), parapharyngeal space (red), esophagus and anterior to the preverte- and carotid space (light blue). B, Axial contrast-enhanced CT image caudal to A shows two additional spaces: sublingual space bral musculature (Fig. 1). The suprahyoid (dark blue) and submandibular space (dark green). retropharyngeal space contains medial A B C Fig. 2—Axial contrast-enhanced CT images in three different patients show infections within pharyngeal mucosal space. (Reprinted from Radiol Clin North Am Vol. 53, Kubal WS, Face and neck infections: what the emergency radiologist needs to know, 827–846, Copyright 2015, with permission from Elsevier) A, Tonsils are enlarged and show increased enhancement bilaterally (black arrows). Enhancement pattern is striated (resembling tiger stripes). Uvula appears enlarged and edematous (white arrow). These findings are compatible with acute tonsillitis. B, Area of decreased density with enhancing rim involving left tonsil (arrow) is seen in this patient. This finding is compatible with peritonsillar abscess. C, Area of decreased density is seen with enhancing, scalloped rim involving left tonsil (arrow) is seen in this patient. This finding is compatible with abscess seen in B. 62 Imaging in the ED Acute Neck Infections and lateral retropharyngeal lymph nodes, walls from the increased internal pressure. sible for inciting the inflammation (Fig. 5). which are more prominent in children These findings contrast those of suppura- Differentiation of calcific tendinitis of the less than 6 years old [12]. The retropha- tive retropharyngeal lymphadenitis, typi- longus colli muscle from retropharyngeal ryngeal space has a bowtie configuration cally encountered in the pediatric popu- abscess is essential, because treatment of with variable presence of a median raphe, lation, which are focal, rim-enhancing the tendonitis is nonsurgical with nonste- more often superiorly, which may confine fluid collections along the lateral margins roidal antiinflammatory medications. disease to half of the space. The retropha- of the suprahyoid retropharyngeal space. ryngeal space extends from the clivus to Retropharyngeal abscesses require surgi- The Masticator Space terminate between the T1 and T6 verte- cal drainage. Patients with suppurative The masticator space includes the mus- bral levels. The danger space is a poten- retropharyngeal lymphadenitis typically cles of mastication and portions of the ad- tial space located posterior to the retro- receive a trial of IV antibiotics
Load more

Recommended publications
  • Te2, Part Iii
    TERMINOLOGIA EMBRYOLOGICA Second Edition International Embryological Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TE2, PART III Contents Caput V: Organogenesis Chapter 5: Organogenesis (continued) Systema respiratorium Respiratory system Systema urinarium Urinary system Systemata genitalia Genital systems Coeloma Coelom Glandulae endocrinae Endocrine glands Systema cardiovasculare Cardiovascular system Systema lymphoideum Lymphoid system Bibliographic Reference Citation: FIPAT. Terminologia Embryologica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, February 2017 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Embryologica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: ORGANOGENESIS Chapter 5: ORGANOGENESIS
    [Show full text]
  • Clinical Features of Acute Epiglottitis in Adults in the Emergency Department
    대한응급의학회지 제 27 권 제 1 호 � 원저� Volume 27, Number 1, February, 2016 Eye, Ear, Nose & Oral Clinical Features of Acute Epiglottitis in Adults in the Emergency Department Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do1, Korea Kyoung Min You, M.D., Woon Yong Kwon, M.D., Gil Joon Suh, M.D., Kyung Su Kim, M.D., Jae Seong Kim, M.D.1, Min Ji Park, M.D. Purpose: Acute epiglottitis is a potentially fatal condition Key Words: Epiglottitis, Emergency medical services, Fever, that can result in airway obstruction. The aim of this study is Intratracheal Intubation to examine the clinical features of adult patients who visited the emergency department (ED) with acute epiglottitis. Methods: This retrospective observational study was con- Article Summary ducted at a single tertiary hospital ED from November 2005 What is already known in the previous study to October 2015. We searched our electronic medical While the incidence of acute epiglottitis in children has records (EMR) system for a diagnosis of “acute epiglottitis” shown a marked decrease as a result of vaccination for and selected those patients who visited the ED. Haemophilus influenzae type b, the incidence of acute Results: A total of 28 patients were included. There was no epiglottitis in adults has increased. However, in Korea, few pediatric case with acute epiglottitis during the study period. studies concerning adult patients with acute epiglottitis The mean age of the patients was 58.0±14.8 years. The who present to the emergency department (ED) have been peak incidences were in the sixth (n=7, 25.0%) and eighth reported.
