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Thomas A, Adam S, Goussard P, Venkatakrishna SSB, Andronikou S, Grobbelaar J. Retropharyngeal Abscess Complicated by Mediastinitis in Infants. Respiration 2024:1-9. [PMID: 39084200 DOI: 10.1159/000540525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 07/20/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Most paediatric upper respiratory infections are virally mediated and result in self-limiting reactive lymphadenopathy. In children younger than 5 years, retropharyngeal lymph nodes may give rise to deep neck space infections in this potential space. Retropharyngeal infections are rare after 5 years because lymph nodes undergo atrophy. METHODS We present a series of 6 cases of paediatric retropharyngeal abscesses (RPA) complicated by mediastinitis, managed at a tertiary hospital over a 4-year period. RESULTS All our cases presented with fever, difficulty feeding, and neck swelling. The age range was 11 weeks-11 months, and all tested negative for human immunodeficiency virus. The diagnosis and complications were confirmed on computed tomography (CT) scan. The CT scans consistently revealed RPA with varying degrees of deep neck space and mediastinal extension. All children were promptly taken to theatre for source control. Two were extubated successfully immediately after surgery, and the other 4 were extubated in the paediatric intensive care unit, with the longest duration of intubation being 3 days. Methicillin-sensitive Staphylococcus aureus (MSSA) was cultured in all 6 cases. CONCLUSION Management of these cases may be challenging, and young children with RPA require close care and airway monitoring. CT or magnetic resonance imaging is essential to delineate the extent of infection. Surgical drainage should be performed when there is a large abscess, a complication occurs, or an inadequate response in 24-48 h to medical management.
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Affiliation(s)
- Ann Thomas
- Department of Otorhinolaryngology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Shaun Adam
- Department of Otorhinolaryngology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa,
| | - Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | | | - Savvas Andronikou
- Department of Paediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Johan Grobbelaar
- Department of Otorhinolaryngology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Ratnapalan S, Thevaranjan J, Perera N, Nassarallah B, Wolter NE. Retropharyngeal and parapharyngeal infections in children: A retrospective analysis. Pediatr Neonatol 2024:S1875-9572(24)00118-9. [PMID: 39019720 DOI: 10.1016/j.pedneo.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/31/2023] [Accepted: 12/13/2023] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES To describe presentations, management and outcomes of retropharyngeal and parapharyngeal infections in children presenting to a tertiary care pediatric emergency department. METHODS A retrospective chart review of children with deep neck infections such as retropharyngeal or parapharyngeal infection from January 2008 to December 2018 was conducted at a pediatric hospital. RESULTS There were 176 retropharyngeal, 18 parapharyngeal and 6 with both retropharyngeal and parapharyngeal infections treated during the 10-year study period. Males were 60% of the cohort and the mean age was 4.3 (SD: 3.2) years. No significant differences in age or sex ratio or presentations were seen in children with retropharyngeal infections compared with parapharyngeal infections. All received parenteral antibiotics; 42% (84/200) of children underwent surgery and four of them had more than one surgical drainage. Age <12 months and the diagnosis of parapharyngeal infections were associated with significantly higher rates of surgical treatment. Children under 12 months of age were sicker at presentation and had a high complication rate of 23% compared with 1% in the older children (p = 0.002). Seven children had co-existence of Kawasaki disease with deep neck infections. CONCLUSIONS Early diagnosis of retropharyngeal and parapharyngeal infections especially in infants under a year of age is important as they are more likely to have complications and need surgical management. Most paediatric patients with retropharyngeal and parapharyngeal infections have a phlegmon or very small abscesses and are treated non-operatively with parenteral antibiotics.
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3
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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report. Pediatrics 2024; 154:e2024066855. [PMID: 38932719 DOI: 10.1542/peds.2024-066855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 06/28/2024] Open
Abstract
Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging, are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report. J Am Coll Radiol 2024; 21:e37-e69. [PMID: 38944445 DOI: 10.1016/j.jacr.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging (MRI), are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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5
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Garvey EA, Jamil TL, Levi JR, Cohen MB. Demographic disparities in children with retropharyngeal and parapharyngeal abscesses. Am J Otolaryngol 2024; 45:104140. [PMID: 38070379 DOI: 10.1016/j.amjoto.2023.104140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/03/2023] [Indexed: 03/16/2024]
Abstract
PURPOSE To explore the impact that demographic and socioeconomic factors such as age, gender, race, and insurance status have on the diagnosis of retropharyngeal (RPA) and parapharyngeal abscesses (PPA) in the pediatric population. METHODS The 2016 HCUP KID was searched for all RPA/PPA discharges using the joint ICD-10 code J39.0. Descriptive statistics, univariate, and multivariate analyses were performed to assess the relationship between demographic factors and their impact on RPA/PPA diagnosis. Results were reported with their corresponding odds ratio with a 95 % confidence interval and p-value. RESULTS 56.4 per 100,000 weighted discharges were discharged with a diagnosis of a RPA/PPA, the average age was 5.7 years old, with a male predominance. Pediatric discharges diagnosed with a RPA/PPA were less likely to identify as Hispanic or Asian/Island Pacific. They were also less likely to be insured by Medicaid and reside in zip codes with a lower median income. CONCLUSION The analysis of this national pediatric database demonstrated significant demographic differences in children diagnosed with RPA/PPAs. Following the multivariate analysis, children from a higher socioeconomic background and those with private insurance were more likely to be diagnosed with a RPA/PPAs. However, disparities in children's overall hospital course and complications is a potential area for future research.
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Affiliation(s)
- Emily A Garvey
- Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, USA
| | - Taylor L Jamil
- Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, USA; Department of Otolaryngology - Head and Neck Surgery, University of Colorado, 12631 E 17th Ave, Aurora, CO 80045, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA 02118, USA
| | - Michael B Cohen
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA 02118, USA.
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Hankey PB, Tracy M, Arganbright JM. Emerging findings for the assessment and treatment of pediatric deep neck abscesses. Curr Opin Otolaryngol Head Neck Surg 2023; 31:407-411. [PMID: 37820224 DOI: 10.1097/moo.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize new literature regarding the description, diagnosis, and treatment of pediatric deep neck abscesses. RECENT FINDINGS Providers should include multi-inflammatory syndrome in children (MIS-C) in a differential diagnosis in children suspected of having a retropharyngeal abscess. MRI may guide the proper management of children with deep neck abscesses by more accurately detecting free fluid compared to computed tomography imaging. Factors that may predict the need for surgical management include elevations in white blood cell counts and abscess size more than 3 cm. However, future investigation is necessary to establish consistent guidelines. Medical management is effective in many children, with a new study indicating success using a combination of cefotaxime and rifampicin. SUMMARY Anatomical and age-related risk factors predispose children to the development of deep neck abscesses. Findings from recent studies may aid providers in making an accurate diagnosis and providing proper medical or surgical management of children with these infections.
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Affiliation(s)
- Paul Bryan Hankey
- West Virginia University, Department of Otolaryngology-Head and Neck Surgery, Morgantown, West Virginia
| | - Meghan Tracy
- Children's Mercy Hospital, Division of Otolaryngology
| | - Jill M Arganbright
- Children's Mercy Hospital, Division of Otolaryngology
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
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Bory C, Bory O, Guelfucci B, Nicollas R, Moreddu E. Deep cervical abscesses in children: efficacy of the cefotaxime-rifampicin combination. Eur J Pediatr 2023; 182:2315-2324. [PMID: 36881146 DOI: 10.1007/s00431-023-04917-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
The objective is to determine whether a medical treatment, the combination of cefotaxime and rifampicin, is effective in avoiding surgery for managing deep cervical abscesses in children and to determine prognostic factors in the efficacy of this medical treatment. This is a retrospective analysis of all patients under 18 presenting with para- or retro-pharyngeal abscess over the period 2010-2020 in two hospitals' pediatric otorhinolaryngology departments. One hundred six records were included. Multivariate analyses were performed to study the relationship between the prescription of the Cefotaxime-rifampicin protocol at the onset of the management and the use of surgery and to evaluate the prognostic factors of its efficacy. The 53 patients who received the cefotaxime-rifampicin protocol as first-line treatment (vs. 53 patients receiving a different protocol) required surgery less frequently: 7.5% versus 32.1%, validated by a Kaplan-Meier survival curve and a Cox model analysis adjusted for age and abscess size (Hazard Ratio = 0.21). This good outcome of the cefotaxime-rifampicin protocol was not demonstrated when it was instituted as a second-line treatment after the failure of a different protocol. An abscess larger than 32 mm at hospitalization was significantly associated with more frequent use of surgery in multivariate analysis adjusted for age and sex (Hazard Ratio = 8.5). Conclusions: The cefotaxime-rifampicin protocol appears to be an effective first-line treatment in managing non-complicated deep cervical abscesses in children. What is Known: • Nowadays, medical treatment is preferred for managing deep neck abscesses in children. There has yet to be a consensus on the antibiotic therapy to be proposed. • Staphylococcus aureus and streptococci are the most frequent causative organisms. What is New: • The cefotaxime-rifampicin protocol introduced at first intention is effective, with only 7.5% of patients requiring drainage surgery. • The only risk factor for failure of the medical treatment is the initial size of the abscess.
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Affiliation(s)
- Céline Bory
- Department of Pediatric Otorhinolaryngology-Head and Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, 264 rue Saint Pierre, 13385 Cedex 05, Marseille, France
- Department of Otorhinolaryngology-Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Olivier Bory
- Department of Ambulatory Medicine, Louis Mourier Hospital, Université de Paris, Paris, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology-Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Richard Nicollas
- Department of Pediatric Otorhinolaryngology-Head and Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, 264 rue Saint Pierre, 13385 Cedex 05, Marseille, France.
| | - Eric Moreddu
- Department of Pediatric Otorhinolaryngology-Head and Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, 264 rue Saint Pierre, 13385 Cedex 05, Marseille, France.
