Introduction
Deep Neck Infections (DNIs) represent a relatively common condition with potentially life-threatening consequences. The advent of antibiotics has led to improved infection outcomes; nevertheless, they have several drawbacks. Wide spectrum empirical iv-antibiotics are initiated until culture and sensitivities are reported,1-3 even so, culture results can be erratic due to the sampling timing, since some patients are on empirical oral antibiotics before admission or IV-treatment starts prior to aspiration. Hence, the clinician should make a call about optimal treatment, timing, and surgical access if needed, based on clinical findings and information from imaging studies.
Sound knowledge of pertinent surgical anatomy is of paramount importance in order to access all involved neck spaces.1,2 In particular, pharyngeal mucosal space (PMS) is the most superficial neck space, lying just deep to pharyngeal mucosa anteromedially to parapharyngeal space and directly anterior to the retropharyngeal space. Its clinical significance has recently been recognized through cross-sectional imaging studies. Anatomically is defined between pharyngeal mucosa (superficially) and investing layer of deep cervical fascia (deep). The latter surrounds the pharyngeal constrictors. It extends from skull base to the lower cricoid border, involving naso-oro-hypopharynx. It is bordered superiorly by the superior constrictor muscle’s aponeurosis where it merges with the middle layer of deep cervical fascia. PMS contains loose areolar tissue that facilitates deglutition, lymphoid tissue and minor salivary glands. Dense connective tissue is present only in its deep surface (deep cervical fascia).4-7 Some studies suggest that peritonsillar space is virtually a part of PMS,4-6however more recent studies definite them as separate spaces.7
PMS pathology includes neoplasms, congenital and inflammatory lesions,4-6 while there is a lack of literature on pharyngeal mucosal space abscesses (PMA).6 The purpose of this study was to present our experience and highlight the clinical behavior of abscesses constrained in PMS.