Infective Conditions
Cellulitis may occur in any of the cellular planes in the neck, the most important form being that which occurs under the cervical fascia, for example in the course of acute infective diseases, such as scarlet fever, measles, or pyæmia. The pus tends to spread widely throughout the neck, infiltrating the connective-tissue spaces around the blood vessels, the air-passages, and the œsophagus. The density and tension of the cervical fascia cause the pus to burrow downwards towards the mediastinal spaces of the thorax, where it may give rise to such complications as empyema, infective pericarditis, or gangrene of the lung. The pus may also reach the axilla by spread of the infection along the subclavian vessels.
An acute phlegmonous peri-adenitis sometimes occurs in the loose cellular tissue around the submaxillary gland, and spreads with great rapidity through the cellular planes of the neck. The condition—which goes by the name of angina Ludovici—is usually met with in adults, and appears to originate in some infective focus in the mouth.
Clinical Features.—In all forms the process spreads rapidly, and the neck becomes swollen, brawny, and of a dusky red colour. The head is flexed towards the affected side, and there is pain on movement and on palpating the swelling. Pus forms early, but, as it is under great tension, fluctuation can seldom be detected. Respiration may be interfered with by pressure on the air-passages, or by the onset of œdema of the glottis, and tracheotomy may be urgently called for. Swallowing may also be affected by pressure on the pharynx and œsophagus. Pressure on the important nerves traversing the neck may give rise to irritative or paralytic symptoms. The main vessels may become thrombosed or eroded—particularly when the cellulitis is associated with scarlet fever—and in the latter case copious hæmorrhage may follow incision of the abscess.
There is always marked constitutional disturbance, as evidenced by rigors, high temperature, a small, rapid pulse, and delirium; and death may result within a few days from toxæmia.
Treatment.—In the earliest stages hot fomentations or ichthyol and glycerine should be applied, but if the process does not begin to abate within twenty-four hours, and if the swelling becomes brawny in character, one or more incisions should be made through the deep fascia where the signs of inflammation are most intense, and the deeper planes of the neck opened up by dissection. Drainage is secured by tubes or strips of rubber tissue. If profuse hæmorrhage occurs it may be necessary to ligate the main artery lower in the neck.
Actinomycosis manifests itself in the neck as a diffuse, painless swelling, which slowly infiltrates the superficial structures, becoming brawny at some places, and at others breaking down and forming sinuses from which the ray fungus escapes in the discharge.
Boils and carbuncles frequently occur on the back of the neck, where the skin is thick and coarse and is rubbed by the collar.
The affections of the cervical lymph glands have already been described (Volume I., p. 330).