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Muacevic A, Adler JR. Complications and Diagnosis of Branchial Cleft Cysts: A Case Report. Cureus 2022; 14:e32667. [PMID: 36660529 PMCID: PMC9845494 DOI: 10.7759/cureus.32667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
Branchial cleft cysts (BCCs) are congenital anomalies that can be found in children and young adults. The exact incidence of these anomalies is unknown as the diagnosis may be missed. Branchial cleft cysts can present in a variety of locations depending on the cleft they are derived from. Regardless of location, branchial cleft cysts are rather benign. However, a variety of complications can arise due to infection, and infections are often recurrent. Diagnosis may occur incidentally on imaging studies as such studies are often performed to rule out a variety of complications from infections alone. Treatment includes first treating any infection and any such complications that exist, followed by surgical excision. Surgical excision is performed to prevent the recurrence of infection. A case of a 14-year-old female with a painful swollen throat, trismus, and difficulty swallowing is reported.
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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 meta-analysis of positive predictive value. PLoS One 2022; 17:e0276544. [PMID: 36288374 PMCID: PMC9604924 DOI: 10.1371/journal.pone.0276544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/08/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To review the diagnostic accuracy of contrast-enhanced computed tomography (CT) in differentiating abscesses from cellulitis in patients with neck infections, using surgical findings as the reference standard. MATERIALS AND METHODS Previous studies in the last 32 years were searched from PubMed and Embase. Because of partial verification bias (only positive abscess findings are usually verified surgically), sensitivity and specificity estimates are unreliable, and we focused on positive predictive value (PPV). For all studies, PPV was calculated as the proportion of true positives out of all positives on imaging. To estimate pooled PPV, we used both the median with an interquartile range and a model-based estimate. For narrative purposes, we reviewed the utility of common morphological CT criteria for abscesses, such as central hypodensity, the size of the collection, bulging, rim enhancement, and presence of air, as well as sensitivity and specificity values reported by the original reports. RESULTS 23 studies were found reporting 1453 patients, 14 studies in children (771 patients), two in adults (137 patients), and seven including all ages (545 patients). PPV ranged from 0.67 to 0.97 in individual studies, had a median of 0.84 (0.79-0.87), and a model-based pooled estimate of 0.83 (95% confidence interval 0.80-0.85). Most morphological CT criteria had considerable overlap between abscesses and cellulitis. CONCLUSIONS The pooled estimate of PPV is 0.83 for diagnosing neck abscesses with CT. False positives may be due to limited soft tissue contrast resolution. Overall, none of the morphological criteria seem to be highly accurate for differentiation between abscess and cellulitis.
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Affiliation(s)
- Jon Hagelberg
- Department of Radiology, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere University, Tampere, Finland
| | - Bernd Pape
- Turku Clinical Research Center, Turku University Hospital, Turku, Finland
- School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | - Jaakko Heikkinen
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Janne Nurminen
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Kimmo Mattila
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere University, Tampere, Finland
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
- * E-mail:
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Waśniewska-Włodarczyk A, Pepaś R, Janowicz R, Konopka W. Streptococcus equi subsp. equi in Retropharyngeal Abscess: Case Report and Review of Literature. Microorganisms 2022; 10:microorganisms10102032. [PMID: 36296308 PMCID: PMC9610968 DOI: 10.3390/microorganisms10102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 11/15/2022] Open
Abstract
Retropharyngeal abscesses (RPAs) represent the group of deep space infections of the neck. Although RPA is a well-known condition, some aspects of it still may be challenging. Localization, symptoms, and etiology may confuse even the most experienced physicians. S. equi subspecies are zoonotic agents and cause multiple diseases in diverse animals. Infections in humans are rare. This report presents an extremely rare case of retropharyngeal abscess in a 12-year-old girl caused by an infection of Streptococcus equi subsp. equi.
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Affiliation(s)
- Anna Waśniewska-Włodarczyk
- Department of Otolaryngology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
- Department of Normal and Clinical Anatomy, Medical University of Lodz, 90-419 Lodz, Poland
- Correspondence:
| | - Renata Pepaś
- Department of Otolaryngology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | - Renata Janowicz
- Department of Otolaryngology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | - Wiesław Konopka
- Department of Otolaryngology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
- Department of Paediatric Didactics, Medical University of Lodz, 90-419 Lodz, Poland
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Villanueva-Fernández E, Casanueva-Muruáis R, Vivanco-Allende A, Llorente JL, Coca-Pelaz A. Role of steroids in conservative treatment of parapharyngeal and retropharyngeal abscess in children. Eur Arch Otorhinolaryngol 2022; 279:5331-5338. [PMID: 35767057 PMCID: PMC9519669 DOI: 10.1007/s00405-022-07423-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/25/2022] [Indexed: 11/17/2022]
Abstract
Purpose To characterize the clinical features and outcomes of pediatric patients with retropharyngeal (RPA) or parapharyngeal abscesses (PPA) managed only with medical treatment and showing the importance of early symptoms and imaging studies in the diagnosis of deep neck space infections (DNIs) in children. Methods A retrospective analysis of all patients diagnosed with RPA and PPA between 2007 and 2017 was performed in Hospital Universitario Central de Asturias. Results 30 children were identified, with 11 RPA and 19 PPA. 23 children (76.7%) were under 5 years old, and all were treated with intravenous amoxicillin/clavulanic acid and corticosteroids. Torticollis and fever were present in all patients. The mean length of hospital stay was 7.5 days. There were no complications associated. Conclusion DNIs can be treated in a conservative way, reserving the surgical drainage for cases with a complication associated (airway compromise, lack of response to antibiotic therapy, immunocompromised patients). Treatment with intravenous antibiotics and corticosteroids is a safe option, reducing the duration of symptoms and the length of hospital stay.
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Affiliation(s)
- Eva Villanueva-Fernández
- Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Avenida de Roma s/n, 3301, Oviedo, Spain.
| | - R Casanueva-Muruáis
- Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Avenida de Roma s/n, 3301, Oviedo, Spain
| | - A Vivanco-Allende
- Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J L Llorente
- Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Avenida de Roma s/n, 3301, Oviedo, Spain.,University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - A Coca-Pelaz
- Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Avenida de Roma s/n, 3301, Oviedo, Spain.,University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
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12
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Perina V, Szaraz D, Harazim H, Urik M, Klabusayova E. Paediatric Deep Neck Infection—The Risk of Needing Intensive Care. CHILDREN 2022; 9:children9070979. [PMID: 35883963 PMCID: PMC9315740 DOI: 10.3390/children9070979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/19/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022]
Abstract
Deep neck infections are potentially dangerous complications of upper respiratory tract or odontogenic infections. The pathophysiology, clinical presentation, and potential spreading depend on the complex anatomy of the neck fascia. These infections can lead to severe pathological conditions, such as mediastinitis, sepsis, and especially airway impairment with difficult management. Because of the risk of life-threatening emergency situations and the possible impacts on the overall health status of affected children, their early recognition is of utmost importance. Torticollis, drooling, and stridor are the most common signs of advancing disease. Children presenting with these symptoms should be admitted to the paediatric intensive care unit for vital function monitoring, where the airway could be readily secured if function is compromised.
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Affiliation(s)
- Vojtech Perina
- Department of Oral and Maxillofacial Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavska 20, 625 00 Brno, Czech Republic; (V.P.); (D.S.)
| | - David Szaraz
- Department of Oral and Maxillofacial Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavska 20, 625 00 Brno, Czech Republic; (V.P.); (D.S.)
| | - Hana Harazim
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic;
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Milan Urik
- Department of Paediatric Otorhinolaryngology, University Hospital Brno, Faculty of Medicine, Masaryk University, Cernopolni 9, 662 63 Brno, Czech Republic;
| | - Eva Klabusayova
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic;
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Correspondence: ; Tel.: +420-532-234-693
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Conte M, Vinci F, Muzzi E, Canuto A, Barbi E, Cozzi G. Magnetic resonance imaging accuracy before surgery in children with retropharyngeal abscesses. J Paediatr Child Health 2022; 58:504-507. [PMID: 34605585 DOI: 10.1111/jpc.15761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
AIMS Retropharyngeal abscess (RPA) is a deep neck infection occurring in childhood. The gold standard technique for diagnosis is computerised tomography (CT) with a contrast medium. The aim of this study is to answer the question of whether magnetic resonance imaging (MRI) can be an alternative in diagnosing RPA and predicting pus drainage at surgery. METHODS This is a retrospective study conducted at the paediatric emergency department of a tertiary level children hospital. The medical records of 31 children admitted to the Otorhinolaryngology and Paediatric ward, with a suspected diagnosis of RPA, were reviewed. The primary study outcome was the diagnostic accuracy of CT and MRI in predicting the amount of pus during surgery. RESULTS Twenty-two patients (71%) underwent surgery. Among them, 18 had imaging before surgery. Eleven patients evaluated with CT scan underwent surgery: four had non-significant purulent drainage, three of them were reported to have a significant fluid collection (negative predictive value 66% and positive predictive value of 55%). Nine patients evaluated with MRI underwent surgery: four cases had non-significant purulent drainage, three of them showed a significant fluid collection at MRI (negative predictive value of 60%; positive predictive value of 56%). CONCLUSION MRI and CT scans showed similar accuracy in predicting successful pus drainage during surgery; therefore, it could be a valid alternative in the diagnosis of RPA in children.
