## 4 Clinical and Paralinical Diagnosis
Involvement of the parotid gland (through a defect in the deep cervical fascia), however, is common, and leads to swelling of the parotid space. The main clinical findings are fever, odynophagia, and general toxic state. The presence of epiglottis edema can lead to dyspnea. Given the anatomical structures contained in the retrostylian space, the number of complications is increased by erosion or thrombosis of the carotid artery and thrombosis of the internal jugular vein [45; 46]. Necrotizing fascitis is the most dreaded form of cervical mediastinal suppuration, with fulminant onset caused by infection with anaerobic bacteria. At presentation, the patient may have a relatively good general condition in contrast to the pathogenesis of the disease. The onset of symptoms coincides with extensive infection with tissue necrosis. Severely affected patients show symptoms and signs of sepsis, which has a poor prognosis. If aggressive surgical treatment is not instituted early, the patient presents complications that increase mortality through the appearance of shock. Patients with necrotizing infections present arterial hypotension in 50% of cases, and acute renal failure, impairment of liver function, and acute respiratory distress in 10-30% of cases [28; 46]. The patient initially presents with cervical swelling, pain upon palpation, edema, and erythema. The progression of the infection leads to the appearance of repetitions or emphysema at the level of the neck and upper chest, with the appearance of local ischemia and necrosis, clinical pallor, and necrosis of the skin. Necrotizing cervical fascitis has a downward direction, with severe evolution and the appearance of mediastitis. Mortality can be reduced by early diagnosis and therapeutic conduct. Acute mediastinitis after traumatic perforations at the crico-pharyngeal level (upper esophageal sphincter) is usually detected early. The main symptoms, according to their frequency, are the following: dysphagia (80.6%), retrosteral pain with interscapular radiation (56.5%), nausea and vomiting (50%), fever and chills (38.7%), dyspnea (19.4%),and confusion (15.5%) [45]. Clinical examination usually reveals tachypnea, tachycardia, edema of the face and neck, subcutaneous emphysema located at the level of the chest or basi-cervical area, and Hamman's sign with crackles on heart auscultation [45; 46; 47]. Comorbidities (diabetes mellitus, HIV infection, cancer, autoimmune diseases) must also be taken into account in developing the diagnostic and therapeutic management of patients with deep throat infection. Diabetes mellitus is the most common systemic disease associated with deep throat infection. Patients with comorbidities (immunocompromised) have a higher risk of developing fatal complications, even if the signs and symptoms are minor [35]. In patients with cervical mediastinal supurations, the values of leukocytes, C-reactive protein, fibrinogen, ESR, procalcitonin, presepsin, hemoglobin, renal and hepatic function, and blood sugar are evaluated from admission and in dynamics. Follow-up of inflammatory markers after the initiation of treatment helps in decision-making in therapeutic management. In various studies, it is observed that the C-reactive protein value is significantly higher in patients with multiple abscesses in different cervical spaces [43]. In isolated abscesses, the number of leukocytes may remain normal. Blood analyses in patients with necrotizing fascitis show metabolic acidosis and increased values of lactate and creatinine, with rapid evolution towards septic shock [43]. The bacteriological examination of the germs involved in infections of cervicalomedial-astinal supurations is carried out through microbiological tests to highlight the germs, as well as an antibiogram to establish the antibiotic treatment with the highest sensitivity. In recent years, there has been a significant increase in carriers of pathogenic staphylococci.