Skip to main content

Advertisement

SpringerLink
Log in

Imaging assessment of deep neck spaces infections: an anatomical approach

  • Computed Tomography
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Despite the widespread use of antibiotics, deep neck infections are still a relevant clinical problem and can cause severe and potentially life-threatening complications. Imaging plays a pivotal role into the clinical management of deep neck infections, allowing identification of the source of infections, definition of the precise extension of the disease and early diagnosis of local or distant complications. The complex anatomy of deep neck spaces may hide the actual extent of disease: the knowledge of neck anatomy enables radiologists to rapidly evaluate expected routes of spread of infections and to effectively communicate crucial information to surgeons. Computed Tomography is the most used imaging modality for assessing primary site of infection, extent of disease and local complications. Magnetic resonance imaging may be used as a second level imaging modality for individuating intracranial or spinal complications. The present work aims to review the imaging of deep neck spaces infections, focusing on relevant anatomy and clinical scenarios, underlining practical teaching points for each of them. Familiarity with deep neck spaces anatomy and knowledge of most common routes of spread of infections allow the radiologist to make a prompt diagnosis and to look for early signs of potential complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

Abbreviations

DNSI:

Deep neck spaces infections

DNSs:

Deep neck spaces

CECT:

Contrast-enhanced computed tomography

MRI:

Magnetic resonance imaging

FOV:

Field of view

IJV:

Internal jugular vein

SLDCF:

Superficial layer of the deep cervical fascia

MLDCF:

Middle layer of the deep cervical fascia

DLDCF:

Deep layer of the deep cervical fascia

NF:

Necrotizing fasciitis

References

  1. Boscolo-Rizzo P, Stellin M, Muzzi E et al (2012) Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol 269:1241–1249

    Article  PubMed  Google Scholar 

  2. Gallo O, Mannelli G, Lazio MS, Santoro R (2018) How to avoid life-threatening complications following head and neck space infections: an algorithm-based approach to apply during times of emergency. When and why to hospitalise a neck infection patient. J Laryngol Otol 132:53–59. https://doi.org/10.1017/S0022215117002201

    Article  CAS  PubMed  Google Scholar 

  3. Dabirmoghaddam P, Mohseni A, Navvabi Z et al (2017) Is ultrasonography-guided drainage a safe and effective alternative to incision and drainage for deep neck space abscesses? J Laryngol Otol 131:259–263. https://doi.org/10.1017/S002221511700007X

    Article  CAS  PubMed  Google Scholar 

  4. Vieira F, Allen SM, Stocks RMS, Thompson JW (2008) Deep neck infection. Otolaryngol Clin North Am 41:459–483

    Article  PubMed  Google Scholar 

  5. Nurminen J, Velhonoja J, Heikkinen J et al (2021) Emergency neck MRI: feasibility and diagnostic accuracy in cases of neck infection. Acta radiol 62:735–742. https://doi.org/10.1177/0284185120940242

    Article  PubMed  Google Scholar 

  6. Kamalian S, Avery L, Lev MH et al (2019) Nontraumatic head and neck emergencies. Radiographics 39:1808–1823. https://doi.org/10.1148/rg.2019190159

    Article  PubMed  Google Scholar 

  7. Maroldi R, Farina D, Ravanelli M et al (2012) Emergency imaging assessment of deep neck space infections. Semin Ultrasound CT MR 33:432–442. https://doi.org/10.1053/j.sult.2012.06.008

    Article  PubMed  Google Scholar 

  8. Som PM, Curtin HD (2011) Head and neck imaging. Elsevier Mosby, St. Louis

    Google Scholar 

  9. Zhang M, Lee ASJ (2002) The investing layer of the deep cervical fascia does not exist between the sternocleidomastoid and trapezius muscles. Otolaryngol-Head Neck Surg 127:452–457. https://doi.org/10.1067/mhn.2002.129823

    Article  PubMed  Google Scholar 

  10. Nash L, Nicholson HD, Zhang M (2005) Does the investing layer of the deep cervical fascia exist? Anesthesiology 103:962–968. https://doi.org/10.1097/00000542-200511000-00010