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Affiliation(s)
- Mariasole Conte
- Pediatric Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Francesco Vinci
- Otorhinolaryngology and Audiology, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Enrico Muzzi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Arianna Canuto
- Pediatric Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Pediatric Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.,Otorhinolaryngology and Audiology, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Giorgio Cozzi
- Pediatric Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
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14
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Donà D, Gastaldi A, Campagna M, Montagnani C, Galli L, Trapani S, Pierossi N, De Luca M, D'Argenio P, Tucci FM, De Vincentiis G, Grotto P, Da Mosto MC, Frigo AC, Volo T, Emanuelli E, Martini A, Da Dalt L. Deep Neck Abscesses in Children: An Italian Retrospective Study. Pediatr Emerg Care 2021; 37:e1358-e1365. [PMID: 32097379 DOI: 10.1097/pec.0000000000002037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Retropharyngeal and parapharyngeal abscesses (RPAs, PPAs) usually affect young children. Surgical drainage and/or antibiotic therapy are treatment of choice, but no specific guidelines exist. In order to reduce the risk of severe complications, appropriate diagnosis and therapy are necessary. The aims of the study were to review diagnosis and management of children with RPAs/PPAs and to compare surgical versus medical approach. METHODS This is a multicenter retrospective study including all patients younger than 15 years admitted at 4 Italian pediatric hospitals of Florence, Padua, Rome, and Treviso, with International Classification of Diseases, Ninth Revision discharge diagnosis code of RPAs and PPAs, from January 1, 2008, to December 31, 2016. RESULTS One hundred fifty-three children were included. The median age was 4.4 years, with overall male predominance. Heterogeneous signs and symptoms (fever, neck cervical, lymphadenopathy, pain, and stiff neck most frequently) and a large mixture of bacteria from pus cultures were detected. Computer tomography (66.7%) and magnetic resonance imaging (27.5%) were performed to confirm the presence of abscess. Fifty-one percent of abscesses were greater than 3 cm. Eighty-seven patients (56.9%) underwent surgery, and 66 (43.1%) were treated with antibiotics alone (mostly ceftriaxone, metronidazole, amikacin, and clindamycin) with median days of therapy of 26.5 days and length of therapy of 16.0 days of median. Median length of stay was 11 days. None had severe complications. Multivariate analysis indicated as independent predictive factors of surgery abscess of 3 cm or greater, high white blood cell count, and-most of all-the hospital of admission. CONCLUSIONS Deep neck abscesses mostly affect patients in early childhood, with a combination of nonspecific signs and symptoms, and it still emerges as a heterogeneous approach in diagnosis and management of these infections. Thus, common shared protocols represent an essential tool in order to standardize care and improve patients' outcomes.
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Affiliation(s)
- Daniele Donà
- From the Division of Pediatric Infectious Diseases
| | - Andrea Gastaldi
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua
| | - Marta Campagna
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua
| | - Carlotta Montagnani
- Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence
| | | | - Sandra Trapani
- Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence
| | - Nicola Pierossi
- Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence
| | - Maia De Luca
- Unit of Immune and Infectious Diseases, University Department of Pediatrics, Bambino Gesù Children's Hospital
| | - Patrizia D'Argenio
- Unit of Immune and Infectious Diseases, University Department of Pediatrics, Bambino Gesù Children's Hospital
| | - Filippo Maria Tucci
- Unit of Otolaryngology-Head and Neck Surgery, Bambino Gesù Children's Hospital Research Institute, Rome
| | - Giovanni De Vincentiis
- Unit of Otolaryngology-Head and Neck Surgery, Bambino Gesù Children's Hospital Research Institute, Rome
| | - Paolo Grotto
- Division of Pediatrics, S. Maria of Ca' Foncello
| | - Maria Cristina Da Mosto
- Department of Neurosciences, University of Padua, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, Treviso
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences
| | - Tiziana Volo
- Department of Otolaryngology and Endoscopic Surgery of the Upper Airways, University of Padua, Padua, Italy
| | - Enzo Emanuelli
- Department of Otolaryngology and Endoscopic Surgery of the Upper Airways, University of Padua, Padua, Italy
| | - Alessandro Martini
- Department of Otolaryngology and Endoscopic Surgery of the Upper Airways, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua
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Torretta S, Ibba T, Guastella C, Gaini L, Di Cicco M, Folino F, Marchisio P, Bosis S, Pinzani R, D'Amico M, Pignataro L. Management of upper retropharyngeal abscesses in children: Two case reports of a troublesome situation. Clin Case Rep 2021; 9:e04598. [PMID: 34631059 PMCID: PMC8489505 DOI: 10.1002/ccr3.4598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/13/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022] Open
Abstract
Management of upper retropharyngeal abscesses in children is challenging. In surgical cases, ultrasound-assisted intra-operative procedures may be helpful to reach peculiar locations, thus reducing surgical morbidity and complications rate.
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Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | - Tullio Ibba
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Claudio Guastella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Lorenzo Gaini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Maurizio Di Cicco
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Francesco Folino
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
| | - Samantha Bosis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Raffaella Pinzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Mario D'Amico
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
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Klug TE, Andersen C, Hahn P, Danstrup CS, Petersen NK, Mikkelsen S, Døssing H, Christensen AL, Rusan M, Kjeldsen A, Greve T. Clinical evaluation of antibiotic regimens in patients with surgically verified parapharyngeal abscess: a prospective observational study. Eur Arch Otorhinolaryngol 2021; 279:2057-2067. [PMID: 34196735 DOI: 10.1007/s00405-021-06962-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to evaluate the effectiveness of different antibiotic regimens for the treatment of parapharyngeal abscess (PPA) and characterize patients, who suffered potentially preventable complications (defined as death, abscess recurrence, spread of infection, or altered antibiotic treatment because of insufficient progress). METHODS Sixty adult patients with surgically verified PPA were prospectively enrolled at five Danish Ear-nose-throat departments. RESULTS Surgical treatment included internal incision (100%), external incision (13%), and tonsillectomy (88%). Patients were treated with penicillin G ± metronidazole (n = 39), cefuroxime ± metronidazole (n = 16), or other antibiotics (n = 5). Compared to penicillin-treated patients, cefuroxime-treated patients were hospitalized for longer (4.5 vs 3.0 days, p = 0.007), were more frequently admitted to intensive care (56 vs 15%, p = 0.006), underwent external incision more frequently (31 vs 5%, p = 0.018), and suffered more complications (50 vs 18%, p = 0.022), including re-operation because of abscess recurrence (44 vs 3%, p < 0.001). Nine patients suffered potentially preventable complications. These patients displayed significantly higher C-reactive protein levels, received antibiotics prior to admission more frequently, underwent external incision more commonly, and were admitted to intensive care more frequently compared to other patients. CONCLUSION The majority of patients with PPA were effectively managed by abscess incision, tonsillectomy, and penicillin G ± metronidazole. Cefuroxime-treated patients were more severely ill at time of admission and had worse outcome compared to penicillin-treated patients. We recommend penicillin G + metronidazole as standard treatment for patients with PPA, but in cases with more risk factors for potentially preventable complications, we recommend aggressive surgical and broadened antibiotic therapy, e.g. piperacillin-tazobactam.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
| | - Camilla Andersen
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Pernille Hahn
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Lillebaelt, Vejle, Denmark
| | - Christian Sander Danstrup
- Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Krintel Petersen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Sophie Mikkelsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Døssing
- Department of Otorhinolaryngology, Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Anne-Louise Christensen
- Department of Otorhinolaryngology, Head and Neck Surgery, Regional Hospital, Holstebro, Denmark
| | - Maria Rusan
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Anette Kjeldsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
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Velhonoja J, Lääveri M, Soukka T, Hirvonen J, Kinnunen I, Irjala H. Early surgical intervention enhances recovery of severe pediatric deep neck infection patients. Int J Pediatr Otorhinolaryngol 2021; 144:110694. [PMID: 33799100 DOI: 10.1016/j.ijporl.2021.110694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Pediatric deep neck space infection (DNI) is a relatively rare but potentially life-threatening condition and requires prompt and accurate management. This study retrospectively reviews our experience in a tertiary referral hospital from 2004 to 2019. METHODS Systematic data collection from medical records using ICD10 codes between 2004 and 2019. INCLUSION CRITERIA age ≤16 years, DNI requiring hospitalization and/or surgery. EXCLUSION: peritonsillar abscess without complications. RESULTS We identified 42 patients, 21 boys and 21 girls, with a median age of 4.9 years. Most of the patients had severe symptoms, the most common of which were neck swelling (n = 39; 92.9%), neck pain (n = 39; 92.9%) and fever (n = 32; 76.2%). Twenty-two (52.4%) had torticollis, and the mean duration of symptoms before hospitalization was 4.95 days. Diagnosis was confirmed by MRI (n = 24), contrast-enhanced CT (n = 11) or ultrasonography (n = 6), except in one case. Twenty-three (54.8%) required an open neck incision, ten (23.8%) patients had intraoral surgery and nine were treated conservatively. Twelve (28.6%) patients were admitted to the pediatric ICU. Median hospitalization duration was six days. The infection most commonly had tonsillopharyngeal etiology (n = 18) and a retropharyngeal location (n = 17). Staphylococcus Aureus (n = 7) and Streptococcus pyogenes (n = 7) were the most frequent pathogens. We compared the early surgical intervention group (<2 days of intravenous antibiotics; n = 18; 42.9%) to the late surgery group (n = 15; 35.7%) and the conservatively treated groups (n = 9; 21.4%). The overall length of stay (LOS) was lower in the shorter preoperative medication group (mean 4.4 vs. 7.2; p = 0.009). The size of the abscess did not differ between the groups (mean 28 mm; 30 mm; 21 mm; p = 0.075) and the neck incision rate was similar in the operated groups. CONCLUSION Early surgical intervention is associated with decreased LOS among severe pediatric DNI patients.
