Today, I reviewed the PedsCases’ podcast and show notes, Approach to Deep Neck Infections.
The big danger of these infections is airway obstruction. And sudden pediatric laryngospasm can occur if overly vigorous stimulation of the oropharynx occurs.
Note to myself: Here are some resources on Pediatric Laryngospasm to review again.
- A Link To “Pediatric Laryngospasm: Prevention And Treatment”
Posted on September 2, 2017 by Tom Wade MD - Management of Laryngospasm in the Operating Room from Pediatric Anesthesia Digital Handbook accessed 5-4-2023.
- Prevention and Treatment of Laryngospasm in the Pediatric Patient: A Literature Review. AANA Journal, April 2019, Vol. 87, No. 2
- “Succinylcholine has long been the classic treatment of
a patient having a laryngospasm.17 Because of the adverse
side effects (eg, bradycardia, arrhythmias), it is usually
the last option, but the most reliable pharmacologic agent
to break a laryngospasm.2 The recommended dose of succinylcholine is 1.0 to 2.0 mg/kg intravenously or 4 mg/kg for the intramuscular route.2,17”
- “Succinylcholine has long been the classic treatment of
All that follows is from Approach to Deep Neck Infections.
This podcast provides an overview of deep neck infections with a focus on the 3 most common deep neck infections: peritonsillar abscess, retropharyngeal abscess and parapharyngeal infections. It provides an approach to describing the relevant anatomy and pathophysiology of deep neck infections, recognizing the typical clinical presentation of deep neck infections, and explaining the initial steps of diagnosis and management of deep neck infections. Created by Owen Sieben, fourth-year medical student at the University of Alberta, and Dr. Hamdy El-Hakim, a pediatric otolaryngologist.
Related content:
Deep neck infections are described in terms of the fascial spaces that they occupy. In this podcast, we will focus on infections in the peritonsillar, the retropharyngeal, and the parapharyngeal spaces.4
The peritonsillar abscess is the most common deep neck
infection in the general population, occurring most frequently in adolescents and young adults. These infections are less common in younger children but may occur especially if the child is
immuno-compromised.8When a younger child like Kyle presents with symptoms suggestive of a deep neck infection, a retropharyngeal abscess should first come to mind. Retropharyngeal infections occur most frequently in young children between the ages of 2 and 4 due to chains of lymph nodes present in children that atrophy before puberty.11 Early on in the disease process the presentation may be similar to that of uncomplicated pharyngitis. . . The ability to visualize the oropharynx may be limited by trismus, and special care should be taken to avoid precipitating a laryngospasm by forceful oral cavity exam.9 [Emphasis added]
Most importantly, high clinical suspicion for signs and symptoms of airway obstruction should be held for all children presenting with any of the deep neck infections. [Emphasis added] The presentation of children with airway obstruction varies with the degree of obstruction. Drooling, dyspnea, and stridor are signs indicating that a child is at risk of airway obstruction. Children with an already obstructed airway may appear anxious, positioned leaning forward with their head in the “sniffing position,” with marked suprasternal retractions, as well as nasal flaring or grunting.13
The most important consideration in the evaluation of a patient presenting with a potential deep neck infection is to first assess and stabilize the airway. Patients with signs or symptoms of
airway obstruction must be in a safe, monitored environment where an emergent airway can be established if needed. If there are any signs of airway compromise, such as rapidly changing
vital signs or shortness of breath, consult anesthesia and otolaryngology right away to help secure the airway followed by surgical drainage in the operating room.14
