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DOI: https://doi.org/10.22263/2312-4156.2026.4.87

A.S. Nechiporenko¹, D.M. Plavsky²
Diagnosis of neck phlegmon with computer tomography
¹Grodno State Medical University, Grodno, Republic of Belarus
²Grodno University Clinic, Grodno, Republic of Belarus

Vestnik VGMU. 2026;25(4):87-97.

Abstract.
The article substantiates the effectiveness of a structured algorithm for analyzing computed tomography (CT) images based on the “Cube Rule” principle for diagnosing neck phlegmons in combination with using the developed scheme of the routes of spreading inflammatory processes into the soft tissues of the neck Using clinical observations as examples, it is demonstrated that applying this algorithm with the assessment of the lesion’s localization, size, internal structure, its relationships with critical anatomical structures, spreading routes, and search for the primary source—enables a complete topographic-anatomical description of the process. The methodology ensures precise topical diagnosis, 88 differentiation between diffuse phlegmonous processes with delimited ones, which in some cases is fundamentally important in determining the tactics of patients’ management. A detailed scheme of possible infection spread routes not only significantly facilitates the search for the primary source of infection, but also helps to detail the routes of its spread. The resulting structured description of CT scans provides clear answers to key questions: the location of the primary lesion, possible etiology (usually odontogenic), the nature of the process itself (diffuse inflammation or with signs of delimitation and/or with a tendency to abscess formation), the routes of spread (involvement of the cellular spaces of the neck, possible spread towards the mediastinum), and the presence of potential complications. Answers to the above questions can help to choose the optimal treatment method and, if surgical treatment is necessary, determine not only the choice of surgical approach but also possible drainage options for purulent foci. The comprehensive approach based on the “Cube Rule” and the developed scheme of the routes of spreading inflammatory processes into the soft tissues of the neck improves diagnostic accuracy, allows for prediction of complications, optimizes surgical planning, and improves treatment outcomes, justifying the feasibility of its implementation into routine practice.

Keywords: neck phlegmon, computed tomography, diagnosis, cube rule, fascial spaces.

References

• 1. Nazipov AA, Surinov MA. Intensive therapy and anesthesia in cases of spilled phlegmons in the neck and jaw-facial area, aggravated by respiratory disorders and mediastinitis. Kazanskii Meditsinskii Zhurnal. 2000;81(2):121-124. (In Russ.). doi: 10.17816/kazmj96286
• 2. Bugaj A, Nogal P, Wiczuk-Wiczewska M, Balcerowiak A, Andruszko A, Leszczyńska M. Phlegmon of the neck with an atypical manifestation and severe course. Postępy w Chirurgiigłowyiszyi. 2024;23(46):12-15. doi: 10.5114/ ahns.2024.144429
• 3. Zwaan M, Ahrens KH, Blume B. Computerized tomography findings in neck abscessю Laryngorhinootologie. 1990 Sep;69(9):483-485. doi: 10.1055/s-2007-998236
• 4. Hrydnova V, Stępiński MJ. A case of a patient with severe odontogenic phlegmon of the neck (as caused by Streptococcus anginosus and Prevotella intermedia) associated with mixed systemic infection (sepsis) and pneumonia. Polish Otorhinolaryngology Review. 2023;12(3):42-47. doi: 10.5604/01.3001.0053.8530
• 5. Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngologic clinics of North America. 2008 Jun;41(3):459-483. doi: 10.1016/j.otc.2008.01.002
• 6. Leaper D. Evidence-based wound care in the UK. International Wound Journal. 2009 Apr;6(2):89-91. doi: 10.1111/j.1742-481X.2009.00581.x
• 7. Khorov VG, Zholik AYu. Analysis of clinical observations of neck muscle. V: Pokhoden'ko-Chudakova IO, red. Parinskie chteniya 2020. Aktual'nye voprosy diagnostiki, lecheniya i dispanserizatsii patsientov s khirurgicheskoi patologiei chelyustno-litsevoi oblasti i shei: materialy Nats kongr s mezhdunar uchastiem, 7-8 maya 2020 g, g Minsk, Resp Belarus'. Minsk, RB: Izd tsentr BGU; BGMU, 2020. Р. 156-160. URL: https://rep.bsmu.by/bitstream/handle/ BSMU/28741/32.pdf [Accessed 02th Jule 2026]. (In Russ.).
• 8. Paramonova OA, Savchenko YuP, Gerbova TV, Uvarova AG. Modern aspects of treatment of phlegmons of the face and neck. Kubanskii Nauchnyi Meditsinskii Vestnik. 2018;25(5):58-64. (In Russ.). doi: 10.25207/1608-6228- 2018-25-5-58-64
• 9. Fagan J, Taylor K, Bolding E, de Groot M, Witt RL, Edkins O, et al. Open Access Atlas of Otolaryngology, Head and Neck Operative Surgery. UCT Libraries; 2017. Vol 1: Head and Neck. DOI: 10.15641/0-7992-2534-1
• 10. Hagelberg J, Pape B, Heikkinen J, Nurminen J, Mattila K, Hirvonen J. Diagnostic accuracy of contrast-enhanced CT for neck abscesses: A systematic review and metaanalysis of positive predictive value. PLoS One. 2022 Oct;17(10):e0276544. doi: 10.1371/journal.pone.0276544
• 11. Meyerz SP. Differential diagnosis in neuroimaging. Head and neck. Moscow, RF: MEDpress-inform; 2023. 652 р. (In Russ.).
• 12. Prasad KC, Prasad SC, Mouli N, Agarwal S. Osteomyelitis in the head and neck. Acta Oto-laryngologica. 2007 Feb;127(2):194-205. doi: 10.1080/00016480600818054 13. Yu E, Shankar L. Introductory Head and Neck Imaging. New Delhi, India: Jaypee Brothers Medical Publishers; 2014. 690 p.

Submitted 31.03.2026
Accepted 27.08.2026

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