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Affiliation(s)
- Jarno Velhonoja
- Department of Otorhinolaryngology and Head and Neck Surgery, Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520, Turku, Finland.
| | - Meira Lääveri
- Department of Oral and Maxillofacial Surgery, Turku University Hospital and University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland.
| | - Tero Soukka
- Department of Oral and Maxillofacial Surgery, Turku University Hospital and University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland.
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520, Turku, Finland.
| | - Ilpo Kinnunen
- Department of Otorhinolaryngology and Head and Neck Surgery, Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520, Turku, Finland.
| | - Heikki Irjala
- Department of Otorhinolaryngology and Head and Neck Surgery, Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520, Turku, Finland.
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18
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Stevens C, Ladd P, Ghadersohi S, Gitomer SA. Minimally invasive transoral image-guided drainage of a retropharyngeal abscess with mediastinal extension. Int J Pediatr Otorhinolaryngol 2020; 138:110288. [PMID: 32836140 DOI: 10.1016/j.ijporl.2020.110288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Abstract
Retropharyngeal abscess (RPA) in children is a serious deep neck space infection that rarely is complicated by extension into the mediastinum. RPA with mediastinal abscess requires prompt surgical management, generally via external or transoral approach. We present the case of a 3-year-old boy with RPA with mediastinal extension who was managed with a unique multidisciplinary surgical approach with otolaryngology and interventional radiology. A transoral approach was utilized to pass a transnasal drain with image guidance into the mediastinal fluid collection. This report reviews the presentation and surgical management of RPA with mediastinal extension and describes a unique minimally invasive approach to drainage.
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Affiliation(s)
| | - Patricia Ladd
- Division of Pediatric Radiology, Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Saied Ghadersohi
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA
| | - Sarah A Gitomer
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA.
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19
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Malia L, Sivitz A, Chicaiza H. A novel approach: Point-of-care ultrasound for the diagnosis of retropharyngeal abscess. Am J Emerg Med 2020; 46:271-275. [PMID: 33046324 DOI: 10.1016/j.ajem.2020.07.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Laurie Malia
- Department of Emergency Medicine, Columbia University Medical Center/Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, United States of America.
| | - Adam Sivitz
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Children's Hospital of New Jersey, Newark, NJ, United States of America
| | - Henry Chicaiza
- Department of Pediatric Emergency Medicine, Connecticut Children's Medical Center, Hartford, CT, United States of America
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20
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Utility of Soft Tissue Lateral Neck Radiographs in the Emergency Department: The 5-Year Experience of a Large Tertiary Care Pediatric Hospital. Pediatr Emerg Care 2020; 36:e254-e257. [PMID: 29084070 DOI: 10.1097/pec.0000000000001318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although retropharyngeal infection (RPI) may present with voice change, drooling, fever, and a toxic appearance, diagnosis based on symptoms alone is unreliable. As incidence is increasing in children and drug-resistant bacterial strains such as methicillin-resistant Staphylococcus aureus are becoming more common, we decided to assess the clinical utility of lateral neck radiography. OBJECTIVE The aim of this study was to review the experience of a large tertiary care pediatric emergency department (ED) in using lateral soft tissue neck radiographs in the diagnosis of suspected RPI. METHODS A retrospective analysis of all lateral soft tissue neck radiograph reports from 2011 to 2015 in conjunction with a review of patients' charts to describe clinical and laboratory findings, disposition, and final diagnosis was performed. Patients aged 31 days to 18 years who presented to the ED with suspicion of RPI were included. RESULTS Review of 366 radiographic reports revealed that 46 were positive for RPI, 286 were negative, and 34 indeterminate. A final discharge diagnosis of RPI was made in 38 patients. Lateral neck radiographs had a sensitivity of 84.3% and a specificity of 93.7% for diagnosing RPI. In triage, most patients had no fever (264, 72.1%), stridor (356, 97%), drooling (348, 95%), or voice change (342, 93%). Surgical intervention occurred in 15 patients (39.5%) with a final diagnosis of RPI. CONCLUSIONS Lateral neck radiography is useful for diagnosis of RPI in the ED with good sensitivity and specificity. Additional imaging is to be considered at the behest of physician's clinical judgment.
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Desai S, Shah SS, Hall M, Richardson TE, Thomson JE. Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis. J Hosp Med 2020; 15:197-203. [PMID: 31891560 PMCID: PMC7153489 DOI: 10.12788/jhm.3333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This study aimed to describe variation in imaging practices and examine the association between early imaging and outcomes in children hospitalized with cervical lymphadenitis. METHODS This multicenter cross-sectional study included children between two months and 18 years hospitalized with cervical lymphadenitis between 2013 and 2017. Children with complex chronic conditions, transferred from another institution, and with prior hospitalizations for lymphadenitis were excluded. To examine hospital-level variation, we calculated the proportion of children at each hospital who received any imaging study, early imaging (conducted on day 0 of hospitalization), multiple imaging studies, and CT imaging. Generalized linear or logistic mixed effects models examined the association between early imaging and outcomes (ie, multiple imaging studies, surgical drainage, 30-day readmission, and length of stay) while accounting for patient demographics, markers of illness duration and severity, and clustering by hospital. RESULTS Among 10,014 children with cervical lymphadenitis, 61% received early imaging. There was hospital-level variation in imaging practices. Compared with children who did not receive early imaging, children who received early imaging presented increased odds of having multiple imaging studies (adjusted odds ratio [aOR] 3.0; 95% CI: 2.6-3.6), surgical drainage (aOR 1.3, 95%CI: 1.1-1.4), and 30-day readmission for lymphadenitis (aOR 1.5, 95%CI: 1.2-1.9), as well as longer lengths of stay (adjusted rate ratio 1.2, 95%CI: 1.1-1.2). CONCLUSIONS Children receiving early imaging had more resource utilization and intervention than those without early imaging. Our findings may represent a cascade effect, in which routinely conducted early imaging prompts clinicians to pursue additional testing and interventions in this population.
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Affiliation(s)
- Sanyukta Desai
- Division of Hospital Medicine, Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
- Corresponding Author: Sanyukta Desai, MD; E-mail: ; Telephone: 206-987-7370
| | - Samir S Shah
- Divisions of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Divisions of Infectious Diseases, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | | | - Joanna E Thomson
- Divisions of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Clinical characteristics for conservative therapy of pediatric parapharyngeal abscesses. Braz J Otorhinolaryngol 2019; 87:410-415. [PMID: 32169554 PMCID: PMC9422428 DOI: 10.1016/j.bjorl.2019.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/26/2019] [Accepted: 10/04/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction The role of surgical drainage versus conservative therapy in treating patients with parapharyngeal abscesses is still a theme of debate. Objectives This study aimed to investigate the characteristics associated with good outcomes in pediatric patients with parapharyngeal abscesses treated with conservative therapy. Methods This retrospective chart review was performed on children aged 0.3–14 years with the diagnosis of parapharyngeal abscesses confirmed by computed tomography from January 2013 to March 2018. Patients with a severe upper airway obstruction required early intervention, while those in a stable condition initially received conservative therapy with antibiotics. If the patients appeared unlikely to recover, additional surgical drainage was provided. Multivariate logistic regression models were constructed to investigate the clinical characteristics associated with a good response to conservative therapy. A receiver operating characteristic curve was used to identify the age and abscess size cutoff for predicting a successful response. Results A total of 48 children were included in the study. Patient age, antecedent illness, and abscess size were significantly associated with a response to therapy (Odds Ratio = 1.326, 2.314 and 1.235, respectively). The age cutoff associated with the conservative therapy was 4.2 years (76.9% sensitivity, 68.2% specificity), and the abscess size cutoff associated with the conservative therapy was 23 mm (84.6% sensitivity, 77.3% specificity). Conclusion The findings suggested that younger age, smaller abscess size, and less frequent antecedent illnesses, such as upper respiratory tract infection and lymphadenitis, could predict a successful response to conservative therapy in pediatric patients with parapharyngeal abscesses.
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A Perspective of Clinical Behaviour and Management of Deep Neck Space Infections (DNSI): The Clinical Conundrum. Indian J Otolaryngol Head Neck Surg 2019; 71:594-604. [PMID: 31742027 DOI: 10.1007/s12070-018-1423-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022] Open
Abstract
The diagnosis and management of deep neck space infections remain a challenging task for otolaryngologists. A retrospective observational analysis of 137 cases of deep neck infections at a tertiary care centre was reviewed. We present 137 treated cases of DNSIs in a retrospective 5 years clinical study conducted in the department of otolaryngology at a tertiary care center from January 2012 to December 2016. Demographic information, Socio-economic data, etiopathogenesis, clinical presentation, spaces involved, diagnosis, and treatment strategies, associated morbidities, course and complications were analysed and compared with past experiences. Odontogenic and salivary gland infections causes were the most common source of DNIs. Major complication observed was skin defect. In this study, submandibular space infection was found to be the most common space involved in DNSI. Pain (100%) was the most common clinical complaint followed by neck swelling (65.69%). Staphylococcus aureus (38 cases) was the most common micro-organism isolated. Surgical intervention was the main modality of treatment and there was one mortality. DNSIs are fairly common challenging and potentially lethal entities which can lead to severe complications in a very short time, should there be delay in its prompt diagnosis and management. Computerized Tomography Scan (CT scan) with contrast is the investigation of choice in diagnosing DNSIs. Assessment of airway control must take precedence.
