Global Burden of Deep Neck Space Abscesses: Epidemiology, Challenges, and Outcomes

TL;DR

Deep neck space abscesses are increasing globally, with higher risks for people with diabetes and other conditions, and require prompt treatment to avoid severe complications.

Contribution

This review provides a comprehensive synthesis of DNSA epidemiology, challenges, and outcomes to guide global prevention and management strategies.

Findings

DNSA incidence is rising in both high-income and resource-limited settings.

Diabetes and immunosuppression are strongly linked to poor DNSA outcomes.

Mortality ranges from 1.6% to 7.6%, with higher rates in cases involving mediastinitis.

Abstract

Background/Objectives: Deep neck space abscesses (DNSAs), representing severe suppurative infections, continue to pose a significant global health challenge due to their morbidity, mortality, and evolving epidemiology. This review synthesizes existing knowledge regarding DNSA definitions, anatomic basis, epidemiological trends, microbiology, clinical presentation, diagnostic strategies, treatment paradigms, outcomes, health system challenges, and disparities to guide global efforts in DNSA prevention, management, and research. Methods: A structured narrative review was performed following SANRA guidelines. PubMed/MEDLINE and the Cochrane Library were searched from January 2000 to May 2025, retrieving 1102 records. After screening, 49 studies met the inclusion criteria. Data were extracted using standardized templates and synthesized thematically. Results: During the period 2004–2015, annual case increases were reported in a Finnish population-based retrospective cohort (n = 277), going from 14 to 24 subjects, and for a UK tertiary center retrospective series, going from 1 to 15 cases annually (2006–2015) (Pearson’s correlation, r = 0.9; p = 0.00019). The microbiological environment is mostly polymicrobial, composed of group streptococci and staphylococcus strains and anaerobes. Factors associated with poor outcomes include diabetes mellitus (adjusted hazard ratio of 10.7 [95% CI 6.0–19.1] in a retrospective, population-based cohort of 12,738 diabetic patients compared to 50,952 individuals without diabetes), immunosuppressed state, elderly age, and multispace involvement. Diagnosis relies on contrast-enhanced CT imaging (sensitivity > 90%), and treatment consists of early multidisciplinary intervention combining empiric broad-spectrum antibiotics with surgical drainage in 60–97% of cases. Mortality ranges from 1.6% to 7.6%, with higher rates in cases complicated by mediastinitis (up to 40%). Conclusions: DNSAs demonstrate a clear upward incidence trend across high-income and resource-limited settings. Establishing standardized DNSA registries, validating risk-stratification tools, reinforcing antimicrobial stewardship to address rising resistance, and implementing early detection protocols in primary care remain critical priorities. While emerging technologies, including rapid molecular diagnostics and AI-based decision support, represent promising research directions, current DNSA management relies fundamentally on conventional clinical assessment, prompt imaging, and coordinated multidisciplinary care.

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