    [Show full text]
  • The Surgical Plane for Lingual Tonsillectomy: an Anatomic Study Eugene L
    Son et al. Journal of Otolaryngology - Head and Neck Surgery (2016) 45:22 DOI 10.1186/s40463-016-0137-3 ORIGINAL RESEARCH ARTICLE Open Access The surgical plane for lingual tonsillectomy: an anatomic study Eugene L. Son1*, Michael P. Underbrink1, Suimin Qiu2 and Vicente A. Resto1 Abstract Background: The presence of a plane between the lingual tonsils and the underlying soft tissue has not been confirmed. The objective of this study is to ascertain the presence and the characteristics about this plane for surgical use. Methods: Five cadaver heads were obtained for dissection of the lingual tonsils. Six permanent sections of previous tongue base biopsies were reviewed. Robot assisted lingual tonsillectomy was performed using the dissection technique from the cadaver dissection. Results: In each of the 5 cadavers, an avascular plane was revealed deep to the lingual tonsils. Microscopic review of the tongue base biopsies revealed a clear demarcation between the lingual tonsils and the underlying minor salivary glands and muscle tissue. This area was relatively avascular. Using the technique described above, a lingual tonsillectomy using TORS was performed with similar findings from the cadaver dissections. Conclusions: A surgical plane for lingual tonsillectomy exists and may prove to have a role with lingual tonsillectomy with TORS. Keywords: Lingual tonsil, Surgical plane, Transoral robotic surgery, Lingual tonsillectomy Background There has been an increase in the incidence of human The base of tongue had once been a difficult area for papilloma virus (HPV) related oropharyngeal squamous surgery to perform on because of problems with expos- cell carcinoma [3]. A large of number of SCCUP with ure.
    [Show full text]
  • FOCUSED PRACTICE in HOSPITAL MEDICINE Maintenance of Certification (MOC) Examination Blueprint
    ® FOCUSED PRACTICE IN HOSPITAL MEDICINE Maintenance of Certification (MOC) Examination Blueprint ABIM invites diplomates to help develop the Purpose of the Hospital Medicine MOC exam Hospital Medicine MOC exam blueprint The MOC exam is designed to evaluate the knowledge, Based on feedback from physicians that MOC assessments diagnostic reasoning, and clinical judgment skills expected of should better reflect what they see in practice, in 2016 the the certified hospitalist in the broad domain of the discipline. American Board of Internal Medicine (ABIM) invited all certified The exam emphasizes diagnosis and management of prevalent hospitalists and those enrolled in the focused practice program conditions, particularly in areas where practice has changed to provide ratings of the relative frequency and importance of in recent years. As a result of the blueprint review by ABIM blueprint topics in practice. diplomates, the MOC exam places less emphasis on rare This review process, which resulted in a new MOC exam conditions and focuses more on situations in which physician blueprint, will be used on an ongoing basis to inform and intervention can have important consequences for patients. update all MOC assessments created by ABIM. No matter For conditions that are usually managed by other specialists, what form ABIM’s assessments ultimately take, they will need the focus is on recognition rather than on management. The to be informed by front-line clinicians sharing their perspective exam is developed jointly by the ABIM and the American on what is important to know. Board of Family Medicine. A sample of over 100 hospitalists, similar to the total invited Exam format population of hospitalists in age, gender, geographic region, and time spent in direct patient care, provided the blueprint The traditional 10-year MOC exam is composed of 220 single- topic ratings.
    [Show full text]
  • Retropharyngeal Cellulitis in a 5-Week-Old Infant
    Retropharyngeal Cellulitis in a 5-Week-Old Infant Florence T. Bourgeois, MD*, and Michael W. Shannon, MD, MPH‡ ABSTRACT. An infant who presents with acute, unex- abnormalities. An abdominal radiograph was also unremarkable. plained crying requires a thorough examination to iden- Initial laboratory studies revealed a leukocyte count of 3900/mm3 tify the source of distress. We report the case of a 5-week- (12% band forms, 28% segmented neutrophils, 4% monocytes, 49% old infant who had sudden irritability and was found to lymphocytes, 1% eosinophils), a hematocrit of 37%, and a platelet count of 299 000/mm3. Urinalysis was negative. have retropharyngeal cellulitis caused by group B The infant continued to be extremely irritable and refused all Streptococcus. Pediatrics 2002;109(3). URL: http://www. feeds. He could be comforted intermittently, but any repositioning pediatrics.org/cgi/content/full/109/3/e51; group B Strepto- distressed him. Because of the sudden onset of the child’s symp- coccus, retropharyngeal cellulitis, infant, irritability. toms and his unwillingness to be moved, the question of acute injury was raised and a skeletal survey was performed. While obtaining the radiographs, it was noted that the child would calm ABBREVIATION. GBS, group B streptococcal. down when his neck was positioned in hyperextension. Lateral cervical spine films showed prominence of the prevertebral soft tissues, and a fluoroscopic assessment of the airway demonstrated rying is an infant’s principle form of commu- retropharyngeal soft tissue swelling, which persisted with the nication. Usually an infant’s source of distress neck in both flexed and extended positions. The remainder of the can be identified easily, and the child can be skeletal survey was negative.