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Lim S, Lee NY, Han SB, Jeong DC, Kang JH. Deep Neck Inflammation: Probable Kawasaki Disease in Korean Children. Clin Exp Otorhinolaryngol 2019; 13:77-82. [PMID: 31599139 PMCID: PMC7010501 DOI: 10.21053/ceo.2019.00948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/23/2019] [Indexed: 11/27/2022] Open
Abstract
Objectives Deep neck infections (DNIs) can cause life-threatening complications, and prompt diagnosis and management are necessary. Kawasaki disease (KD) may be accompanied by deep neck inflammation; making it difficult to distinguish from DNIs. This study was performed to evaluate clinical features and outcomes of children with parapharyngeal and retropharyngeal inflammation. Methods Medical records of the children diagnosed with parapharyngeal and retropharyngeal cellulitis or abscess using cervical computed tomography (CT) between 2013 and 2017 were retrospectively reviewed. Results A total of 47 children were diagnosed with parapharyngeal and retropharyngeal inflammation. Eleven (23.4%) of them were eventually diagnosed with KD, and 36 (76.6%) were diagnosed with DNIs. There were no significantly different clinical and laboratory characteristics on admission between children diagnosed with KD and DNIs; however, significantly more children with KD were febrile for ≥3 days after admission compared to those with DNIs (P=0.009). Deep neck abscesses on CT were observed in 16 children with DNIs (44.4%) and in no child with KD (P=0.009). Among the 36 children with DNIs, 30 (83.3%) were cured with antibiotic therapy only. Conclusion A quarter of children presenting with deep neck inflammation were diagnosed with KD. KD should be considered in children showing deep neck inflammation unresponsive to empirical antibiotic therapy after 3 days, especially in those presenting with deep neck cellulitis rather than deep neck abscess.
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Affiliation(s)
- Sooyeon Lim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Na Young Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Chul Jeong
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Carroll W, Van Beck J, Roby B. Is vessel narrowing secondary to pediatric deep neck space infections of clinical significance? Int J Pediatr Otorhinolaryngol 2019; 125:56-58. [PMID: 31254914 DOI: 10.1016/j.ijporl.2019.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pediatric deep neck space infections (DNSI) may cause internal jugular vein and/or carotid artery narrowing. Radiologists and otolaryngologists are often queried by emergency room providers and pediatricians with regards to the clinical significance when this radiographic finding is noted. There are often questions raised about need for further imaging, anticoagulation and overall management strategy. There is limited data to support our answers to these questions. This study investigated the clinical significance of vessel narrowing of the internal jugular vein and carotid artery in the setting of DNSI in children. METHODS 208 patients over a 10 year period were reviewed in retrospective fashion. CT scans reports were evaluated for vessel narrowing, and clinical outcomes were analyzed. RESULTS This study found that nearly half (44.7%, 93 of 208) of pediatric DNSIs reviewed showed evidence of either carotid and/or internal jugular vein narrowing. There was no significant difference in vascular complications in those with vessel narrowing and those without (p = 0.09). There were no observed neurologic complications in either group. CONCLUSIONS Vessel narrowing is a very common finding in pediatric DNSI. Vascular complications are very rare, and importantly no patients had neurologic complications in either group (vessel narrowing or not). We found no evidence to support more aggressive surgical management, getting further imaging, starting anticoagulation, nor changing overall management strategy for patients based solely to the finding of vessel narrowing in DNSI.
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Affiliation(s)
- William Carroll
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, MN, USA; University of Minnesota, Department of Otolaryngology, Minneapolis, MN, USA.
| | - Jenna Van Beck
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, MN, USA; University of Minnesota, Department of Otolaryngology, Minneapolis, MN, USA
| | - Brianne Roby
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, MN, USA; University of Minnesota, Department of Otolaryngology, Minneapolis, MN, USA
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Gill C, Scott O, Beck CE. A Toddler With Prolonged Fever and Intermittent Cough. Glob Pediatr Health 2019; 6:2333794X18822999. [PMID: 30719495 PMCID: PMC6348535 DOI: 10.1177/2333794x18822999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 11/17/2022] Open
Abstract
Fever of unknown origin is an important diagnostic challenge in pediatrics that requires a thoughtful approach. The differential diagnosis is broad and includes infectious, autoimmune, oncologic, neurologic, genetic, and iatrogenic causes. Infection remains the most common etiology, and uncommon presentations of infections are still more likely than classic presentations of rare conditions. We report a case of a retropharyngeal abscess in a toddler whose presentation is marked by a prolonged fever (>3 weeks). This case highlights the importance of close follow-up with serially repeated history and physical examinations to guide the evaluation of a patient with fever of unknown origin.
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Affiliation(s)
- Carson Gill
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Ori Scott
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carolyn E Beck
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada.,Univeristy of Toronto, Toronto, Ontario, Canada
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Abstract
This article reviews the presentation, diagnosis, and management of common and "can't miss" infections of the oropharynx, including streptococcal pharyngitis, infectious mononucleosis, peritonsillar abscess, retropharyngeal abscess, and epiglottitis.
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Affiliation(s)
- Matthew R Klein
- Department of Emergency Medicine, Northwestern University, 211 East Ontario - Suite 300, Chicago, IL 60611, USA.
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28
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Freeman R. An apparently simple case of fever and sore throat. Arch Dis Child Educ Pract Ed 2018; 103:194-196. [PMID: 28500023 DOI: 10.1136/archdischild-2016-312234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/25/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Richard Freeman
- Children's Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, UK
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Ban MJ, Jung JY, Kim JW, Park KN, Lee SW, Koh YW, Park JH. A clinical prediction score to determine surgical drainage of deep neck infection: A retrospective case-control study. Int J Surg 2018; 52:131-135. [PMID: 29455048 DOI: 10.1016/j.ijsu.2018.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/27/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of this retrospective study was to identify predictors of an abscess guaranteed to be surgically drained successfully in patients with deep neck infection (DNI). MATERIALS AND METHODS We divided 97 consecutive patients with DNI into a drained group and a non-drained group. We then developed a clinical prediction score and validated it in 32 further patients. RESULTS Significant predictors of successful surgical drainage (i.e., positive for pus) were rim enhancement on computed tomography, C-reactive protein, erythrocyte sedimentation rate, and the neutrophil to lymphocyte ratio. The estimated cut-off values (excluding rim enhancement, which is a yes/no parameter) were 41.25, 56.5, and 8.02, respectively, and the clinical prediction score for each of the four other factors was determined to be 2, 2, 3, and 3 points, respectively. The cut-off score for the sum of these points was 6.5 and the scoring system had an accuracy of 87.5% in the validation group. CONCLUSION Our clinical prediction scoring system can predict whether drainage is successful in patients with DNI.
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Affiliation(s)
- Myung Jin Ban
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; Department of Medicine, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Jae Yeup Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Jae Wook Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Ki Nam Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Seung Won Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Hong Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
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Infections of the Upper and Middle Airways. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152082 DOI: 10.1016/b978-0-323-40181-4.00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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LeRiger MM, Miler V, Tobias JD, Raman VT, Elmaraghy CA, Jatana KR. Potential for severe airway obstruction from pediatric retropharyngeal abscess. Int Med Case Rep J 2017; 10:381-384. [PMID: 29200894 PMCID: PMC5703170 DOI: 10.2147/imcrj.s146661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Retropharyngeal abscesses in the pediatric population can cause severe respiratory distress. We report a rare case of significant airway obstruction in a 14-month-old patient requiring rapid, emergent tracheotomy after attempts at endotracheal intubation by an experienced airway surgeon were unsuccessful. The patient was diagnosed with streptococcal pharyngitis 9 days prior to presentation to our facility and was being treated with amoxicillin. Prompt diagnosis, communication, and appropriate multidisciplinary airway management can lead to successful outcomes even in these severe cases.
