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Liu Y, Nicotera DJ, Islam AA, Dunsky K, Lieu JEC. Prognostic Factors for Retropharyngeal Abscess in Children Receiving Surgery or Antibiotic Therapy. Laryngoscope 2024; 134:1955-1960. [PMID: 37740903 DOI: 10.1002/lary.31064] [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: 07/03/2023] [Revised: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE Effective management of retropharyngeal abscess (RPA) may predicate upon identification of key patient characteristics. We analyzed characteristics and outcomes of pediatric patients with RPA to identify prognostic factors associated with successful surgical intervention. METHODS A financial database was searched for pediatric otolaryngology patients with RPA from 2010 to 2021. Medical charts were reviewed for demographics, presenting history, physical examination, laboratory testing, imaging, surgical findings, and hospital course. Bivariate analyses were performed to identify potentially significant predictors of positive drainage. These variables were included in multivariate analysis of surgical outcomes. RESULTS Of 245 total patients, 159 patients (65%) received surgery and 86 patients (35%) received antibiotics only. Patients with restricted cervical motion, neck swelling, and computed tomography (CT) cross-sectional area (CSA) >2 cm2 were more likely to receive surgery. Rim enhancement on CT imaging was associated with positive surgical drainage (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.16-5.74). However, no variables from clinical symptoms or physical exam were associated with positive drainage. Variables that approached significance were included in multivariate analysis, which revealed only rim enhancement predicted positive drainage (OR 2.57, 95% CI 1.13-5.83). The mean length of stay (LOS) was 2.6 versus 3.5 days (p < 0.001) for medical vs surgical treatment groups, respectively. CONCLUSION Our study revealed a high success rate of medical management. Although patient characteristics and clinical features were not significant predictors of surgical outcomes, CT findings such as rim enhancement were strongly associated with positive surgical drainage. LEVEL OF EVIDENCE 2 Laryngoscope, 134:1955-1960, 2024.
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Affiliation(s)
- Yupeng Liu
- Department of Pediatric Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
| | - Dante J Nicotera
- Department of Pediatric Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
| | - Aseeyah A Islam
- Department of Pediatric Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
| | - Kate Dunsky
- Department of Pediatric Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
| | - Judith E C Lieu
- Department of Pediatric Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
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2
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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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3
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Rajanna L, Raina S, Bayad HC, Tripathi S, Chahar OS, Singh O. A Rare Case of Retropharyngeal Abscess in a 3 Month Old Male Infant: Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:4066-4070. [PMID: 37974837 PMCID: PMC10646015 DOI: 10.1007/s12070-023-04043-2] [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: 05/19/2023] [Accepted: 06/26/2023] [Indexed: 11/19/2023] Open
Abstract
Retropharyngeal abscess (RPA) is a rare, potentially fatal condition found more frequently in young children usually who were having a history of Upper respiratory infection. RPA is an acute suppurative infection of the retropharyngeal space. In view of scarce literature availability and atypical presentation in infants, it poses a definitive diagnostic dilemma to the clinicians. Here, we are reporting a three-month-old male infant presented with feeding difficulty, obstructive sleep apnea and intermittent inspiratory stridor. Child was managed in a pediatric ICU with a multidisciplinary approach which involved pediatrician, otorhinolaryngologist pediatric anesthesiologist, microbiologist, and radiologist. With the recent advances, early radio imaging have a vital role in diagnosing the condition and also helps in planning of surgery. Prompt diagnosis and surgical management with appropriate antimicrobial therapy for this condition is imperative to prevent complications such as airway obstruction and mediastinitis. Timely surgical intervention, preferably intraoral transpharyngeal approach, to drain the abscess is recommended.
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Affiliation(s)
- Lohith Rajanna
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Sheetal Raina
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Himanshu Chhagan Bayad
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Shailendra Tripathi
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Omvir Singh Chahar
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Ombir Singh
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
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4
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Mariani M, Saffioti C, Mesini A, Palmero C, D’Agostino R, Garofolo S, Rossi A, Damasio MB, Castagnola E. Clinical and Microbiological Characteristics of Deep Neck Abscesses in Pediatrics: Analysis of a Case Series from a 3rd Level Pediatric Hospital. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1506. [PMID: 37761467 PMCID: PMC10528812 DOI: 10.3390/children10091506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
As there is currently no consensus on managing deep neck infections in pediatric populations, we report a case series from a large pediatric hospital. Clinical data of patients discharged from Istituto Gaslini-Children's Hospital from January 2014 to June 2020 with peritonsillar, parapharyngeal, or retropharyngeal abscess diagnoses were collected. A total of 59 patients were identified. Patients underwent surgical drainage in 47% of cases. Streptococcus mitis/oralis was the most isolated pathogen. Surgically treated patients did have larger abscesses compared to others, but there were no differences in the duration of hospitalization. Children who received NSAIDs at home had significant delays in diagnosis (median 4 vs. 1.5 days, p = 0.008). In our experience, clinical presentation of DNIs is often evocative, but evaluation should include imaging with CT/MRI. Surgery is effective in larger abscesses, allowing for etiological diagnosis with consequent antibiotic adjusting. From an anamnestic point of view, home medications such as NSAIDs could delay diagnosis.
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Affiliation(s)
- Marcello Mariani
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Carolina Saffioti
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessio Mesini
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Candida Palmero
- Microbiology Laboratory, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Roberto D’Agostino
- Otolaryngology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Sabrina Garofolo
- Otolaryngology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
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Nurminen J, Heikkinen J, Happonen T, Nyman M, Sirén A, Vierula JP, Velhonoja J, Irjala H, Soukka T, Ivaska L, Mattila K, Hirvonen J. Pictorial Review of MRI Findings in Acute Neck Infections in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:967. [PMID: 37371199 DOI: 10.3390/children10060967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Abstract
Pediatric neck infections and their complications, such as abscesses extending to deep neck compartments, are potentially life-threatening acute conditions. Medical imaging aims to verify abscesses and their extensions and exclude other complications. Magnetic resonance imaging (MRI) has proven to be a useful and highly accurate imaging method in acute neck infections in children. Children and adults differ in terms of the types of acute infections and the anatomy and function of the neck. This pictorial review summarizes typical findings in pediatric patients with neck infections and discusses some difficulties related to image interpretation.
