Deep space neck infections – salivary gland as source is commoner in elderly patients
Reviewed by Rohit Verma

Whilst deep space neck infections (DNI) can originate from many sources, dental and salivary glands are commonly the culprit. This paper details 44 patients treated for deep space neck infections originating from salivary gland and compares them to a previously published cohort of 191 cases of DNI originating from non-salivary gland. The patients were treated at a single centre over 11 years. The mean age of the salivary gland group was 62 years. In 38 out of 44 cases, the submandibular gland was the source of sepsis, the parotid was the source in six out of 44. In patients with DNI from a non-salivary gland source, mean age was 44.5 years. In 103 out of 191 cases, the sepsis stemmed from a dental origin, 53 from an oropharyngeal origin. The remainder came from infected cysts, hypopharyngeal lesions, with five out of 191 cases from other ascertained ENT sources of sepsis. Odynophagia was a less common complaint in salivary gland sources of sepsis (53.9% vs 29.6%). Patients with salivary gland sources were older, had more co-morbidities and required surgical intervention in 47.7% of cases, this is compared to surgical intervention being required in 69.1% in non-salivary DNI. This last result is not statistically significant but the authors suggest that it does suggest a trend. Mean hospital stay was 8.2 days. This paper highlights that in elderly patients, a salivary source of sepsis in DNI is more common than in younger patients. This may be due to several factors including increased use of xerogenic medications such as anti-depressants, beta-blockers, Alzheimer’s disease medications and diuretics. In addition age-related atrophy of salivary gland tissue, especially in the sub-mandibular gland, makes sepsis more likely. The authors report that analysing their entire cohort suggests that a salivary gland source of DNI is present in 19% of cases.

Deep neck infections originating from the major salivary glands
Favaretto N, Fasanaro E, Staffieri, et al.
AMERICAN JOURNAL OF OTOLARYNGOLOGY-HEAD AND NECK MEDICINE AND SURGERY
2015;36(4):559-64.