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Affiliation(s)
- Michelle M LeRiger
- Division of Pediatric Anesthesiology, Omaha Children's Hospital & Medical Center.,Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | | | | | | | - Charles A Elmaraghy
- Department of Pediatric Otolaryngology-Head & Neck Surgery, Nationwide Children's Hospital.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at Ohio State University, Columbus, OH, USA
| | - Kris R Jatana
- Department of Pediatric Otolaryngology-Head & Neck Surgery, Nationwide Children's Hospital.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at Ohio State University, Columbus, OH, USA
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Moreddu E, Le Treut C, Triglia JM, Nicollas R. Abscess with osteomyelitis of the clivus after adenoidectomy: An uncommon complication of a common procedure. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 135:81-82. [PMID: 29107573 DOI: 10.1016/j.anorl.2017.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- E Moreddu
- Service d'ORL et chirurgie cervico-faciale pédiatrique, hôpital d'Enfants-de-la-Timone (Aix-Marseille-Université), 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
| | - C Le Treut
- Service d'ORL et chirurgie cervico-faciale pédiatrique, hôpital d'Enfants-de-la-Timone (Aix-Marseille-Université), 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - J-M Triglia
- Service d'ORL et chirurgie cervico-faciale pédiatrique, hôpital d'Enfants-de-la-Timone (Aix-Marseille-Université), 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - R Nicollas
- Service d'ORL et chirurgie cervico-faciale pédiatrique, hôpital d'Enfants-de-la-Timone (Aix-Marseille-Université), 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
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Fellner A, Marom T, Muallem-Kalmovich L, Shlamkovitch N, Eviatar E, Lazarovitch T, Pitaro J. Pediatric neck abscesses: No increase in methicillin-resistant Staphylococcus aureus. Int J Pediatr Otorhinolaryngol 2017; 101:112-116. [PMID: 28964280 DOI: 10.1016/j.ijporl.2017.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Recent studies from Western countries showed an increased incidence rate of methicillin-resistant Staphylococcus aureus (MRSA) isolated from pediatric neck abscesses cultures. We sought to examine the microbiology and antibiotic susceptibility of such samples over a 10-year period, and particularly of Staphylococcus aureus (SA), in order to determine whether a similar trend exists in our institution. METHODS A retrospective chart review of children ≤18 years that underwent needle aspiration or surgical drainage of neck abscesses, including suppurative lymphadenitis, retropharyngeal abscesses, and parapharyngeal abscesses was conducted between 1/1/06-31/12/15. RESULTS Sixty-two children were identified with a male predominance (34, 55%). The median age was 2 years. There were 37 (60%) suppurative lymphadenitis, 15 (24%) parapharyngeal abscess, and 10 (16%) retropharyngeal abscess cases. Twenty-nine (47%) children received antibiotic treatment prior to admission, most commonly β-lactam agents. Of them, 15 (52%) had positive cultures, including 7 (47%) with SA. On admission, 45 (73%) children had already received amoxicillin-clavulanate. Of those who did not improve, 16 (26%) received ceftriaxone and clindamycin. Twenty-one (38%) cultures were negative. The most common isolated bacteria were SA in 13 (24%), Streptococcus pyogenes in 7 (13%), and Streptococcus viridians group in 9 (16%). Of the SA isolates, there was only 1 (8%) case of MRSA; however, there were 4 (31%) clindamycin-resistant SA isolates. CONCLUSION Unlike previously published data, there was no increase in MRSA incidence at our institution. However, the high prevalence of clindamycin-resistant SA was in line with previous reports. These findings should be considered when starting empirical therapy in pediatric neck abscesses.
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Affiliation(s)
- Avital Fellner
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel
| | - Limor Muallem-Kalmovich
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel
| | - Nathan Shlamkovitch
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel
| | - Ephraim Eviatar
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel
| | - Tzilia Lazarovitch
- Clinical Microbiology Laboratory, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel.
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Shimizu Y, Hidaka H, Ozawa D, Kakuta R, Nomura K, Yano H, Watanabe KI, Katori Y. Clinical and bacteriological differences of deep neck infection in pediatric and adult patients: Review of 123 cases. Int J Pediatr Otorhinolaryngol 2017; 99:95-99. [PMID: 28688574 DOI: 10.1016/j.ijporl.2017.05.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/12/2017] [Accepted: 05/31/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Deep neck infections (DNIs) can lead to life-threatening disease. However, the detailed pathophysiology remains unclear due to its rarity and only a few reports have directly compared DNIs in children and adults. This study aimed to reveal the clinical differences between DNIs in children and adults. METHODS We retrospectively reviewed 123 patients who suffered from DNIs at Tohoku University Hospital from August 2005 to July 2015. We extracted data on patient sex, age, antecedent illness, extension of infections, operative procedures, and bacteriology results. The patients were categorized into pediatric (≤18 years) and adult (>18 years) groups. Fisher's exact test was performed to determine significant differences between the two groups. RESULTS Fifteen children (6 males and 9 females) and 108 adults (71 males and 37 females) were identified. The most common antecedent illness in pediatric patients was lymphadenitis, which was the least common in adult patients (73% vs 7%, p < 0.0001). The incidence of DNIs extending below the hyoid bone was significantly lower in pediatric patients than in adult patients (20% vs 53%, p < 0.05). Regarding bacterial culture analysis, Staphylococcus species was the most common pathogen in children (60%), whereas only 9% of adults were positive for Staphylococcus (p < 0.001). Streptococcus species were significantly less common in children than in adults (27% vs 56%, p = 0.05). Anaerobes were also significantly less common in children than in adults (13% vs 45%, p < 0.01). Concerning surgical intervention, 53% of pediatric patients underwent external incision compared with 70% of adults. Specifically, tracheostomy was significantly less frequently performed in children than in adults (7% vs 54%, p < 0.01). CONCLUSION DNIs in children feature different characteristics from those in adults regarding severity, antecedent illness, bacteriology, and clinical management.
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Affiliation(s)
- Yuichi Shimizu
- Department of Otolaryngology - Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiroshi Hidaka
- Department of Otolaryngology - Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Daiki Ozawa
- Department of Otolaryngology - Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Risako Kakuta
- Department of Otolaryngology - Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Otolaryngology, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology - Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hisakazu Yano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Nara, Japan
| | - Ken-Ichi Watanabe
- Department of Otolaryngology - Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yukio Katori
- Department of Otolaryngology - Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Ralston ME, de Caen A. Teaching Pediatric Life Support in Limited-Resource Settings: Contextualized Management Guidelines. J Pediatr Intensive Care 2017; 6:39-51. [PMID: 31073424 PMCID: PMC6260263 DOI: 10.1055/s-0036-1584675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 02/15/2016] [Indexed: 10/21/2022] Open
Abstract
Of the estimated 6.3 million global annual deaths in children younger than the age of 5 years, nearly all (99%) occur in low- to middle-income countries (LMIC). Existing management guidelines for children with emergency conditions as taught in a variety of current pediatric life support courses are mostly applicable to high-income countries with a different disease range and full resources compared with LMIC. A revised curriculum with evidence-based application to limited-resource settings would expand their potential for reducing pediatric mortality worldwide. This review provides a supplemental curriculum of standards for selected pediatric emergency conditions with attention to the context of disease range and level-specific resources in LMIC. During training sessions, contextualized management guidelines create the framework for realistic and fruitful case simulations.
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Affiliation(s)
- Mark E. Ralston
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | - Allan de Caen
- Division of Pediatric Critical Care Medicine, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
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Abstract
Fever is a common presenting chief complaint in the pediatric emergency department. We report the case of a well-appearing 11-month-old female with 2 weeks of daily fevers who was found to have an extensive retropharyngeal abscess with mediastinal and extrapleural extension. We review the literature on retropharyngeal abscesses and mediastinitis in children and note that this patient is unusual as she presented with such extensive disease with minimal symptoms. This case demonstrates the importance of a thorough history and broad differential diagnosis when evaluating children presenting prolonged fevers.
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Khudan A, Jugmohansingh G, Islam S, Medford S, Naraynsingh V. The effectiveness of conservative management for retropharyngeal abscesses greater than 2 cm. Ann Med Surg (Lond) 2016; 11:62-65. [PMID: 27761237 PMCID: PMC5065001 DOI: 10.1016/j.amsu.2016.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/02/2016] [Accepted: 10/02/2016] [Indexed: 11/06/2022] Open
Abstract
Objectives Conservative management for retropharyngeal abscesses <2 cm is now a first line option. It is unclear if conservative management can be used to manage larger abscesses without increased morbidity and mortality. Study design A prospective case series was performed from 2012 to 2015 by the Otolaryngology department of the San Fernando General Hospital involving pediatric patients who presented with retropharyngeal abscesses. All patients were initially treated with antibiotics alone. Methods Patients with clinical features and CT scan confirmation of a retropharyngeal abscess were included in the study. Those who improved clinically and biochemically within 48 h continued to be treated conservatively and those who deteriorated had surgical intervention. Results Sixteen patients fulfilled the inclusion criteria. Most patients were Afro Trinidadian males between the ages of two and five who were also found to be iron deficient. Drooling was a sensitive predictor for the presence of an abscess but did not indicate the need for drainage. Hoarseness was the clinical feature that prompted surgical intervention. Sixty three percent of patients had an abscess >2 cm of which 90% improved within 48 h. One patient required surgical drainage with no increase in morbidity or mortality. Conclusion Conservative management of retropharyngeal abscesses >2 cm can be offered to patients during the first 48 h. If the patient demonstrates clinical and biochemical improvement, antibiotics alone can be continued. If the patient deteriorates, surgical drainage can be subsequently performed with no increase in morbidity and mortality. The retropharyngeal abscess is a deep neck space infection commonly seen in the pediatric population. Drainage of these abscesses is associated with multiple complications. Patient presenting with hoarseness requires surgical intervention. Conservative management can be successfully performed in patients who have abscesses that are greater than 2 cm. Patients treated with antibiotic alone need to be closely followed up for lack of improvement or deterioration.