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Affiliation(s)
- Janne Nurminen
- Department of Radiology, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Jaakko Heikkinen
- Department of Radiology, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Tatu Happonen
- Department of Radiology, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Mikko Nyman
- Department of Radiology, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Aapo Sirén
- Department of Radiology, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Jari-Pekka Vierula
- Department of Radiology, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Jarno Velhonoja
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Heikki Irjala
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Tero Soukka
- Department of Oral and Maxillofacial Surgery, University of Turku, 20014 Turku, Finland
| | - Lauri Ivaska
- Department of Paediatrics and Adolescent Medicine, InFLAMES Research Flagship Center, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Kimmo Mattila
- Department of Radiology, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, University of Turku and Turku University Hospital, 20520 Turku, Finland
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Sellami M, Kharrat I, Kharrat O, Hammami B, Mnejja M, Zouche I, Chaabouni MA, Charfeddine I. Acute Retropharyngeal and Parapharyngeal Abscesses: A Case Series. EAR, NOSE & THROAT JOURNAL 2023:1455613231169232. [PMID: 37019663 DOI: 10.1177/01455613231169232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the diagnosis circumstances, predisposing factors, investigations, and therapeutic management of retropharyngeal and parapharyngeal abscesses. METHODS A retrospective chart review of patients diagnosed with retropharyngeal or parapharyngeal abscess from 2001 to 2021 was performed. Epidemiological characteristics, clinical signs, investigations, medical treatment, and surgical interventions were analyzed for each patient. RESULTS A total of 30 patients with retropharyngeal or parapharyngeal abscess were identified. Computed tomography was performed in all cases, and magnetic resonance imaging was performed in three cases. Twelve patients had a "pure" retropharyngeal abscess, nine patients had a prestyloid abscess, one patient had a prestyloid abscess associated with a peritonsillar abscess, three patients had a retrostyloid abscess, and five patients had a prestyloid abscess associated with a retropharyngeal abscess or a retrostyloid abscess. The median long axis of the abscess was 42 cm. All patients received intravenous antibiotics for a median period of 8 days [4-30]. Seventeen patients required surgical trans-cervical drainage. Other patients underwent transoral or transnasal drainage. The pus culture revealed no growth in six cases, streptococcus (four cases), methicillin-sensitive Staphylococcus aureus (two cases), Klebsiella (two cases), Enterobacter (one case), Fungi (two cases), and Mycobacterium tuberculosis (a twelve-year-old boy). It was not documented in twelve cases. Histological examination revealed caseofollicular tuberculosis in a 53-year-old man. In 25 patients, no adverse events were observed during follow-up. Five patients had an unfavorable outcome. CONCLUSION We have found an increase in the incidence of these infections in recent years. Computed tomography is the best imaging examination for the diagnosis and follow-up of retropharyngeal and parapharyngeal abscess. Early drainage and antimicrobial therapy are essential for rapid recovery and prevention of complications of these abscesses.
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Affiliation(s)
- Moncef Sellami
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Ines Kharrat
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Ons Kharrat
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Boutheina Hammami
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Malek Mnejja
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Imen Zouche
- Department of anesthesiology Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Mohamed Amine Chaabouni
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Ilhem Charfeddine
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
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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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8
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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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9
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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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10
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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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11
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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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12
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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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13
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Goenka PK, Hall M, Shah SS, Florin TA, Leone N, Narayanan S, Ishman S, Gill P, Liewehr S, Palumbo N, McGeechan S, Mestre M, Parikh K. Corticosteroids in the Treatment of Pediatric Retropharyngeal and Parapharyngeal Abscesses. Pediatrics 2021; 148:peds.2020-037010. [PMID: 34697219 DOI: 10.1542/peds.2020-037010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Treatment of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs) includes antibiotics, with possible surgical drainage. Although corticosteroids may decrease inflammation, their role in the management of RPAs and PPAs is unclear. We evaluated the association of corticosteroid administration as part of initial medical management on drainage rates and length of stay for children admitted with RPAs and PPAs. METHODS We conducted a retrospective study using administrative data of children aged 2 months to 8 years discharged with RPAs and PPAs from 2016 to 2019. Exposure was defined as systemic corticosteroids administered as part of initial management. Primary outcome was surgical drainage. Bivariate comparisons were made between patients in the corticosteroid and noncorticosteroid groups by using Wilcoxon rank or χ2 tests. Outcomes were modeled by using generalized linear mixed-effects models. RESULTS Of the 2259 patients with RPAs and PPAs, 1677 (74.2%) were in the noncorticosteroid group and 582 (25.8%) were in the corticosteroid group. There were no significant differences in age, sex, or insurance status. There was a lower rate of drainage in the corticosteroid cohort (odds ratio: 0.28; confidence interval: 0.22-0.36). Patients in this group were more likely to have repeat computed tomography imaging performed, had lower hospital costs, and were less likely to have opioid medications administered. The corticosteroid cohort had a higher 7-day emergency department revisit rate, but there was no difference in length of stay (rate ratio 0.97; confidence interval: 0.92-1.02). CONCLUSIONS Corticosteroids were associated with lower odds of surgical drainage among children with RPAs and PPAs.