    [Show full text]
  • Table of Contents
    viii Contents Chapter 1. Taking the Certification Examination . 1 General Suggestions for Preparing for the Exam About the Certification Exams Chapter 2. Developmental and Behavioral Sciences . 11 Mary Jo Gilmer, PhD, MBA, RN-BC, FAAN, and Paula Chiplis, PhD, RN, CPNP Psychosocial, Cognitive, and Ethical-Moral Development Behavior Modification Physical Development: Normal Growth Expectations and Developmental Milestones Family Concepts and Issues Family-Centered Care Cultural and Spiritual Diversity Chapter 3. Communication . 23 Mary Jo Gilmer, PhD, MBA, RN-BC, FAAN, and Karen Corlett, MSN, RN-BC, CPNP-AC/PC, PNP-BC Culturally Sensitive Communication Components of Therapeutic Communication Communication Barriers Modes of Communication Patient Confidentiality Written Communication in Nursing Practice Professional Communication Advocacy Chapter 4. The Nursing Process . 33 Clara J. Richardson, MSN, RN–BC Nursing Assessment Nursing Diagnosis and Treatment Chapter 5. Basic and Applied Sciences . 49 Mary Jo Gilmer, PhD, MBA, RN-BC, FAAN, and Paula Chiplis, PhD, RN, CPNP Trauma and Diseases Processes Common Genetic Disorders Common Childhood Diseases Traction Pharmacology Nutrition Chemistry Clinical Signs Associated With Isotonic Dehydration in Infants ix Chapter 6. Educational Principles and Strategies . 69 Mary Jo Gilmer, PhD, MBA, RN-BC, FAAN, and Karen Corlett, MSN, RN-BC, CPNP-AC/PC, PNP-BC Patient Education Chapter 7. Life Situations and Adaptive and Maladaptive Responses . 75 Mary Jo Gilmer, PhD, MBA, RN-BC, FAAN, and Karen Corlett, MSN, RN-BC, CPNP-AC/PC, PNP-BC Palliative Care End-of-Life Care Response to Crisis Chapter 8. Sensory Disorders . 87 Clara J. Richardson, MSN, RN–BC Developmental Characteristics of the Pediatric Sensory System Hearing Disorders Vision Disorders Conjunctivitis Otitis Media and Otitis Externa Retinoblastoma Trauma to the Eye Chapter 9.
    [Show full text]
  • Care Process Models Streptococcal Pharyngitis
    Care Process Model MONTH MARCH 20152019 DEVELOPMENTDIAGNOSIS AND AND MANAGEMENT DESIGN OF OF CareStreptococcal Process Models Pharyngitis 20192015 Update This care process model (CPM) was developed by Intermountain Healthcare’s Antibiotic Stewardship team, Medical Speciality Clinical Program,Community-Based Care, and Intermountain Pediatrics. Based on expert opinion and the Infectious Disease Society of America (IDSA) Clinical Practice Guidelines, it provides best-practice recommendations for diagnosis and management of group A streptococcal pharyngitis (strep) including the appropriate use of antibiotics. WHAT’S INSIDE? KEY POINTS ALGORITHM 1: DIAGNOSIS AND TREATMENT OF PEDIATRIC • Accurate diagnosis and appropriate treatment can prevent serious STREPTOCOCCAL PHARYNGITIS complications . When strep is present, appropriate antibiotics can prevent AGES 3 – 18 . 2 SHU acute rheumatic fever, peritonsillar abscess, and other invasive infections. ALGORITHM 2: DIAGNOSIS Treatment also decreases spread of infection and improves clinical AND TREATMENT OF ADULT symptoms and signs for the patient. STREPTOCOCCAL PHARYNGITIS . 4 • Differentiating between a patient with an active strep infection PHARYNGEAL CARRIERS . 6 and a patient who is a strep carrier with an active viral pharyngitis RESOURCES AND REFERENCES . 7 is challenging . Treating patients for active strep infection when they are only carriers can result in overuse of antibiotics. Approximately 20% of asymptomatic school-aged children may be strep carriers, and a throat culture during a viral illness may yield positive results, but not require antibiotic treatment. SHU Prescribing repeat antibiotics will not help these patients and can MEASUREMENT & GOALS contribute to antibiotic resistance. • Ensure appropriate use of throat • For adult patients, routine overnight cultures after a negative rapid culture for adult patients who meet high risk criteria strep test are unnecessary in usual circumstances because the risk for acute rheumatic fever is exceptionally low.