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Affiliation(s)
- A Khudan
- Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - G Jugmohansingh
- Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - S Islam
- Department of General Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - S Medford
- Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - V Naraynsingh
- Department of Clinical Surgical Sciences, University of West Indies, St. Augustine, Trinidad and Tobago
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Woods CR, Cash ED, Smith AM, Smith MJ, Myers JA, Espinosa CM, Chandran SK. Retropharyngeal and Parapharyngeal Abscesses Among Children and Adolescents in the United States: Epidemiology and Management Trends, 2003-2012. J Pediatric Infect Dis Soc 2016; 5:259-68. [PMID: 26407249 DOI: 10.1093/jpids/piv010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 02/10/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The epidemiology and hospital course of children with retropharyngeal abscess (RPA) or parapharyngeal abscess (PPA) have not been fully described at the national level in the United States. METHODS Pediatric discharges for PPA and RPA were evaluated by using the Kids' Inpatient Database from 2003, 2006, 2009, and 2012. Cases were identified by using International Classification of Disease, Ninth Revision, Clinical Modification codes 478.22 and 478.24 for PPA and RPA, respectively. Nationally representative incidence data were calculated by using weighted case estimates and US census data. Demographic and cost analyses were conducted by using unweighted analyses. RESULTS There were 2685 hospital discharges for PPA and 6233 hospital discharges for RPA during the 4 study years combined. The incidence of RPA increased from 2.98 per 100 000 population among children <20 years old in 2003 to 4.10 per 100 000 in 2012. The incidence of PPA peaked at 1.49 per 100 000 in 2006. Incidences were highest among children <5 years old and boys in all age groups for PPA and RPA. Winter-to-spring seasonality also was evident for both. PPA was managed surgically in 58.1% of the cases, and RPA was managed surgically in 46.7%. Surgery was performed most often on the day of admission or the following day, was more frequent at teaching hospitals, and was associated with higher hospital charges. The mean hospital length of stay was longer for children who had surgery versus those who did not (4.4 vs 3.1 days [for PPA] and 4.8 vs 3.2 days [for RPA], respectively; both P < .001). The median charges for RPA and PPA were similar. The proportions of children with RPA or PPA covered by Medicaid increased during the study period. CONCLUSION PPA and RPA represent relatively common male-predominant childhood infections with similar epidemiologies. The incidence of hospital discharges with a diagnosis of RPA increased during the study period. Substantial proportions of children with PPA or RPA are now managed without surgery. Surgical drainage was associated with higher hospital charges and longer lengths of stay.
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Affiliation(s)
| | - Elizabeth D Cash
- Department of Otolaryngology-HNS and Communicative Disorders, University of Louisville School of Medicine, Kentucky
| | - Aaron M Smith
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis
| | | | - John A Myers
- Department of Pediatrics, Division of Infectious Diseases
| | | | - Swapna K Chandran
- Department of Otolaryngology-HNS and Communicative Disorders, University of Louisville School of Medicine, Kentucky
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Shefelbine SE, Mancuso AA, Gajewski BJ, Ojiri H, Stringer S, Sedwick JD. Pediatric retropharyngeal lymphadenitis: Differentiation from retropharyngeal abscess and treatment implications. Otolaryngol Head Neck Surg 2016; 136:182-8. [PMID: 17275536 DOI: 10.1016/j.otohns.2006.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Indexed: 11/19/2022]
Abstract
Objectives Our objectives were to review the retropharyngeal anatomy, define retropharyngeal adenitis and abscess, and determine if CT may guide the clinician in treatment planning for pediatric retropharyngeal infections. Study Design and Setting A retrospective chart review and CT scan review of 30 children with retropharyngeal infections. Results All patients had retropharyngeal adenitis. Average volume of the low-attenuation focus in the medical treatment group was 1.2 cm3. Average volume in the surgical group was 4 cm3. Surgery patients with no purulent findings were then grouped with the medical treatment group; the average volume of the low-attenuation focus in this group was 2.2 cm3. Average volume in the group in which purulence was identified was 4.4 cm3. Conclusion CT can identify patients with retropharyngeal infections who have a high likelihood of being successfully treated with antibiotics alone. Significance CT imaging may assist in avoiding unnecessary surgical exploration.
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Affiliation(s)
- Sarah E Shefelbine
- Department of Otolaryngology, University of Florida, Gainesville, FL 32610-0264, USA
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Adil E, Tarshish Y, Roberson D, Jang J, Licameli G, Kenna M. The Public Health Impact of Pediatric Deep Neck Space Infections. Otolaryngol Head Neck Surg 2015; 153:1036-41. [DOI: 10.1177/0194599815606412] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/26/2015] [Indexed: 11/16/2022]
Abstract
Objective There is little consensus about the best management of pediatric deep neck space infections (DNSIs) and limited information about the national disease burden. The purpose of this study is to examine the health care burden, management, and complications of DNSIs from a national perspective. Study Design Retrospective administrative data set review. Setting National pediatric admission database. Subjects and Methods Pediatric patients diagnosed with a parapharyngeal space and/or retropharyngeal abscess were identified from the 2009 KIDS’ Inpatient Database. Patient demographic, hospital, and clinical characteristics were compared between patients who received surgical and nonsurgical management. All results for the analyses were weighted, clustered, and stratified appropriately according to the sampling design of the KIDS’ Inpatient Database. Results The prevalence of DNSIs was 3444 in 2009, and the estimated incidence was 4.6 per 100,000 children. The total hospital charges were >$75 million. The patients who were drained surgically had a 22% longer length of stay (mean = 4.19 days) than that of those who were managed without surgery (mean = 3.44 days). Mean hospital charges for patients who were drained surgically were almost twice those of patients who were managed medically ($28,969 vs $17,022); 165 patients (4.8%) had a complication. Results There are >3400 admissions for pediatric DNSIs annually, and they account for a significant number of inpatient days and hospital charges. A randomized controlled trial of management may be indicated from a public health perspective.
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Affiliation(s)
- Eelam Adil
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Yael Tarshish
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - David Roberson
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jisun Jang
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Clinical Research Center, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Greg Licameli
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Lisan Q, Tran H, Verillaud B, Herman P. Infectious arteritis of the internal carotid artery complicating retropharyngeal abscess. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 133:55-7. [PMID: 26386614 DOI: 10.1016/j.anorl.2015.08.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Retropharyngeal abscess is a well-known entity in children, but can also occur in adults. The two main vascular complications are vascular compression and pseudoaneurysm, while infectious arteritis of the internal carotid artery is exceptional. CASE REPORT The authors describe a case of a retropharyngeal abscess in an adult woman complicated by infectious arteritis of the internal carotid artery. This rare complication was treated by endovascular occlusion of the internal carotid artery and incision and drainage of the abscess in combination with antibiotic and anticoagulant therapy. The patient did not present any neurological sequelae and follow-up MRI did not reveal any signs of vascular or neurological complications. DISCUSSION This case highlights the importance of thorough examination of imaging performed in the context of deep neck space abscess to detect signs of vascular involvement. Treatment must be aggressive in view of the life-threatening risk of arterial rupture or septic embolism. This is the first reported case of infectious arteritis involving the internal carotid artery complicating retropharyngeal abscess.
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Affiliation(s)
- Q Lisan
- Service d'otorhinolaryngologie et chirurgie cervicofaciale, hôpital Lariboisière, AP-HP, université Paris 7 Denis-Diderot, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
| | - H Tran
- Service d'otorhinolaryngologie et chirurgie cervicofaciale, hôpital Lariboisière, AP-HP, université Paris 7 Denis-Diderot, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - B Verillaud
- Service d'otorhinolaryngologie et chirurgie cervicofaciale, hôpital Lariboisière, AP-HP, université Paris 7 Denis-Diderot, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - P Herman
- Service d'otorhinolaryngologie et chirurgie cervicofaciale, hôpital Lariboisière, AP-HP, université Paris 7 Denis-Diderot, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
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Tumturk A, Kaya Ozcora G, Kacar Bayram A, Kabaklioglu M, Doganay S, Canpolat M, Gumus H, Kumandas S, Unal E, Kurtsoy A, Per H. Torticollis in children: an alert symptom not to be turned away. Childs Nerv Syst 2015; 31:1461-70. [PMID: 26043711 DOI: 10.1007/s00381-015-2764-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study is to investigate the spectrum of underlying disease in children with torticollis. METHODS We investigated the spectrum of underlying disease and to evaluate the clinical features of the children presented with torticollis in the last 2 years. RESULTS Of the 20 children (13 girls and 7 boys with the mean age of 8 years, ranging 2 months-12 years), eight of them have craniospinal pathologies (cerebellar tumors in three, exophytic brain stem glioma, eosinophilic granuloma of C2 vertebra, neuroenteric cyst of the spinal cord, Chiari type 3 malformation, arachnoid cysts causing brainstem compression, and cerebellar empyema), followed by osseous origin in five (congenital vertebral anomalies including hemivertebrae, blocked vertebra, and segmentation anomalies), two muscular torticollis (soft tissue inflammation due to subclavian artery catheterization, myositis ossificans with sternocleidomastoid muscle atrophy), and ocular (congenital cataract and microphthalmia), Sandifer syndrome, paroxysmal torticollis, retropharyngeal abscess each in one patients were detected. Ten patients underwent surgery; two patients received medical therapy for reflux and benign paroxysmal torticollis; and one patient with torticollis due to muscle spasm and soft tissue inflammation was treated with physiotherapy. CONCLUSIONS Various underlying disorders from relatively benign to life-threatening conditions may present with torticollis. The first step should be always a careful and complete physical examination, which must include all systems. Imaging must be performed for ruling out underlying life-threatening diseases in children with torticollis, particularly, if acquired neurological symptoms exist. Besides craniospinal tumors, ophthalmological problems and central nervous system infections should also be kept in mind. Moreover, early diagnosis of these disorders will reduce mortality and morbidity. Therefore, alertness of clinicians in pediatric and pediatric neurosurgery practice must be increased about this alert symptom.
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Affiliation(s)
- Abdulfettah Tumturk
- Faculty of Medicine, Department of Neurosurgery, Erciyes University, Kayseri, Turkey,
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Intraoral drainage under surgical microscopy with tonsillectomy for parapharyngeal abscesses. The Journal of Laryngology & Otology 2015; 129:595-7. [DOI: 10.1017/s0022215115000791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:An intraoral approach combined with tonsillectomy has been used to access the parapharyngeal space. However, the utility of this technique for parapharyngeal abscesses in paediatric patients has not been investigated. This paper describes an intraoral drainage technique combined with tonsillectomy for treating children with a parapharyngeal abscess that obviates the need for skin incision.Methods:Clinical case records are presented, along with a description of the surgical procedure accompanied by a video clip.Results:Both cases encountered involved paediatric parapharyngeal space abscesses that extended to the skull base. The patients underwent an intraoral approach combined with tonsillectomy performed under surgical microscopy; this resulted in a good post-operative course without complications.Conclusion:To our knowledge, no previous reports have addressed the use of surgical microscopy to help access the parapharyngeal space. The procedure described herein, performed under surgical microscopy, was specifically helpful in enabling access to these challenging spaces; it also meant that surgical procedures could be recorded clearly and findings shared with other medical staff.
