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Deep neck abscesses usually present with marked neck pain and swelling in a toxic febrile patient They are emergencies because they may rapidly compromise the airway They may also spread to the mediastinum or cause septicemia Most commonly, they originate from odontogenic infections Other causes include suppurative lymphadenitis, direct spread of pharyngeal infection, penetrating trauma, pharyngoesophageal foreign bodies, cervical osteomyelitis, and intravenous injection of the internal jugular vein, especially in drug abusers Recurrent deep neck infection may suggest an underlying congenital lesion such as a branchial cleft cyst Fundamentals of treatment include securing the airway, intravenous antibiotics, and incision and drainage In highly selected patients without airway compromise, needle aspiration and catheter drainage or even conservative management without antibiotics alone has been reported to be successful in uniloculated abscesses The airway may be secured, when indicated, either by intubation or tracheotomy Tracheotomy is preferable in the patients with substantial pharyngeal edema, since attempts at intubation may precipitate acute airway obstruction Bleeding in association with a deep neck abscess suggests the possibility of carotid artery or internal jugular vein involvement and requires prompt neck exploration both for drainage of pus and for vascular control Contrast-enhanced CT usually augments the clinical examination in defining the extent of the infection It often will distinguish inflammation (requiring antibiotics) from abscess (requiring drainage) and define for the surgeon the extent of an abscess CT with MRI may also identify

The disadvantage is a higher memory footprint than the terminal-based version; it also cannot run in the background from the command line To use it from the command line, add the following statement to your initialization file (cshrc):.

Despite the frequency with which tonsillectomy is performed, the indications for the procedure remain controversial Most clinicians would agree that airway obstruction causing sleep apnea or cor pulmonale is an absolute indication for tonsillectomy Similarly, persistent marked tonsillar asymmetry should prompt an excisional biopsy to rule out lymphoma Relative indications include recurrent streptococcal tonsillitis, causing considerable loss of time from

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sialagogues (eg, lemon drops), and massage of the gland Usually one can switch to an oral agent based on clinical and microbiologic improvement to complete a 10-day course Failure of the process to resolve on this regimen suggests abscess formation, ductal stricture, stone, or tumor causing obstruction Ultrasound or CT scan may be helpful in establishing the diagnosis In the setting of acute illness, a severe and potentially life-threatening form of sialadenitis, sometimes called suppurative sialadenitis may develop The causative organism is usually S aureus, but often no pus will drain from Stensen s papilla These patients often do not respond to rehydration and intravenous antibiotics alone and thus may require operative incision and drainage to resolve the infection

Question 14-1. What is the convention for naming an indexer Question 14-2. What types can be used in an indexer to index a collection Question 14-3. What are the preconditions for calling Sort( ) on a collection Question 14-4. What is the purpose of generics Question 14-5. What is the purpose of the IEnumerable<T> interface Question 14-6. What do you use the yield keyword for Question 14-7. What is the principal difference between a List<T> and an array Question 14-8. What is the Capacity property of the List used for Question 14-9. What is the difference between a Stack and a Queue Question 14-10. In a Dictionary, what is the meaning of the key and the value

thrombophlebitis of the internal jugular vein secondary to oropharyngeal inflammation This condition, known as Lemierre s syndrome, may be associated with septic emboli and requires prompt institution of antibiotics appropriate for Fusobacterium necrophorum as well as the more usual upper airway pathogens The presence of pulmonary infiltrates (or septic arthritis) in the setting of a neck abscess should lead one to suspect Lemierre s syndrome Ludwig s angina is the most commonly encountered neck space infection It is a cellulitis of the sublingual and submaxillary spaces, often arising from infection of the mandible Clinically, there is edema and erythema of the upper neck under the chin and often of the floor of the mouth The tongue may be displaced upward and backward by the posterior spread of cellulitis This may lead to occlusion of the airway and necessitate tracheotomy Microbiologic isolates include streptococci, staphylococci, Bacteroides, and Fusobacterium Usual doses of penicillin plus metronidazole, ampicillin-sulbactam, clindamycin, or selective cephalosporins are good initial choices Culture and sensitivity data will then refine the choice Dental consultation is advisable External drainage via bilateral submental incisions is required if the airway is threatened or when medical therapy has not reversed the process

Brook I Microbiology and management of deep facial infections and Lemierre syndrome ORL J Otorhinolaryngol Relat Spec 2003 Mar Apr;65(2):117 20 [PMID: 12824734] Lin D et al Internal jugular vein thrombosis and deep neck infection from intravenous drug use: management strategy Laryngoscope 2004 Jan;114(1):56 60 [PMID: 14709995] Ridder GJ et al Spectrum and management of deep neck space infections: an 8-year experience of 234 cases Otolaryngol Head Neck Surg 2005 Nov;133(5):709 14 [PMID: 16274797]

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