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.