Background: This article gives an overview of severe and fulminant infections of the head and neck region. The focus is on the treatment, diagnostics and causes of abscesses, phlegmon and necrotizing fasciitis.
Objective: Despite guideline-conform treatment soft tissue infections of the head and neck can spread rapidly and be life-threatening.
Material and methods: Analysis and discussion of basic research and expert recommendations, case reports.
Results: While purulent tonsillitis is the primary cause of severe bacterial soft tissue infections in children, dental infections are the leading cause in adults. The infections often spread along anatomic spaces and can extend into the brain or mediastinum and a hematogenic dissemination is also possible. Multiple operations and combined antibiotic treatment are often required as well as additional treatment, such as intubation, tracheotomy and dialysis. Late or early onset complications can occur and reconstructive measures might be necessary in addition to rehabilitation.
Conclusion: Severe bacterial soft tissue infections can be still life-threatening despite guideline-conform treatment and are associated with a high mortality especially in high-risk patients even with intensive medical care. They can lead to disfiguration and loss of function resulting in a greatly reduced quality of life. Rapid diagnostics and therapy are essential for successful treatment.
Keywords: Abscess; Infections of deep neck spaces; Necrotizing fasciitis; Odontogenic infections; Phlegmon.