    Article  PubMed  Google Scholar 

  11. Guidera AK, Dawes PJD, Fong A, Stringer MD (2014) Head and neck fascia and compartments: no space for spaces. Head Neck 36:1058–1068. https://doi.org/10.1002/hed.23442

    Article  PubMed  Google Scholar 

  12. Grodinsky M, Holyoke EA (1938) The fasciae and fascial spaces of the head, neck and adjacent regions. Am J Anatom 63:367–408. https://doi.org/10.1002/aja.1000630303

    Article  Google Scholar 

  13. Gavid M, Dumollard JM, Habougit C et al (2018) Anatomical and histological study of the deep neck fasciae: does the alar fascia exist? Surg Radiol Anat 40:917–922. https://doi.org/10.1007/s00276-018-1977-5

    Article  CAS  PubMed  Google Scholar 

  14. Patel S, Bhatt AA (2018) Imaging of the sublingual and submandibular spaces. Insights Imaging 9(3):391–401. https://doi.org/10.1007/s13244-018-0615-4

    Article  PubMed  PubMed Central  Google Scholar 

  15. López F, Suárez C, vander Poorten V, et al (2018) Contemporary management of primary parapharyngeal space tumors. Head Neck hed. https://doi.org/10.1002/hed.25439

    Article  Google Scholar 

  16. Arya S, Rane P, D’Cruz A (2012) Infratemporal fossa, masticator space and parapharyngeal space: can the radiologist and surgeon speak the same language? Otorhinolaryngol Clinic 4:125–135. https://doi.org/10.5005/jp-journals-10003-1098

    Article  Google Scholar 

  17. Debnam JM, Guha-Thakurta N (2012) Retropharyngeal and prevertebral spaces: anatomic imaging and diagnosis. Otolaryngol Clin North Am 45:1293–1310

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mills MK, Shah LM (2015) Imaging of the perivertebral space. Radiol Clin North Am 53:163–180

    Article  PubMed  Google Scholar 

  19. Chengazi HU, Bhatt AA (2019) Pathology of the carotid space. Insights Imaging 10(1):21. https://doi.org/10.1186/s13244-019-0704-z

    Article  PubMed  PubMed Central  Google Scholar 

  20. Picasso R, Zaottini F, Pistoia F et al (2020) High-resolution ultrasound of small clinically relevant nerves running across the posterior triangle of the neck. Semin Musculoskelet Radiol 24:101–112. https://doi.org/10.1055/s-0040-1710067

    Article  PubMed  Google Scholar 

  21. Brucker JL, Gentry LR (2015) Imaging of head and neck emergencies. Radiol Clin North Am 53(1):215–252. https://doi.org/10.1016/j.rcl.2014.09.007

    Article  PubMed  Google Scholar 

  22. Scheinfeld MH, Shifteh K, Avery LL et al (2012) Teeth: what radiologists should know. Radiographics 32:1927–1944. https://doi.org/10.1148/rg.327125717

    Article  PubMed  Google Scholar 

  23. Li RM, Kiemeney M (2019) Infections of the Neck. Emerg Med Clin North Am 37:95–107. https://doi.org/10.1016/j.emc.2018.09.003

    Article  CAS  PubMed  Google Scholar 

  24. Takita H, Takeshita T, Shimono T et al (2017) Cystic lesions of the parotid gland: radiologic-pathologic correlation according to the latest world health organization 2017 classification of head and neck tumours. Jpn J Radiol 35:629–647. https://doi.org/10.1007/s11604-017-0678-z

    Article  CAS  PubMed  Google Scholar 

  25. Fernandes T, Lobo JC, Castro R et al (2013) Anatomy and pathology of the masticator space. Insights Imaging 4(5):605–616. https://doi.org/10.1007/s13244-013-0266-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Chughtai S, Chughtai KA, Montoya S, Bhatt AA (2020) Radiographic review of anatomy and pathology of the masticator space: what the emergency radiologist needs to know. Emerg Radiol 27:329–339. https://doi.org/10.1007/s10140-020-01756-7

    Article  PubMed  Google Scholar 

  27. Nguyen I, Urbanczyk K, Mtui E, Li S (2020) Intracranial CNS infections: a literature review and radiology case studies. Semin Ultrasound CT MR 41:106–120. https://doi.org/10.1053/j.sult.2019.09.003

