Incision and drainage produced approximately 10 mL of purulent material. Culture was sterile, as was the initial blood culture. Improvement was obvious within 24 hours of the surgical treatment. The boy was discharged after seven days of treatment with intravenous nafcillin and was continued on a course of oral penicillin for an additional 10 days. A knowledge of neck spaces and fascial relationships is important in diagnosing and treating neck infections.
Spaces created by various fasciae of the neck are potential areas of infection.
Invasion by bacteria produces cellulitis or abscess, and spread occurs by continuity along these paths of least resistance, rather than by lymphatic channels. The infectious process expands superiorly and posteriorly, elevating the floor of the mouth and the tongue. This then evolves to an infectious compartment syndrome of the submandibular and sublingual spaces. Sublingual space, superior to mylohyoid muscle. The submandibular space is inferior to the mylohyoid muscle.