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Affiliation(s)
- Pratichi K Goenka
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Matthew Hall
- Children's Hospital Association, Overland Park, Kansas
| | - Samir S Shah
- Division of Hospital Medicine and Department of Pediatrics
| | - Todd A Florin
- Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nicole Leone
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Sridaran Narayanan
- Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center and School of Medicine, George Washington University, Washington, District of Columbia
| | - Stacey Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Peter Gill
- Division of Paediatric Medicine, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Sheila Liewehr
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Nancy Palumbo
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Stacy McGeechan
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Marcos Mestre
- Division of Pediatric Hospital Medicine, Nicklaus Children's Hospital, Miami, Florida
| | - Kavita Parikh
- Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center and School of Medicine, George Washington University, Washington, District of Columbia
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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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15
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Heikkinen J, Nurminen J, Velhonoja J, Irjala H, Happonen T, Soukka T, Mattila K, Hirvonen J. Clinical and prognostic significance of emergency MRI findings in neck infections. Eur Radiol 2021; 32:1078-1086. [PMID: 34331114 PMCID: PMC8794929 DOI: 10.1007/s00330-021-08200-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/17/2021] [Accepted: 07/02/2021] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Due to its superior soft-tissue contrast and ability to delineate abscesses, MRI has high diagnostic accuracy in neck infections. Whether MRI findings can predict the clinical course in these patients is unknown. The purpose of this study was to determine the clinical and prognostic significance of various MRI findings in emergency patients with acute neck infections. MATERIALS AND METHODS We retrospectively reviewed the 3-T MRI findings of 371 patients with acute neck infections from a 5-year period in a single tertiary emergency radiology department. We correlated various MRI findings, including retropharyngeal (RPE) and mediastinal edema (ME) and abscess diameter, to clinical findings and outcomes, such as the need for intensive care unit (ICU) treatment and length of hospital stay (LOS). RESULTS A total of 201 out of 371 patients (54%) with neck infections showed evidence of RPE, and 81 out of 314 patients (26%) had ME. Both RPE (OR = 9.5, p < 0.001) and ME (OR = 5.3, p < 0.001) were more prevalent among the patients who required ICU treatment than among those who did not. In a multivariate analysis, C-reactive protein (CRP) levels, RPE, and maximal abscess diameter were independent predictors of the need for ICU treatment, and CRP, ME, and maximal abscess diameter were independent predictors of LOS. CONCLUSION In patients with an acute neck infection that requires emergency imaging, RPE, ME, and abscess diameter, as shown by MRI, are significant predictors of a more severe illness. KEY POINTS • Two hundred one out of 371 patients (54%) with neck infection showed evidence of retropharyngeal edema (RPE), and 81 out of 314 patients (26%) had mediastinal edema (ME). • Maximal abscess diameter, RPE, and C-reactive protein (CRP) were independent predictors of the need for intensive care unit (ICU) treatment, and maximal abscess diameter, ME, and CRP were independent predictors of length of hospital stay. • Prognostic significance of MRI findings was evident also while controlling for CRP values.
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Affiliation(s)
- Jaakko Heikkinen
- Department of Radiology, Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Janne Nurminen
- Department of Radiology, Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Jarno Velhonoja
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland
| | - Heikki Irjala
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland
| | - Tatu Happonen
- Department of Radiology, Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Tero Soukka
- Department of Oral and Maxillofacial Surgery, University of Turku, Turku, Finland
| | - Kimmo Mattila
- Department of Radiology, Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland.,Department of Radiology, University of Turku, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland. .,Department of Radiology, University of Turku, Turku, Finland.
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Akhavan M. Ear, Nose, Throat: Beyond Pharyngitis: Retropharyngeal Abscess, Peritonsillar Abscess, Epiglottitis, Bacterial Tracheitis, and Postoperative Tonsillectomy. Emerg Med Clin North Am 2021; 39:661-675. [PMID: 34215408 DOI: 10.1016/j.emc.2021.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ear, nose, and throat (ENT) emergencies presenting with a chief complaint of pharyngitis can be due to infection, trauma, or postprocedure complications. The entities described in this article include retropharyngeal abscess, peritonsillar abscess, epiglottitis, bacterial tracheitis, and post-tonsillectomy bleeding. This article provides the emergency physician with the tools needed to decipher between the mundane and the critical, variations in presentation, and their emergent management. All of them require early recognition for any airway compromise or obstruction in order to avoid serious complications.
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Affiliation(s)
- Mahsa Akhavan
- Goryeb Children's Hospital, Morristown Medical Center/Atlantic Health System, 100 Madison Ave, Morristown, NJ 07960, USA.
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17
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Maroun CA, Zalzal HG, Mustafa AA, Carr M. Transoral versus Transcervical Drainage of Pharyngeal Abscesses in Children: Post-Operative Complications. Ann Otol Rhinol Laryngol 2021; 130:1052-1056. [PMID: 33562999 DOI: 10.1177/0003489421990161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The objective of this study was to compare complications and other perioperative outcomes between intraoral and transcervical drainage of both retropharyngeal and parapharyngeal abscesses. MATERIALS AND METHODS This was a retrospective study that analyzed data from the 2012 to 2016 National Surgical Quality Improvement Program (NSQIP)-Pediatric public use files. Baseline characteristics and perioperative outcomes including postoperative complications and length of hospital stay (LOS) were compared between intraoral and transcervical drainage groups. Multivariable logistic regression was performed to inspect predictors of having an extended LOS, defined as LOS greater than 3 days. RESULTS A total of 1174 patients were included. Mean age was 5.1 ± 3.8 years in the intraoral group (N = 1063) and 4.2 ± 4.3 years in the transcervical group (N = 111, P < .001). There was no significant difference in the rate of post-operative complications between groups (5.7% intraoral vs 8.1% transcervical, P = .316). LOS was significantly longer in the transcervical group (>3 days in 36.2% of intraoral vs 49.5% of transcervical, P = .006). Patients in the transcervical group had 1.59 times the odds of extended LOS, after adjusting for age, pre-operative ventilator support, asthma, structural pulmonary disease, hematologic disorders, and all post-operative complications (P = .024). CONCLUSION There does not appear to be a significant difference in the rate of post-operative complications after intraoral versus transcervical drainage for pharyngeal abscesses in children. However, transcervical drainage was associated with an extended hospital stay. Further prospective studies will be needed to determine the reasons for this.
