ConditionEar, nose & throat
Deep Neck Infection
A deep neck infection is a bacterial infection or abscess in the spaces between the layers of tissue deep in the neck. It usually spreads from an infected tooth, tonsils or throat. Symptoms include fever, a painful swollen neck, difficulty swallowing or opening the mouth, drooling and a muffled voice. These infections can block the airway or spread into the chest, so they need emergency care with IV antibiotics and, often, surgical drainage.
Also called: Deep neck space infection, deep neck abscess, neck space abscess, cervical space infection
At a glance
- What it is
- An infection or pus collection in the deep spaces of the neck.
- Common sources
- Dental infections (most common in adults), tonsillitis and pharyngitis (common in children), injury, IV drug use.
- Types
- Peritonsillar, retropharyngeal, parapharyngeal and submandibular (Ludwig angina) infections.
- Symptoms
- Fever, neck pain and swelling, painful or difficult swallowing, trismus, drooling, muffled voice.
- Treatment
- Hospital care with IV antibiotics, surgical or needle drainage, and airway protection.
When to get help
Call 911 or go to the ER
- Noisy or difficult breathing, a high-pitched sound when breathing in, or being unable to lie flat
- Drooling because swallowing saliva is too painful, or being unable to swallow at all
- Rapidly spreading, hard swelling under the jaw or tongue, or a tongue pushed upward
- Neck swelling with chest pain, high fever or confusion
See a doctor within a day or two
- Fever with neck pain and stiffness, painful swallowing or a muffled "hot potato" voice
- Trouble opening the mouth (trismus) with throat or tooth pain
- A swollen, tender neck lump with fever, especially after a dental infection or sore throat
Book a routine appointment
- A tooth that is painful, loose or has a gum boil; get dental care before it spreads
What deep neck spaces are
The neck contains layers of tissue (fascia) that divide it into spaces around the muscles, airway, esophagus and blood vessels. These spaces are connected, so an infection that enters one can travel through the neck and even down into the chest. When bacteria enter these spaces, they cause cellulitis (spreading inflammation) or an abscess (a pocket of pus).
Types of deep neck infection
| Type | Location | Typical cause | Key features |
|---|---|---|---|
| Peritonsillar abscess (quinsy) | Beside a tonsil | Tonsillitis in teens and young adults | One-sided severe sore throat, trismus, muffled voice, uvula pushed aside |
| Retropharyngeal abscess | Behind the throat | Throat infection in children under 5; injury | Fever, stiff neck, refusal to move head, drooling |
| Parapharyngeal abscess | Side of the throat | Tonsil or dental infection | Swelling below the jaw angle, trismus |
| Submandibular infection / Ludwig angina | Floor of the mouth | Lower molar tooth infection | Hard swelling under the jaw, raised tongue, airway risk |
| Masticator space | Around the jaw muscles | Dental infection | Severe trismus, swelling of cheek |
Causes and risk factors
- dental infections, especially of the lower back teeth (dental abscess)
- tonsillitis and pharyngitis
- salivary gland infections and stones
- injury to the back of the throat, such as from a fish bone or a fall with something in the mouth
- injecting drugs into neck veins
- after procedures such as endoscopy or intubation
- weakened immunity: diabetes is a major risk factor, along with HIV, chemotherapy and steroid use
The bacteria are usually a mix of mouth organisms, including streptococci and anaerobes. Staphylococcus aureus, including MRSA, is also seen.
Symptoms
- fever and chills
- neck pain and swelling, often on one side
- sore throat and painful swallowing (difficulty swallowing)
- trismus: being unable to open the mouth fully
- a muffled voice
- drooling
- stiff neck or pain on turning
- swelling under the jaw or tongue
- noisy breathing (stridor) in advanced cases
Children may simply refuse to eat or drink, be irritable, and hold their neck stiffly.
Complications
These infections are dangerous because they can:
- block the airway, which is the most immediate threat
- spread to the chest, causing mediastinitis, a life-threatening infection around the heart and lungs
- cause sepsis
- cause a clot in the jugular vein with spread of infection (Lemierre syndrome)
- erode into the carotid artery, rarely
Diagnosis
- Examination of the throat, teeth, neck and breathing.
- Contrast-enhanced CT scan of the neck: the main test; shows whether there is an abscess, how far it extends, and the airway.
- Blood tests: white cell count, inflammatory markers, glucose, blood cultures.
- Ultrasound: useful in children and for superficial collections.
- Flexible scope (nasendoscopy) to check the airway.
Treatment
- Airway protection: comes first. Some patients need intubation in a controlled setting or, rarely, a tracheostomy.
- IV antibiotics: broad-spectrum antibiotics covering mouth bacteria, adjusted when culture results return.
- Drainage: a peritonsillar abscess is often drained with a needle or small incision under local anesthetic. Larger or deeper abscesses are drained surgically through the mouth or neck.
- Treat the source: dental extraction or root canal treatment, tonsillectomy for recurrent quinsy.
- Supportive care: IV fluids, pain relief and blood sugar control.
Small collections and early cellulitis sometimes resolve with antibiotics alone, under close observation in hospital.
Prevention
- regular dental checkups, and prompt treatment of tooth pain and gum swellings
- seeing a doctor for a severe or one-sided sore throat, especially with trouble opening the mouth
- good blood sugar control in diabetes
Frequently asked questions
What is a deep neck infection?
It is a bacterial infection or abscess in the deep spaces of the neck, usually spreading from a tooth, tonsils or throat. It causes fever, neck pain and swelling, and difficulty swallowing, and can threaten the airway.
What causes deep neck infections?
In adults, the most common cause is a dental infection, especially in the lower back teeth. In children, throat and tonsil infections are common causes. Injury, drug injection, salivary gland infections and diabetes also increase the risk.
Is a deep neck infection an emergency?
Yes. Deep neck infections can quickly narrow the airway or spread into the chest. Anyone with neck swelling and fever who has difficulty breathing, swallowing or opening the mouth needs emergency care.
How are deep neck abscesses treated?
They are treated in hospital with IV antibiotics and usually drainage of the pus, either with a needle or surgery. Protecting the airway comes first. The source, often a tooth, is also treated to prevent recurrence.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Otolaryngology-Head and Neck Surgery: Neck infections patient information
- MedlinePlus: Retropharyngeal abscess; Peritonsillar abscess
- Merck Manual Professional: Neck and Oral Abscesses
- NHS: Quinsy
- StatPearls (NCBI Bookshelf): Deep Neck Space Infections