    [Show full text]
  • Risk of Acute Epiglottitis in Patients with Preexisting Diabetes Mellitus: a Population- Based Case–Control Study
    RESEARCH ARTICLE Risk of acute epiglottitis in patients with preexisting diabetes mellitus: A population- based case±control study Yao-Te Tsai1,2, Ethan I. Huang1,2, Geng-He Chang1,2, Ming-Shao Tsai1,2, Cheng- Ming Hsu1,2, Yao-Hsu Yang3,4,5, Meng-Hung Lin6, Chia-Yen Liu6, Hsueh-Yu Li7* 1 Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan, 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan, 3 Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, 4 Institute of Occupational Medicine and a1111111111 Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan, 5 School of a1111111111 Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, 6 Health a1111111111 Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan, 7 Department of a1111111111 Otolaryngology±Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan a1111111111 * [email protected] Abstract OPEN ACCESS Citation: Tsai Y-T, Huang EI, Chang G-H, Tsai M-S, Hsu C-M, Yang Y-H, et al. (2018) Risk of acute Objective epiglottitis in patients with preexisting diabetes Studies have revealed that 3.5%±26.6% of patients with epiglottitis have comorbid diabetes mellitus: A population-based case±control study. PLoS ONE 13(6): e0199036. https://doi.org/ mellitus (DM). However, whether preexisting DM is a risk factor for acute epiglottitis remains 10.1371/journal.pone.0199036 unclear. In this study, our aim was to explore the relationship between preexisting DM and Editor: Yu Ru Kou, National Yang-Ming University, acute epiglottitis in different age and sex groups by using population-based data in Taiwan.
    [Show full text]
  • 3 Approach-Related Complications Following Anterior Cervical Spine Surgery: Dysphagia, Dysphonia, and Esophageal Perforations
    3 Approach-Related Complications Following Anterior Cervical Spine Surgery: Dysphagia, Dysphonia, and Esophageal Perforations Bharat R. Dave, D. Devanand, and Gautam Zaveri Introduction This chapter analyzes the problems of dysphagia, dysphonia, and esophageal tears during the Pathology involving the anterior subaxial anterior approach to the cervical spine and cervical spine is most commonly accessed suggests ways of prevention and management. through an anterior retropharyngeal approach (Fig. 3.1). While this approach uses tissue planes to access the anterior cervical spine, visceral Dysphagia structures such as the trachea and esophagus and nerves such as the recurrent laryngeal Dysphagia or difficulty in swallowing is a nerve (RLN), superior laryngeal nerve (SLN), and symptom indicative of impairment in the ability pharyngeal plexus are vulnerable to direct or to swallow because of neurologic or structural traction injury (Table 3.1). Complaints such as problems that alter the normal swallowing dysphagia and dysphonia are not rare following process. Postoperative dysphagia is labeled as anterior cervical spine surgery. The treating acute if the patient presents with difficulty in surgeon must be aware of these possible swallowing within 1 week following surgery, complications, must actively look for them in intermediate if the presentation is within 1 to the postoperative period, and deal with them 6 weeks, and chronic if the presentation is longer expeditiously to avoid secondary complications. than 6 weeks after surgery. Common carotid artery Platysma muscle Sternohyoid muscle Vagus nerve Recurrent laryngeal nerve Longus colli muscle Internal jugular artery Anterior scalene muscle Middle scalene muscle External jugular vein Posterior scalene muscle Fig. 3.1 Anterior retropharyngeal approach to the cervical spine.
