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ENT Secrets > Chapter 3 - Deep Neck Infxn > Flashcards

Chapter 3 - Deep Neck Infxn Flashcards

1
Q

Signs of airway compromise

A

Trismus, dysphonia, “hot potato voice,” stridor, stertor

Tachypnea and O2 desats are late manifestations

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2
Q

When to just use IV ABx for deep neck infxn

A

Stable, antibiotic-naive patients, w/out clinical or radio graphic signs of abscess

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3
Q

Source of DNSI adult vs child

A

Adult- teeth (enamel eroded by plaque bacteria —> periapical abscess —> mandible/maxilla/deep neck
Also cellulitis, trauma, FB, IVDU, congenital lesions
Kid- bacterial pharyngotonsillitis —> para/retro/LN 2-4

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4
Q

Classic PTA signs

A

Trismus, uvula devation, muffled voice, soft palatal edema

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5
Q

RF for DNSI

A

Low education, live >1 hr from tertiary care center, tonsils present, Strep infxn, substance abuse, poor dental hygiene

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6
Q

Describe Fascial Planes

A

SCF: SQ, expression, involves SMAS, platysma
SDCF: parotid and SM gland, masticate, trap, SCM, forms stylomandibular ligament
MDCF: organs (larynx, pharynx, trachea, esophagus, thyroid, para), straps
DDCF: alar (SNS trunk), prevert (paraspinal, vert), layers coalesce to form carotid sheath

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7
Q

Retropharyngeal, Danger Space

A 
Anterior to Posterior:
BP Fascia (visceral)
RP Space (ends @ mediastinum, T1-6)
Alar fascia
Danger Space (SB to diaphragm)
Prevertebral Fascia
Prevertebral Space
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8
Q

What’s in prevertebral Space

A

prevertebral muscles (longus colli and longus capitis), vertebral artery, vertebral vein, scalene muscles, phrenic nerve and part of the brachial plexus.

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9
Q

Trapezius

A

O: EOP, SP C7-T12
I: NL, lateral 1/3 posterior clavicle, acromion process, spine scapula
A: transverse cervical (sup br)
N: IX (m), ventral rami c3-4 (s)
A: rotate, retract, elevate, depress scapula

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10
Q

SCM

A 
O: manubrium, medial clavicle 
I: mastoid process, SNL
A: occipital, superior thyroid
N: IX, C2-3 ventral rami
A: u/l- c/l rotation, I/l flexion
    B/l- flexion, elevate sternum, forced inhalation
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11
Q

Longus colli

A 
O: TP C5-T3
I: ant arch atlas
A: ascending pharyngeal, vertebral arteries 
N: C2-6
A: flex neck and head
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12
Q

Longus capitis

A

O: TP C3-6
I: Occip Bone
N: C1-3/4
A: flex neck at Atlanto-Occ Joint

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13
Q

Erector Spinae

A 
O: SP T9-12, Iliac Crest
I: SP cerv, T1-2
A: lateral sacral artery
N: spinal
A: extend vertebral column
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14
Q

Levator Scapulae

A 
O: TP C1-4
I: medial border scapula 
A: dorsal scapular
N: C3-4, C5 (dorsal scapular)
A: elevate, rotate scapula
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15
Q

Splenius

A 
O: NL, SP C7-T3
I: mastoid, occip
A: aorta br
N: post ramus C3-4
A: Ext, Rot, Lat flex head
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16
Q

Scalenes

A 
O: c2-7
I: Ribs 1-2
A: Asc Cerv (off ITA)
N: C3-6
A: elevate ribs 1-2
17
Q

Source of infections:
Peritonsillar
Parapharyngeal
SubM/L

A

Tonsil
Tonsil/pharynx
Gingiva, teeth, gland

18
Q 
Source of infections: 
Retropharyngeal
Prevertebral
Danger
Carotid sheath
A
  • Nose/Sinus, NP, vert bodies
  • heme/ contig from vert/discs (S Aureus, not usually anaerobes)
  • Para or retropharyngeal
  • “