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Affiliation(s)
- Christopher A Maroun
- Department of Otolaryngology- Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Habib G Zalzal
- Department of Otolaryngology-Head and Neck Surgery, George Washington University, Children's National Medical Center, Washington, DC, USA
| | - Ayman A Mustafa
- Department of Otolaryngology-Head and Neck Surgery, University at Buffalo School of Medicine, Buffalo NY, USA
| | - Michele Carr
- Department of Otolaryngology-Head and Neck Surgery, University at Buffalo School of Medicine, Buffalo NY, USA
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18
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Lipsett SC, Porter JJ, Monuteaux MC, Watters K, Hudgins JD. Variation in the Management of Children With Deep Neck Infections. Hosp Pediatr 2021; 11:277-283. [PMID: 33536252 DOI: 10.1542/hpeds.2020-000315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Children with deep neck infections (DNIs) are increasingly being managed nonsurgically with intravenous antibiotics. Our objective was to examine variation in the management of children with DNIs across US children's hospitals. METHODS We conducted a retrospective cohort study using the Pediatric Health Information System database. Children ≤12 years of age hospitalized for retropharyngeal or parapharyngeal abscesses from 2010 to 2018 were included. Hospital variation in management modality and imaging use was described. Temporal trends in management modality were assessed by using logistic regression. Medical management alone versus a combination of medical and surgical management was assessed, and the characteristics of children in these 2 groups were compared. The relationship between hospital rates of initial medical management and failed medical management was assessed by using linear regression. RESULTS Hospitals varied widely in their rates of surgical management from 17% to 70%. The overall rate of surgical management decreased from 42.0% to 33.5% over the study period. Children managed surgically had higher rates of ICU admission (11.5% vs 3.2%; P < .001) and higher hospital charges ($25 241 vs $15 088; P < .001) compared with those managed medically alone. Seventy-three percent of children underwent initial medical management, of whom 17.9% went on to undergo surgery. Hospitals with higher rates of initial medical management had lower rates of failed medical management (β = -.43). CONCLUSIONS Although rates of surgical management of pediatric DNI are decreasing over time, there remains considerable variation in management across US children's hospitals. Children managed surgically have higher rates of resource use and costs.
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Affiliation(s)
- Susan C Lipsett
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and .,Division of Emergency Medicine and
| | | | - Michael C Monuteaux
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and.,Division of Emergency Medicine and
| | - Karen Watters
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Joel D Hudgins
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and.,Division of Emergency Medicine and
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19
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Influence de la « phobie du COVID » sur les diagnostics oto-rhino-laryngologiques précoces. ANNALES FRANÇAISES D'OTO-RHINO-LARYNGOLOGIE ET DE PATHOLOGIE CERVICO-FACIALE 2020. [PMCID: PMC7834472 DOI: 10.1016/j.aforl.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Sideris G, Delides A. “COVIDphobia” influences early otolaryngology diagnoses. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:353-354. [PMID: 32624391 PMCID: PMC7332260 DOI: 10.1016/j.anorl.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 11/24/2022]
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21
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Shay SG, Khayat S, Xu R, Srdanovic N, Patel SJ, Valika T, Lavin JM. Resource utilization of intraoperative cultures for pediatric deep neck space abscesses. Int J Pediatr Otorhinolaryngol 2020; 135:110115. [PMID: 32447171 DOI: 10.1016/j.ijporl.2020.110115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Peritonsillar (PT), parapharyngeal (PP), and retropharyngeal (RP) abscesses are common pediatric deep neck space infections (DNSI). Despite established literature on DNSI microbiology, obtaining intraoperative cultures remains commonplace. The objective was to evaluate the resource utilization of intraoperative cultures when draining PT, PP, and RP abscesses. METHODS Pediatric patients (age <18.0 years) who underwent surgical drainage of a PT, PP, or RP abscess between January 2013 and June 2018 were retrospectively reviewed. Changes in antimicrobials based on intraoperative culture results were assessed by use of Fisher's exact tests or Wilcoxon rank-sum tests, as appropriate. Multivariable linear regression was used to model the association between factors of interest and number of cultures obtained. RESULTS Eighty-eight patients underwent surgical drainage, of which 80 patients (median age 6.96 years) had intraoperative bacterial cultures (32 PT, 21 PP, and 27 RP). There were no positive fungal or acid-fast bacilli cultures. Seven patients had culture-directed changes in treatment; none of these patients had a PT abscess. Age was inversely associated with culture-directed changes (p = 0.006) while the use of blood cultures (p = 0.012) was positively associated with culture-directed treatment changes. Hospital length of stay (p < 0.001) and history of prior DNSI (p = 0.001) were associated with number of cultures obtained. CONCLUSIONS Younger children with PP and RP abscesses are most likely to benefit from intraoperative bacterial cultures. Cultures of PT abscesses are unlikely to change clinical management. Fungal and acid-fast bacilli cultures are unlikely to yield clinically useful information. Prudent use of intraoperative cultures may decrease the use of hospital resources and admission-related costs.