    [Show full text]
  • Head & Neck Surgery Course
    Head & Neck Surgery Course Parapharyngeal space: surgical anatomy Dr Pierfrancesco PELLICCIA Pr Benjamin LALLEMANT Service ORL et CMF CHU de Nîmes CH de Arles Introduction • Potential deep neck space • Shaped as an inverted pyramid • Base of the pyramid: skull base • Apex of the pyramid: greater cornu of the hyoid bone Introduction • 2 compartments – Prestyloid – Poststyloid Anatomy: boundaries • Superior: small portion of temporal bone • Inferior: junction of the posterior belly of the digastric and the hyoid bone Anatomy: boundaries Anatomy: boundaries • Posterior: deep fascia and paravertebral muscle • Anterior: pterygomandibular raphe and medial pterygoid muscle fascia Anatomy: boundaries • Medial: pharynx (pharyngobasilar fascia, pharyngeal wall, buccopharyngeal fascia) • Lateral: superficial layer of deep fascia • Medial pterygoid muscle fascia • Mandibular ramus • Retromandibular portion of the deep lobe of the parotid gland • Posterior belly of digastric muscle • 2 ligaments – Sphenomandibular ligament – Stylomandibular ligament Aponeurosis and ligaments Aponeurosis and ligaments • Stylopharyngeal aponeurosis: separates parapharyngeal spaces to two compartments: – Prestyloid – Poststyloid • Cloison sagittale: separates parapharyngeal and retropharyngeal space Aponeurosis and ligaments Stylopharyngeal aponeurosis Muscles stylohyoidien Stylopharyngeal , And styloglossus muscles Prestyloid compartment Contents: – Retromandibular portion of the deep lobe of the parotid gland – Minor or ectopic salivary gland – CN V branch to tensor
    [Show full text]
  • Injection Into the Longus Colli Muscle Via the Thyroid Gland
    Freely available online Case Reports Injection into the Longus Colli Muscle via the Thyroid Gland Małgorzata Tyślerowicz1* & Wolfgang H. Jost2 1Department of Neurophysiology, Copernicus Memorial Hospital, Łódź, PL, 2Parkinson-Klinik Ortenau, Wolfach, DE Abstract Background: Anterior forms of cervical dystonia are considered to be the most difficult to treat because of the deep cervical muscles that can be involved. Case Report: We report the case of a woman with cervical dystonia who presented with anterior sagittal shift, which required injections through the longus colli muscle to obtain a satisfactory outcome. The approach via the thyroid gland was chosen. Discussion: The longus colli muscle can be injected under electromyography (EMG), computed tomography (CT), ultrasonography (US), or endoscopy guidance. We recommend using both ultrasonography and electromyography guidance as excellent complementary techniques for injection at the C5-C6 level. Keywords: Anterior sagittal shift, longus colli, thyroid gland, sonography, electromyography Citation: Tyślerowicz M, Jost WH. Injection into the longus colli muscle via the thyroid gland. Tremor Other Hyperkinet Mov. 2019; 9. doi: 10.7916/tohm.v0.718 *To whom correspondence should be addressed. E-mail: [email protected] Editor: Elan D. Louis, Yale University, USA Received: August 13, 2019; Accepted: October 24, 2019; Published: December 6, 2019 Copyright: © 2019 Tyślerowicz and Jost. This is an open-access article distributed under the terms of the Creative Commons Attribution–Noncommercial–No Derivatives License, which permits the user to copy, distribute, and transmit the work provided that the original authors and source are credited; that no commercial use is made of the work; and that the work is not altered or transformed.
    [Show full text]
  • Deep Neck Infections 55
    Deep Neck Infections 55 Behrad B. Aynehchi Gady Har-El Deep neck space infections (DNSIs) are a relatively penetrating trauma, surgical instrument trauma, spread infrequent entity in the postpenicillin era. Their occur- from superfi cial infections, necrotic malignant nodes, rence, however, poses considerable challenges in diagnosis mastoiditis with resultant Bezold abscess, and unknown and treatment and they may result in potentially serious causes (3–5). In inner cities, where intravenous drug or even fatal complications in the absence of timely rec- abuse (IVDA) is more common, there is a higher preva- ognition. The advent of antibiotics has led to a continu- lence of infections of the jugular vein and carotid sheath ing evolution in etiology, presentation, clinical course, and from contaminated needles (6–8). The emerging practice antimicrobial resistance patterns. These trends combined of “shotgunning” crack cocaine has been associated with with the complex anatomy of the head and neck under- retropharyngeal abscesses as well (9). These purulent col- score the importance of clinical suspicion and thorough lections from direct inoculation, however, seem to have a diagnostic evaluation. Proper management of a recog- more benign clinical course compared to those spreading nized DNSI begins with securing the airway. Despite recent from infl amed tissue (10). Congenital anomalies includ- advances in imaging and conservative medical manage- ing thyroglossal duct cysts and branchial cleft anomalies ment, surgical drainage remains a mainstay in the treat- must also be considered, particularly in cases where no ment in many cases. apparent source can be readily identifi ed. Regardless of the etiology, infection and infl ammation can spread through- Q1 ETIOLOGY out the various regions via arteries, veins, lymphatics, or direct extension along fascial planes.
    [Show full text]