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Chariton Bobylev
Chariton Bobylev

Lee Child Deep Down Epub Download Free PORTABLE



Objectives:Summarize the epidemiology of deep neck infections.Describe the typical clinical presentation of deep neck infections.Identify the management options for deep neck infections.Explain the importance of collaboration amongst interprofessional teams to providing optimal management to patients with deep neck infections.Access free multiple choice questions on this topic.




Lee Child Deep Down Epub Download Free



Deep neck space infections are almost uniformly polymicrobial, representing their origin from the normal flora of the oral cavity and upper respiratory tract. The most common source of deep neck infections among adults are the dental and periodontal structures, with the second most common source being from the tonsils. Tonsil and pharyngeal sources are the most common etiologies in children. Streptococcus viridans,Staphylococcus aureus, Klebsiella, gram-negative rods, anaerobes, Fusobacterium species are all frequently encountered microorganisms, representing pathologic overgrowth of expected oropharyngeal flora. Actinomyces, Mycobacterium, and fungi are also potential causative organisms but are rarer. The presence of risk factors such as immunocompromised state, diabetes mellitus, intravenous (IV) drug use, as well as the site of origin of infection, influences the type of causative organism.[6]


To understand the pathophysiology of deep neck infections it is essential to have a thorough understanding of the cervical compartments and interfascial spaces. The cervical fascia can be divided into superficial and deep fascia. The superficial fascia is the subcutaneous tissue of the neck and contains the platysma. This layer completely envelops the head and neck. The deep fascia of the neck is divided into superficial, middle, and deep layers. The superficial layer of the deep fascia covers the submaxillary and parotid glands, the trapezius, sternocleidomastoid, and strap muscles. It is also termed the investing layer. Infections of odontogenic and submandibular origin affect this space, which includes the submandibular and masticator spaces. The middle layer encloses vital parts of the neck including the pharynx, larynx, trachea, upper esophagus, thyroid, and parathyroid glands. Infections of pharyngeal, tonsillar, and laryngeal origin affect this space, which includes the parapharyngeal and retropharyngeal spaces. This space can also become involved by odontogenic infections of the 2nd and 3rd molars, where infection can spread inferior to the dentate line of the mandible to penetrate the middle layer of deep cervical fascia. The deep layer of the deep cervical fascia, also called prevertebral fascia, covers the vertebral column and muscles of the spine. There is an alar fascia present in this space that forms the terminus of the retropharyngeal space and lies between the middle layer fo deep cervical fascia and the prevertebral fascia proper. The space between this alar layer and the prevertebral fascia is the so-called "danger space," as it is in continuity with the mediastinum and infections of upper aerodigestive origin can spread freely to cause mediastinitis. True retropharyngeal infections can involve the deep layer of deep cervical fascia, but the hematogenous spread of other infections (i.e. in IV drug users) can lead to vertebral and prevertebral abscesses.


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