A deep neck infection is an abscess or spreading infection in the spaces between the deep layers of the neck, such as the peritonsillar, parapharyngeal, retropharyngeal or submandibular spaces. It often starts from the teeth or tonsils and can quickly threaten the airway or spread down into the chest.
Key symptoms
- Sore throat, neck pain and swelling
- Fever and feeling unwell
- Painful or hard swallowing, drooling
- Trouble opening the mouth (trismus)
- Muffled voice or neck stiffness
What you find on exam
- Airway first: stridor, drooling, posture, ability to speak
- Neck swelling, tenderness and warmth; firm floor of the mouth in Ludwig angina
- Throat: tonsil bulge and deviated uvula in a peritonsillar abscess
- Teeth and gums for a source
- Vital signs for sepsis
Tests
- CT of the neck with IV contrast: abscess location and extent
- Blood count, lactate, blood cultures
- Culture of pus from drainage
- Glucose, since diabetes raises the risk
Treatment basics
- Secure the airway early when it is threatened, ideally in a controlled setting
- IV antibiotics such as ampicillin-sulbactam or clindamycin; add vancomycin if MRSA risk
- Abscess drainage by ENT (needle or surgery)
- Fluids, pain control, treat the dental or tonsil source
Red flags
- Stridor, drooling or inability to lie flat
- Chest pain or a widened mediastinum (descending infection)
- Sepsis: low blood pressure, confusion
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Sources: NCCPA PANCE Content Blueprint; NASEMSO National Model EMS Clinical Guidelines; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.