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Affiliation(s)
- Sophie G Shay
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Pediatric Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
| | - Sarah Khayat
- Department of Otolaryngology and Head and Neck Surgery, University of Illinois-Chicago, Chicago, IL, USA
| | - Rebecca Xu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nina Srdanovic
- Biostatistics Collaboration Center, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sameer J Patel
- Division of Pediatric Infectious Disease, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Taher Valika
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA; Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer M Lavin
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA; Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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22
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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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23
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Matos R, Martins S, Marques P, Santos M. Unilateral acute cervical lymphadenitis in children: can we predict the need for surgery? Int J Pediatr Otorhinolaryngol 2019; 127:109655. [PMID: 31470203 DOI: 10.1016/j.ijporl.2019.109655] [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: 07/14/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Paediatric acute cervical lymphadenitis is a frequent diagnosis in the emergency department. Traditionally, suppurative cervical lymphadenitis (SCL) is associated with a higher need of surgical drainage. However, a great variability in the management of this suppurative infections can be observed. Moreover, the clinical distinction between non-suppurative cervical lymphadenitis (NSCL) and SCL is not an easy task and there are, currently, no guidelines defining which patients are eligible for imaging study. OBJECTIVES To assess the determinants and benefits in the surgical management of SCL in children. As secondary outcome, to determine differences in epidemiological characteristics, clinical, biochemical and radiological features between NSCL and SCL. MATERIAL AND METHODS A retrospective survey was carried out in a tertiary university hospital between January 2007 and December 2016. Forty-two children with a diagnosis of acute cervical lymphadenitis (ACL) were included and categorized according to the presence of suppuration, resulting in two groups: NSCL and SCL. The latter group was further categorized into surgical and non-surgical groups, according to the need of surgical drainage. RESULTS No significant differences were found between SCL and NSCL groups in gender, age and previous antibiotics intake (p > 0.05). According to clinical presentation, odynophagia was significantly more frequent in NSCL patients (p = 0.01), with no differences found in other clinical parameters (p > 0.05). Patients presenting acute cervical lymphadenitis involving the submandibular region have 16 times the odds of a suppurative process (p = 0.029). In a SCL subgroup analysis, no association was observed between lymphadenitis size or location and the need for surgical drainage (p > 0.05). Children included in the SCL surgical group presented a trend to an increased in the hospitalization length (p = 0.01), when comparing to those in which treatment was limited to intravenous antibiotics. One death was observed in the SCL non-surgical group. CONCLUSIONS Predictive factors for the need of surgery were not found. Furthermore, surgical drainage was not associated with better outcomes. Surgery could be considered in selected stable patients, when alternative medical treatments do not seem to work, in a case-to-case basis.
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Affiliation(s)
- Ricardo Matos
- Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Department of Surgery and Physiology/Otorhinolaryngology, University of Porto Medical School, Portugal.
| | - Sónia Martins
- Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Department of Surgery and Physiology/Otorhinolaryngology, University of Porto Medical School, Portugal
| | - Pedro Marques
- Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Department of Surgery and Physiology/Otorhinolaryngology, University of Porto Medical School, Portugal
| | - Margarida Santos
- Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
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Lin J, Wu XM, Feng JX, Chen MF. Retropharyngeal abscess presenting as acute airway obstruction in a 66-year-old woman: A case report. World J Clin Cases 2019; 7:3838-3843. [PMID: 31799312 PMCID: PMC6887600 DOI: 10.12998/wjcc.v7.i22.3838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/29/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Adult retropharyngeal abscess (RPA) is extremely rare, and most cases reported in the literature were related to tuberculous infection. We present a case of RPA with acute airway obstruction as the main manifestation in a 66-year-old woman that was considered to be non-tubercular suppurative inflammation in the retropharyngeal space.
CASE SUMMARY A 66-year-old woman complaining of chills and fever was admitted to our hospital. She was initially diagnosed with an acute upper respiratory tract infection. She lost consciousness twice during hospitalization. She regained consciousness immediately upon emergency tracheal intubation. Acute upper airway obstruction was suspected as arterial blood gas analysis showed obvious acute retention of carbon dioxide before the second tracheal intubation. The diagnosis of RPA was confirmed by computed tomography and magnetic resonance imaging. Kocuria kristinae was isolated from blood samples taken from both hands. The patient recovered and was subsequently discharged after receiving antibiotic therapy together with surgical incision and drainage of the abscess.
CONCLUSION Clinicians should be alert to the possibility of RPA in patients with acute airway obstruction. Surgical incision and drainage is an effective treatment for RPA.
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Affiliation(s)
- Jian Lin
- Division of Pulmonary and Critical Care Medicine, Wenzhou Medical University Affiliated Taizhou Hospital, Linhai 317000, Zhejiang Province, China
| | - Xiao-Mai Wu
- Division of Pulmonary and Critical Care Medicine, Wenzhou Medical University Affiliated Taizhou Hospital, Linhai 317000, Zhejiang Province, China
| | - Jia-Xi Feng
- Division of Pulmonary and Critical Care Medicine, Wenzhou Medical University Affiliated Taizhou Hospital, Linhai 317000, Zhejiang Province, China
| | - Mei-Fang Chen
- Division of Pulmonary and Critical Care Medicine, Wenzhou Medical University Affiliated Taizhou Hospital, Linhai 317000, Zhejiang Province, China
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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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Luscan R, Truffert E, Simon F, Belhous K, Verillaud B, Garabedian N, Leboulanger N, Couloigner V. Premaxillary abscess without bony erosion: An unusual complication of pediatric acute maxillary sinusitis. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:349-353. [PMID: 31427214 DOI: 10.1016/j.anorl.2019.04.013] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To report an unusual complication of pediatric acute maxillary sinusitis: premaxillary abscess. To describe clinical, radiological and biological presentation, treatment strategy and progression. MATERIAL AND METHODS A retrospective study included all pediatric patients treated for premaxillary abscess complicating acute maxillary sinusitis in two ENT reference centers between 1999 and 2017. Disease history, clinical presentation, biological and radiological findings, treatment modalities and progression were studied. RESULTS Ten patients were included, with a mean age of 10±4.2 years. All presented with fever, rhinorrhea and premaxillary edema. Contrast-enhanced CT scan systematically found complete opacity of the maxillary sinus, without bone lysis, and extensive effusion along the intersinonasal wall up to the premaxillary region, extending in 3 cases back toward the parapharyngeal space. Bacteriology isolated Streptococcus anginosus most frequently (n=4; 40%). Treatment comprised intravenous wide-spectrum antibiotics, with surgical drainage of the abscess if>10mm (n=9; 90%). Seven of these 9 patients (78%) had recurrent abscess requiring surgical revision and 3 (33%) required a third drainage. All patients were cured without sequelae at 1 month. CONCLUSION In case of acute maxillary sinusitis with premaxillary edema, premaxillary abscess should be suspected. The high recurrence rate argues for maximalist surgery associated to close clinical monitoring with radiological examination.