    Article  PubMed  Google Scholar 

  28. Giurintano JP, Kortebein S, Sebelik M et al (2019) Intratonsillar abscess: a not-so-rare clinical entity. Int J Pediatr Otorhinolaryngol 119:38–40. https://doi.org/10.1016/j.ijporl.2018.12.039

    Article  PubMed  Google Scholar 

  29. Walkty A, Embil J (2019) Lemierre’s syndrome. N Engl J Med 380:e16. https://doi.org/10.1056/NEJMicm1808378

    Article  PubMed  Google Scholar 

  30. Sichel J-Y, Attal P, Hocwald E, Eliashar R (2006) Redefining parapharyngeal space infections. Annals Otol, Rhinol & Laryngol 115:117–123. https://doi.org/10.1177/000348940611500207

    Article  Google Scholar 

  31. Boardman J, Kanal E, Aldred P et al (2017) Frequency of acute longus colli tendinitis on CT examinations. Emerg Radiol 24:645–651. https://doi.org/10.1007/s10140-017-1537-z

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hoang JK, Branstetter BF IV, Eastwood JD, Glastonbury CM (2011) Multiplanar CT and MRI of collections in the retropharyngeal space: is it an abscess? AJR Am J Roentgenol 196(4):W426–W432. https://doi.org/10.2214/AJR.10.5116

    Article  PubMed  Google Scholar 

  33. Laur O, Mandell JC, Titelbaum DS et al (2019) Acute nontraumatic back pain: infections and mimics. Radiographics 39:287–288. https://doi.org/10.1148/rg.2019180077

    Article  PubMed  Google Scholar 

  34. Bennet J, Dolin R, Blaser M (2020) Mandell, douglas, and bennett’s principles and practice of infectious diseases, Ninth edition. Philadelphia, PA

  35. Stevens DL, Bryant AE (2017) Necrotizing soft-tissue infections. N Engl J Med 377:2253–2265. https://doi.org/10.1056/NEJMra1600673

    Article  PubMed  Google Scholar 

  36. Becker M, Zbären P, Hermans R et al (1997) Necrotizing fasciitis of the head and neck: role of CT in diagnosis and management. Radiology 202(2):471–476. https://doi.org/10.1148/radiology.202.2.9015076

    Article  CAS  PubMed  Google Scholar 

  37. Miller LE, Shaye DA (2021) Noma and necrotizing fasciitis of the face and neck. Facial Plast Surg 37:439–445. https://doi.org/10.1055/s-0041-1722894

    Article  CAS  PubMed  Google Scholar 

  38. Brajkovic D, Zjalić S, Kiralj A (2022) Prognostic factors for descending necrotizing mediastinitis development in deep space neck infections—a retrospective study. Eur Arch Otorhinolaryngol 279:2641–2649. https://doi.org/10.1007/s00405-021-07081-0

    Article  PubMed  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Genoa, Genoa, Italy

    Simone Caprioli

  2. Department of Health Sciences, University of Genoa, Genoa, Italy

    Alberto Tagliafico & Fabio Borda

  3. Radiology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Alberto Tagliafico, Riccardo Picasso, Cristina Conforti, Alessandro Casaleggio & Giuseppe Cittadini

  4. Neuroradiology Department, Ente Ospedaliero “Ospedali Galliera”, Genoa, Italy

    Martina Fiannacca

Authors
  1. Simone Caprioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alberto Tagliafico
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martina Fiannacca
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabio Borda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Riccardo Picasso
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cristina Conforti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alessandro Casaleggio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giuseppe Cittadini
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study design. The manuscript was conceptualized by Caprioli S. Caprioli S, and Martina F performed literature search and data analysis. Caprioli S and Borda F prepared the images. Caprioli S drafted the manuscript, and all the other authors critically revised it. Cittadini G and Tagliafico A were the supervisors of the work.

Corresponding author

Correspondence to Simone Caprioli.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Ethical standards This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Caprioli, S., Tagliafico, A., Fiannacca, M. et al. Imaging assessment of deep neck spaces infections: an anatomical approach. Radiol med 128, 81–92 (2023). https://doi.org/10.1007/s11547-022-01572-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-022-01572-8

Keywords

Search

Navigation