Note: prevertebral Space infections can also spread to danger space

19
Q

Diseases that masquerade as DNSI

A

Thyroglossal duct cyst, lymphatic malformations, Branchial cleft cyst
Neoplasm

20
Q

Symptoms, Workup, Treatment of mediastinitis

A

Tachycardia, dyspnea, pleuritic chest pain
CXR widening mediastinum
Get contrast chest CT
IV ABx, thoracic c/s, ICU, May need drainage per thoracics

21
Q

DNSI Bacteria

A

Oral flora
Strep, peptostrep, actinomyces, fusobact, prevotella

Immunocomp/DM/Postop: S Aureus, Pseudo, GNR

22
Q

Symptoms of DNSI

A

Neck pain, fever, dysphagia, neck swell, odynophagia

If dysphonia, eval with laryngoscopy

23
Q

Key PE steps with DNSI

A 
Size/induration/swell/fluctuance, color change (mark cellulitic area)
Feel for crepitus (gas bact)
Cranial neuropathies (valve ext with nasal or midface soft tissue infxn)
24
Q

Cause of trismus with DNSI

A

Inflamed parapharyngeal, masseteric, pterygoid, temporal spaces

May lead to difficulty manage secretions, airway compromise

25
Q

Muscles that open jaw

A

Lateral pterygoid, digastric (when mass/temp relaxed), mylohyoid

26
Q

DNSI Workup

A

CBC Diff
XR (if retropharyngeal)
U/S (differ cellulitic vs abscess, guidance)
CT w Con (abscess is hypodense focus centrally with peripheral enhance)

27
Q

Differentiate SM space vs SL Space

A

SL: Sup to mylo, from infxn incisors
SM: Inf to mylo, 2/3 molars

28
Q

Signs of carotid sheath infection

A

Horners
Pulsatile mass with ecchymosis
BRB nose/mouth/EAC
Cranial nerve palsy, septic phlebitis jug

29
Q

When to do surgery DNSI

A

no marked improve 24-72 hr with IV ABx
Airway compromise
Signs of abscess (Clin or Rad)

Remove packing gradually

30
Q

Symptoms, Workup, treatment Lemierres

A 
Thrombophlebitis IJV (from tonsillar)
Fever, lethargy, neck swell/pain
Septic emboli in lungs
Contrast CT
90% Fusobacterium necrophorum
Flagyl
31
Q

Actinomyces

A

Infection crosses fascial planes, sinus tracts, grainy
Non-tender, hard, slow grow perimandibular mass
Penicillin/Amoxicillin

Gm+, Branch, facult anaerobe

32
Q

Ludwig Angina: Signs, Tx

A

Rapid spread SM/SL, teeth
Trismus, fever, drool, dysphonia, dysphagia
Tense swell FOM, tongue protrusion
ABx, poss drain, poss tube/trach

33
Q

Empiric ABx for DNSI

A 
Strep plus oral anaerobes 
Penn G plus Flagyl 
Unasyn
Clinda 
Moxifloxacin
Levoflox plus flagyl
Cipro plus flagyl 
10-14 d, once marked improvement —> oral
34
Q

Cat scratch disease: bug, tx

A 
Barro ella
Several wk after inoculate
Unilateral LAD, resolves 2 mo (maybe 1 yr)
Azithro early (w/in 5d)
Surg if persist discomfort, suppuration
35
Q

Atypical DNSI

A

Painless, slow, WL/night sweats

Consider PPD, HIV, Bartonella, cancer

36
Q

Scrofula

A

TB cervical lymphadenitis
Painless, firm, no fever
Biopsy Cx
Excuse, ABx

37
Q

Classic sign of Necrotizing Fasciitis

A

Pain OOP to PE
Immunosuppressed
Crepitus

ENT Secrets (79 decks)

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