Objectives: Primary head and neck cancer and deep neck infection are not uncommon, but deep neck infection as the initial presentation of primary head and neck cancer is rare and these patients risk potential misdiagnosis.

Materials and methods: The records of 301 patients with deep neck infection and 3337 patients with primary head and neck cancers from 1990 to 2002 were retrospectively reviewed. Patients with primary head and neck cancers who had deep neck infection as their initial presentation were enrolled.

Results: Seven patients were identified (six men and one woman). The median age was 64 years. All patients presented with painful, erythematous neck swelling and all image studies showed abscess formation. Four abscesses received needle aspiration and three received surgical drainage, which yielded malignant cells in four specimens. The primary origins of malignancies were the nasopharynx (two patients), oropharynx (two patients), hypopharynx (one patient), parotid gland (one patient) and maxillary sinus (one patient). All patients had stage IV disease. Only three patients could receive curative therapy and only one patient was disease-free after three years.

Conclusion: We suggest that detailed history-taking, complete examination of the ENT field and pathological study of the infected tissue must be performed for patients with deep neck infection to enable early detection and prompt treatment of any underlying malignancy.