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Affiliation(s)
- R Luscan
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France
| | - E Truffert
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France
| | - F Simon
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France
| | - K Belhous
- Service de radiologie pédiatrique hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France
| | - B Verillaud
- Service d'oto-rhino-laryngologie, hôpital Lariboisière, assistance publique-hôpitaux de Paris, université Paris Diderot, 75010 Paris, France
| | - N Garabedian
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France
| | - N Leboulanger
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France
| | - V Couloigner
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France.
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Ruiz de la Cuesta F, Cortes Castell E, Garcia Ruiz ME, Severa Ferrandiz G. Deep neck space abscesses in children: 15 years of experience in a children's ENT referral unit. An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Ruiz de la Cuesta F, Cortes Castell E, Garcia Ruiz ME, Severa Ferrandiz G. Abscesos cervicales profundos infantiles: experiencia de una unidad de ORL infantil de referencia durante 15 años. An Pediatr (Barc) 2019; 91:30-36. [DOI: 10.1016/j.anpedi.2018.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 09/22/2018] [Accepted: 09/27/2018] [Indexed: 11/16/2022] Open
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Buch K, Reinshagen KL, Juliano AF. MR Imaging Evaluation of Pediatric Neck Masses:. Magn Reson Imaging Clin N Am 2019; 27:173-199. [DOI: 10.1016/j.mric.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Wilkie MD, De S, Krishnan M. Defining the role of surgical drainage in paediatric deep neck space infections. Clin Otolaryngol 2019; 44:366-371. [PMID: 30784193 DOI: 10.1111/coa.13315] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/05/2019] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Surgical drainage is the traditional mainstay of treatment of paediatric deep neck space infection (DNSI), but recently non-operative management in selected cases has been advocated. We sought to identify any characteristics predictive of requirement for surgical intervention. DESIGN Retrospective cohort study using receiver operating characteristics analyses. SETTING Tertiary referral paediatric hospital. PARTICIPANTS Children (≤16 years) with a radiologically confirmed diagnosis of retro- or parapharyngeal abscess over a ten-year period. MAIN OUTCOME MEASURES Predictive value of clinical and radiological variables in determining the requirement for surgical intervention. Length of hospital stay (LoS) was also examined. RESULTS Ninety-three children were studied, 15 (16.1%) of whom underwent immediate surgery, 42 (45.2%) of whom underwent delayed surgery following an initial period of conservative management, and 36 (38.7%) of whom were managed conservatively. Age, WCC and CRP were not predictive of the need for surgical drainage. Radiological abscess diameter, however, was predictive of requirement surgery (AUC = 0.85 [95% CI ± 0.09] P = 0.02), with a cut-off value of 2.5 cm determined assuming equal weight to sensitivity and specificity. All DNSIs were successfully treated with no adverse outcomes, and there was no significant difference in LoS between groups. In those managed surgically, outcome and LoS did not depend on yield of pus. CONCLUSIONS Selected paediatric DNSIs can be successfully managed conservatively, with abscess diameter >2.5 cm a significant predictor of need for surgical intervention. Any benefit of surgery does not appear to depend on intra-operative yield of pus.
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Affiliation(s)
- Mark D Wilkie
- Department of Otorhinolaryngology - Head and Neck Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Sujata De
- Department of Otorhinolaryngology - Head and Neck Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Madhankumar Krishnan
- Department of Otorhinolaryngology - Head and Neck Surgery, Alder Hey Children's Hospital, Liverpool, UK
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Abstract
Infection of the neck is a relatively common emergency department complaint. If not diagnosed and managed promptly, it may quickly progress to a life-threatening infection. These infections can result in true airway emergencies that may require fiberoptic or surgical airways. This article covers common, as well as rare but emergent, presentations and uses an evidence-based approach to discuss diagnostic and treatment modalities.
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Affiliation(s)
- Renjie Michael Li
- Department of Emergency Medicine, Loma Linda University Medical Center, 11234 Anderson Street MC A-108, Loma Linda, CA 92354, USA
| | - Michael Kiemeney
- Department of Emergency Medicine, Loma Linda University School of Medicine, 11234 Anderson Street MC A-108, Loma Linda, CA 92354, USA.
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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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Gavid M, Dumollard JM, Habougit C, Lelonge Y, Bergandi F, Peoc'h M, Prades JM. Anatomical and histological study of the deep neck fasciae: does the alar fascia exist? Surg Radiol Anat 2018; 40:917-922. [PMID: 29380103 DOI: 10.1007/s00276-018-1977-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/18/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to determine whether the alar fascia is a distinct layer of the deep cervical neck fasciae. The present study also aimed to elucidate the anatomical limits of this fascia. METHODS Neck dissections of ten adult cadavers were performed, layer by layer, in the retropharyngeal region, under a powered operating microscope. Detailed dissections revealed the anatomical limits of the deep neck fasciae. Histological descriptions were also performed on large tissue samples collected from three cervical dissections. RESULTS In the ten dissections, three layers of fascia were identified and dissected in the retropharyngeal region: a visceral fascia, a prevertebral fascia and an alar fascia. The alar fascia appeared like a connecting band derivative of the visceral fascia, between both vascular sheaths. It fused completely with the visceral fascia anteriorly at the level of T2 and with the prevertebral fascia posteriorly at the level of C1. No sagittal connection between the visceral fascia and the prevertebral fascia was identified. The stained histological sections confirmed the presence of the visceral and prevertebral fasciae at the oropharyngeal level, with a third intermediate layer closely connected with the visceral fascia. CONCLUSION The alar fascia is a layer of the cervical neck fascia connected with the visceral fascia from C1 to T2 levels. The anatomical limits of this alar fascia and its relationships with the internal carotid artery are important in the surgical management and the prognosis of deep neck infections and retropharyngeal lymph node metastases.
