(639) Predictive Value of Inflammatory Indices for Parapharyngeal Space Involvement in Deep Neck Infections

Introduction: Deep neck infections are potentially life-threatening conditions, and parapharyngeal space involvement is associated with increased morbidity and need for intensive management. This study aimed to evaluate whether routinely available inflammatory biomarkers and ratios can predict parapharyngeal space involvement in deep neck infections.

Methods: An ambispective observational study was conducted including 45 patients treated for deep neck infections at a tertiary referral hospital between 2023 and 2025. Patients were divided into groups based on imaging-confirmed parapharyngeal space involvement. Admission laboratory values were recorded, including leukocyte count, neutrophils, lymphocytes, platelets, and C-reactive protein. The neutrophil-to-lymphocyte ratio and LRINEC score were calculated. Continuous variables were expressed as mean ± standard deviation and compared using Student’s t-test, while categorical variables were analyzed using chi-square testing.

Results: Parapharyngeal space involvement was identified in 6 patients (13.3%). These patients demonstrated a higher systemic inflammatory burden compared with those without parapharyngeal involvement. Mean NLR was 29.4 ± 20.1 versus 9.4 ± 11.2, showing a trend toward statistical significance (p = 0.058). CRP levels were significantly higher in the parapharyngeal group (38.8 ± 16.6 vs 14.6 ± 23.3 mg/L, p = 0.014). Although the LRINEC score was numerically higher in patients with parapharyngeal involvement (5.7 ± 2.6 vs 3.5 ± 3.1), this difference did not reach statistical significance (p = 0.10). Length of hospital stay was similar between groups (p = 0.65).

Conclusions: Parapharyngeal space involvement in deep neck infections is associated with a higher inflammatory burden at presentation. Elevated CRP was a significant predictor, while NLR showed a trend toward association with parapharyngeal involvement. These readily available biomarkers may serve as useful adjuncts for early risk stratification and identification of patients at risk for more severe disease requiring closer monitoring and aggressive management.