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Raffaldi I, Le Serre D, Garazzino S, Scolfaro C, Bertaina C, Mignone F, Peradotto F, Tavormina P, Tovo PA. Diagnosis and management of deep neck infections in children: the experience of an Italian paediatric centre. J Infect Chemother 2014; 21:110-3. [PMID: 25456894 DOI: 10.1016/j.jiac.2014.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/20/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
Abstract
Deep neck infection (DNI) is a severe occurrence in children. We've examined the presenting signs and symptoms, the value of single diagnostic procedures, the rate of complications and the impact of the therapeutic options on the final outcome, in children with a DNI. We retrospectively evaluated patients, aged 0-18 years, who were admitted for a DNI, from January 2006 through December 2012, at Regina Margherita Children's Hospital, Turin, Italy. We subdivided them on the basis of type of treatment: pharmacological treatment alone or antimicrobial treatment plus surgery. An univariate analysis has been performed to examine the differences between the two groups. Sixty patients (32 males, 28 females) with diagnosis of DNI were enrolled; 33 children only received medical treatment (group 1), whereas 27 patients underwent also surgical interventions (group 2). The mean abscess size was significantly higher in group 2 than in group 1 (p = 0.01). The predominant organisms were Streptococcus sp. (11 cases, 52.4%, mostly Streptococcus pyogenes). The most frequent antibiotic regimen was a β lactam alone (either III generation cephalosporin or amoxicillin/clavulanate). The duration of intravenous antibiotic varied between the two groups, without statistical significance (p = 0.052); whereas the oral antibiotic administration was significantly shorter in group 1 than in group 2 (p = 0.0003). Three patients (5%) developed complications. This research confirms that the medical approach, with high doses of intravenous antibiotics for a minimum of 5 days, could be a tolerable and safe option for the treatment of patients with stable condition and/or small DNIs.
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Affiliation(s)
- Irene Raffaldi
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy.
| | - Daniele Le Serre
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Silvia Garazzino
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Carlo Scolfaro
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Chiara Bertaina
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy; Unit of Immunology and Infectious Diseases, University-Hospital Pediatric Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Federica Mignone
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Federica Peradotto
- Department of Paediatric Otolaryngology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Paolo Tavormina
- Department of Paediatric Otolaryngology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Pier-Angelo Tovo
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
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Martin C, Gabrillargues J, Louvrier C, Saroul N, Mom T, Gilain L. Contribution of CT scan and CT-guided aspiration in the management of retropharyngeal abscess in children based on a series of 18 cases. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:277-82. [DOI: 10.1016/j.anorl.2013.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 03/16/2013] [Accepted: 04/03/2013] [Indexed: 11/26/2022]
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Georget E, Gauthier A, Brugel L, Verlhac S, Remus N, Epaud R, Madhi F. Acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children. BMC EAR, NOSE, AND THROAT DISORDERS 2014; 14:8. [PMID: 25206314 PMCID: PMC4158388 DOI: 10.1186/1472-6815-14-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 09/02/2014] [Indexed: 11/30/2022]
Abstract
Background Acute cervical adenitis can evolve into suppurative cervical lymphadenitis and may sometimes be associated with infection of the retropharyngeal and parapharyngeal spaces (i.e., retropharyngeal and poststyloid parapharyngeal abscesses). This study aimed to describe the clinical presentation of acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children and examine the management of these conditions. Methods This was a retrospective study including children from 3 months to 18 years old who were hospitalized in the Pediatric Department of the Centre-Intercommunal-de-Créteil between January 2003 and May 2010. Selected cases were based on the diagnosis of acute cervical lymphadenitis, suppurative cervical lymphadenitis, or infections of the retropharyngeal or parapharyngeal spaces. Case history, clinical signs, laboratory tests, imaging, treatment and clinical course were collected from patient charts. Results We included 75 children (54 males [72%]); 62 (83%) were < 6 years old. Diagnoses were acute cervical lymphadenitis in 43 patients (57%), suppurative cervical lymphadenitis in 13 (17%), retropharyngeal or poststyloid parapharyngeal abscess in 18 (24%) and cervical necrotizing fasciitis in 1 (1%). In total, 72 patients (96%) presented fever and 34 (45%) had torticollis. Suppurative cervical lymphadenitis or abscesses of the retropharyngeal or poststyloid parapharyngeal spaces was significantly higher for children with than without torticollis (52.9% vs. 4.8%, p < 0.001). In all, 21 patients among the 44 > 3 years old (48%) underwent a rapid antigen detection test (RADT) for group A beta-hemolytic Streptococcus pyogenes; results for 10 were positive (48%). Contrast-enhanced CT scan of the neck in children with torticollis (n = 31) demonstrated an abscess in 21 (68%). Fine-needle aspiration was performed in 8 patients (11%) and 8 (11%) required surgical drainage. Bacteriology was positive in 8 patients (11%), with a predominance of Staphylococcus aureus and S. pyogenes. All patients received intravenous antibiotics and the outcome was favorable regardless of surgery. Recurrence was observed in only 1 case among the 34 patients with a follow-up visit after discharge. Conclusion Our data suggest that presentation with cervical lymphadenitis associated with fever and torticollis requires evaluation by contrast-enhanced CT scan. Furthermore, abscess drainage should be restricted to the most severely affected patients who do not respond to antibiotic therapy.
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Affiliation(s)
- Emilie Georget
- Service de Pédiatrie, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, 40, allée de la source, 94195 Villeneuve Saint Georges, France
| | - Anne Gauthier
- Service d'ORL, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Lydia Brugel
- Service d'ORL, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Suzanne Verlhac
- Service de Radiologie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Natacha Remus
- Service de Pédiatrie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Ralph Epaud
- Service de Pédiatrie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France ; Inserm U955, Equipe 11, Faculté de Médecine, Université Paris-Est, 94000 Créteil, France
| | - Fouad Madhi
- Service de Pédiatrie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
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Al-naami AQ, Ali Khan L, Ali Athlawy Y, Sun Z. Ochrobactrum anthropi induced retropharyngeal abscess with mediastinal extension complicating airway obstruction: a case report. J Med Radiat Sci 2014; 61:126-9. [PMID: 26229647 PMCID: PMC4175841 DOI: 10.1002/jmrs.50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/27/2014] [Accepted: 04/03/2014] [Indexed: 11/09/2022] Open
Abstract
Retropharyngeal abscess with involvement of mediastinal abscess represents an uncommon complication of upper respiratory tract infections. We report a case presenting with a large retropharyngeal abscess with airway obstruction as the primary presenting symptom. Contrast-enhanced CT showed a large retropharyngeal abscess in the neck with extension to the upper and posterior mediastinal spaces. The abscess was surgically excised with 200 cc pus drained from the neck and mediastinal regions. We describe this case to assist physicians in making the difficult diagnosis when confronting a patient with airway obstruction, as early recognition of retropharyngeal abscess permits emergent airway management.
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Affiliation(s)
- Awaji Qasim Al-naami
- Department of General and Laparoscopic Surgery, Sabya General Hospital JazanJazan, Saudi Arabia
| | - Liaqat Ali Khan
- Department of General and Laparoscopic Surgery, Sabya General Hospital JazanJazan, Saudi Arabia
| | - Yahya Ali Athlawy
- Department of Radiology, Sabya General Hospital JazanJazan, Saudi Arabia
| | - Zhonghua Sun
- Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin UniversityPerth, Western Australia, Australia
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Characteristics of deep neck infection in children according to weight percentile. Clin Exp Otorhinolaryngol 2014; 7:133-7. [PMID: 24917911 PMCID: PMC4050086 DOI: 10.3342/ceo.2014.7.2.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 12/19/2012] [Accepted: 01/07/2013] [Indexed: 12/03/2022] Open
Abstract
Objectives To evaluate the effect of weight percentile on deep neck infections in children. Methods A retrospective evaluation of 79 patients who were treated for deep neck infections. The patients were divided into six groups according to weight percentile. Patients who had systemic and/or congenital disease were excluded. Their demographics, etiology, localization, laboratory, and treatment results were reviewed. Results In total, 79 pediatric patients were recorded: 48.1% were females and 51.9% were males, with a mean age of 7.3 years. In total, 60 patients were under the 50th percentile according to their weight versus all children. The anteroposterior triangle (29.1%) and submandibular (26.5%) spaces were most commonly involved with deep neck infection. However, the anteroposterior triangle space was the highest in the group below the 3rd percentile (44.4%). In the blood analysis, white blood cell levels in patients with at percentile values of 75-50 were higher than other groups (P<0.05). Significant differences were found between C-reactive protein and hemoglobin levels and diameter of abscesses. The need for surgical drainage in patients in lower percentiles was higher. The patients who needed surgical drainage consisted of 56 patients (93.3%) below the 50th percentile and 9 patients (100%) below the 3rd percentile. Conclusion Deep neck infection is more insidious and dangerous in low-weight-percentile children, especially those having low white blood cell counts, low hemoglobin levels, and high C-reactive protein in laboratory results.
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