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Affiliation(s)
- M Gavid
- Department of Anatomy, Jean Monnet University, Saint-Etienne, France.
- Department of Otorhinolaryngology Head Neck Surgery, CHU Saint-Etienne, Saint-Etienne, France.
| | - J M Dumollard
- Department of Anatomopathology, CHU Saint-Etienne, Saint-Etienne, France
| | - C Habougit
- Department of Anatomopathology, CHU Saint-Etienne, Saint-Etienne, France
| | - Y Lelonge
- Department of Otorhinolaryngology Head Neck Surgery, CHU Saint-Etienne, Saint-Etienne, France
| | - F Bergandi
- Department of Anatomy, Jean Monnet University, Saint-Etienne, France
| | - M Peoc'h
- Department of Anatomopathology, CHU Saint-Etienne, Saint-Etienne, France
| | - J M Prades
- Department of Anatomy, Jean Monnet University, Saint-Etienne, France
- Department of Otorhinolaryngology Head Neck Surgery, CHU Saint-Etienne, Saint-Etienne, France
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Côrte FC, Firmino-Machado J, Moura CP, Spratley J, Santos M. Acute pediatric neck infections: Outcomes in a seven-year series. Int J Pediatr Otorhinolaryngol 2017; 99:128-134. [PMID: 28688554 DOI: 10.1016/j.ijporl.2017.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/18/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to analyse the epidemiology, clinical presentation, diagnostic clues, as biochemical parameters and imaging studies, of children with acute neck infections (ANI) to identify possible independent prognostic factors leading to complications and prolonged hospitalization. METHODS Records of children admitted to a tertiary university hospital from January 2008 to December 2014 with a diagnosis of ANIs were reviewed retrospectively. Diseases were categorized according to the site of infection and patients were divided into two groups: children (aged<10 years) and adolescents (aged 10-18 years). RESULTS A total of 102 patients belonged to the children's group and 57 were adolescents. Forty-nine patients (27.2%) received antibiotics prior to presentation. The most frequent ANI was peritonsillar abscess (n = 72). Four peritonsillar abscesses progressed to parapharyngeal and retropharyngeal abscesses (n = 2 respectively). An association between age and type of abscess was found, with most of the retropharyngeal abscesses occurring in children (p = 0.05), and the submandibular abscesses in adolescents (p < 0.001). The most frequent symptoms/signs were fever (63.9%) and odynophagia (50.6%). Upon admission, all patients received intravenous antibiotics and 86.8% underwent drainage of the abscess. Cultures were harvested in 87 abscesses and the most frequent pathogen isolated was Streptococcus pyogenes. Signs of airway obstruction occurred in two patients with submandibular abscess, one with peritonsillar and one with parapharyngeal abscess. There were no cases of death or severe sequelae. Recurrent ANIs were observed in eight patients including two infected branchial cysts. Children, presence of multiple abscesses and palpable cervical mass on admission, absence of odynophagia and pharyngeal bulging, surgery with general anaesthesia and surgery after 24 h, were associated with prolonged hospitalization. Presence of toothache and neck pain on admission were identified as predictors of complications. CONCLUSIONS The present study found, that often, the diagnosis and treatment of neck abscesses in paediatric patients is not straightforward, but can achieve a favourable outcome. The primary location of the ANI appears to vary in different paediatric age groups. Younger age, presence of multiple abscesses or a palpable cervical mass on admission, were associated with prolonged hospitalization. Presence of toothache and neck pain on admission was identified as possible predictors of complications.
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Affiliation(s)
- Filipa Camacho Côrte
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal.
| | | | - Carla Pinto Moura
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal; Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Jorge Spratley
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal
| | - Margarida Santos
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal
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Bertille N, Pons G, Fournier-Charrière E, Khoshnood B, Chalumeau M. National cross-sectional study of nonsteroidal anti-inflammatory drugs use highlights differences between parents and professionals and prompts safety concerns. Acta Paediatr 2016; 105:e543-e548. [PMID: 27582177 DOI: 10.1111/apa.13566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 06/01/2016] [Accepted: 08/30/2016] [Indexed: 01/23/2023]
Abstract
AIM Controversy surrounding the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) provides an opportunity to study parents' and healthcare professionals' differential use of over-the-counter drugs. METHODS In this national cross-sectional study, general practitioners, paediatricians and pharmacists were asked to include up to five consecutive febrile paediatric patients aged 1 month to 12 years. Parents and healthcare professionals completed questionnaires about the current fever episode. We studied the differential use of NSAIDs by parents and healthcare professionals notably in three clinical conditions with various estimated risk of NSAIDs complications: varicella, gastroenteritis and pharyngitis. RESULTS The 1534 healthcare professionals prescribed 15% of the 6596 children with an NSAID, but 32% of the parents gave their child an NSAID. Generally, NSAID use was associated with older children, higher temperatures, pain due to otitis and the absence of a rash or gastroenteritis. The differential use of NSAIDs by parents and professionals was greater in conditions with high than low estimated risks of NSAID complications, with odds ratios ranging from to 9.0 to 2.9, respectively. CONCLUSION The differential use of NSAIDs by healthcare professionals and parents for clinical conditions with potential risks should prompt discussions about the safety of their over-the-counter status.
