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Case Report
Deep neck space infections: An odontogenic parapharyngeal abscess reaching the base of the skull
1 Resident Physiciens of the 6th Year of Maxillofacial Surgery at University Hospital Center of Lisbon Central, Lisbon
2 Doctor Assistant in the Department of Maxillofacial Surgery at University Hospital Center of Lisbon Central, Lisbon
3 Graduate Assistant in the Department of Maxillofacial Surgery at University Hospital Center of Lisbon Central, Lisbon
4 Head of Maxillofacial Surgery Department at University Hospital Center of Lisbon Central, Lisbon
Address correspondence to:
Clara Carracha
Avenida Dr. José Grilo Evangelista, 207, 5º frente, 2890-007 Alcochete,
Portugal
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Article ID: 100028Z07CC2019
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Carracha C, Silva A, Oliveira H, da Silva LN, Coelho PV. Deep neck space infections: An odontogenic parapharyngeal abscess reaching the base of the skull. J Case Rep Images Dent 2019;5:100028Z07CC2019.ABSTRACT
Introduction: Although the incidence of deep neck space infection (DNSI) has decreased due to the use of antibiotics, this infection continues to be quite frequent and can be associated with high morbidity and mortality. The odontogenic cause is the most frequent in adulthood and, usually, it is a polymicrobial infection. It is important to be aware of the signs and symptoms of its severity and to start a treatment as quickly as possible. Airway protection, removal of the cause, surgical drainage if indicated, and antibiotic therapy, are the treatment steps.
Case Report: A 23-year-old healthy woman with bad oral hygiene was admitted to the emergency department with trismus, unilateral swelling in the pre-auricular and retromandibular regions, fever, dysphagia and odynophagia. She had also a history of odontalgia few months before. Orthopantomography showed a carie of 28 tooth and neck CT revealed the presence of a left parapharyngeal space abscess, reaching the base of the skull, associated with deviation of the airway to the right. She was submitted to surgical drainage and started intravenous antibiotics. Streptococcus pasanguinis and Prevotella buccae were isolated from the culture. After clinical, analytical and imaging improvement, she was discharged with the indication to keep oral antibiotic and to perform oral opening exercise.
Conclusion: Odontogenic infections can develop DNSI regardless of the presence of risk factors. Taking into account the etiology of these infections, would be important to improve oral health of population.
Keywords: Antibiotics, Deep neck space, Infection, Odontogenic, Surgical drainage
SUPPORTING INFORMATION
Author Contributions:
Clara Carracha - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Andreia Silva - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Henrique Oliveira - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Luís Nunes da Silva - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Paulo Valejo Coelho - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
AcknowledgmentsThe authors are grateful to the other health professionals of the Central Hospital Universitário de Lisboa Central, who also contributed to the therapeutic success of this type of patients.
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case report.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Open Access StatementAll relevant data are within the paper and its Supporting Information files.
Copyright© 2019 Clara Carracha et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