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Affiliation(s)
- Nathalie Bertille
- Inserm U1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS); Paris Descartes University; Paris France
- Sorbonne Universités; UPMC Univ Paris 06, IFD; Paris France
- Department of General Paediatrics; Hôpital Necker-Enfants malades; Assistance Publique-Hôpitaux de Paris (AP-HP); Paris France
| | - Gérard Pons
- Clinical Pharmacology; Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP; Paris Descartes University; Paris France
- Inserm U663 Paediatric Epilepsies and Brain Plasticity; Paris France
| | | | - Babak Khoshnood
- Inserm U1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS); Paris Descartes University; Paris France
| | - Martin Chalumeau
- Inserm U1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS); Paris Descartes University; Paris France
- Department of General Paediatrics; Hôpital Necker-Enfants malades; Assistance Publique-Hôpitaux de Paris (AP-HP); Paris France
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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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Kwon M, Seo JH, Cho KJ, Won SJ, Woo SH, Kim JP, Park JJ. Suggested Protocol for Managing Acute Suppurative Cervical Lymphadenitis in Children to Reduce Unnecessary Surgical Interventions. Ann Otol Rhinol Laryngol 2016; 125:953-958. [PMID: 27553593 DOI: 10.1177/0003489416665194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The indications and benefits of surgery in the management of pediatric acute suppurative cervical lymphadenitis (ASCL) remain unclear. We aimed to design a management protocol focusing on the avoidance of unnecessary operation in pediatric ASCL patients. METHODS The study population consisted of 45 pediatric patients with ASCL treated with antibiotics alone and 30 surgically treated patients. The primary outcome was the determination of differences in patient characteristics and radiologic findings in the 2 groups. The secondary outcome, after matching 20 cases with 20 controls, was to determine the benefits of surgery to patients. RESULTS There were no significant differences between the 2 groups in patient characteristics and radiologic findings at initial presentation. In the matched case-control analysis, intravenous antibiotics alone yielded successful treatment outcomes when compared with surgery, with no significant differences in time to symptom resolution, normalized laboratory test results, and duration of hospitalization (all P > .05). CONCLUSIONS The size and location of suppurated lymph nodes are not absolute determinants for surgical drainage in the stable pediatric ASCL patients. If patients show no clinical improvements despite appropriate second- and third-line antibiotics, patients should be carefully reevaluated and image-guided aspiration considered.
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Affiliation(s)
- Minsu Kwon
- Department of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ji-Hyun Seo
- Departments of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Gangnam-ro Jinju, Republic of Korea
| | - Ki Ju Cho
- Departments of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seong Jun Won
- Departments of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seung Hoon Woo
- Departments of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jin Pyeong Kim
- Departments of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jung Je Park
- Department of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Cramer JD, Purkey MR, Smith SS, Schroeder JW. The impact of delayed surgical drainage of deep neck abscesses in adult and pediatric populations. Laryngoscope 2016; 126:1753-60. [DOI: 10.1002/lary.25835] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/05/2015] [Accepted: 11/27/2015] [Indexed: 11/08/2022]
Affiliation(s)
- John D. Cramer
- Department of Otolaryngology-Head and Neck Surgery; Chicago Illinois U.S.A
| | - Matthew R. Purkey
- Northwestern University Feinberg School of Medicine; Chicago Illinois U.S.A
| | - Stephanie Shintani Smith
- Department of Otolaryngology-Head and Neck Surgery; Chicago Illinois U.S.A
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University Feinberg School of Medicine; Chicago Illinois U.S.A
| | - James W. Schroeder
- Department of Otolaryngology-Head and Neck Surgery; Chicago Illinois U.S.A
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Ann and Robert H. Lurie Children's Hospital; Chicago Illinois U.S.A
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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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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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Hyo Y, Fukushima H, Harada T. Neck swelling from a retropharyngeal abscess caused by penicillin-resistant Streptococcus pneumoniae: a case report. BMC Res Notes 2014; 7:291. [PMID: 24885483 PMCID: PMC4045944 DOI: 10.1186/1756-0500-7-291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 04/28/2014] [Indexed: 11/16/2022] Open
Abstract
Background In small children, retropharyngeal abscesses usually occur after upper respiratory tract infections. Unlike in adults, these abscesses are difficult to diagnose in small children, and can rapidly develop into deep neck or mediastinal abscesses. Case presentation A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling. Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall. Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck. The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess. After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma. The lesions improved after intraoral incision and drainage, and administration of antibiotics. Conclusion Lymphangiomas and retropharyngeal abscesses are both known to be more common in children than in adults. However, we found no other reports of concomitant presentation of lymphangioma and retropharyngeal abscess in the literature.
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Affiliation(s)
- Yukiyoshi Hyo
- Department of Otolaryngology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan.
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Favret A, Zanelli E, Germani C, Giorgi R, Grasso DL, Ventura A. A significant increase in potentially life-threatening disease: retropharyngeal abscess. Acta Paediatr 2013; 102:e390-1. [PMID: 23714106 DOI: 10.1111/apa.12303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Favret
- University of Trieste; Trieste Italy
| | - E Zanelli
- University of Trieste; Trieste Italy
| | - C Germani
- University of Trieste; Trieste Italy
| | - R Giorgi
- University of Trieste; Trieste Italy
| | - DL Grasso
- Ear, Nose and Throat Unit; Department of Pediatric Surgery; Institute for Maternal and Child Health - IRCCS ‘Burlo Garofolo’; Trieste Italy
| | - A Ventura
- University of Trieste; Trieste Italy
- Pediatric Clinical Department; Institute for Maternal and Child Health - IRCCS ‘Burlo Garofolo’; Trieste and University of Trieste Italy
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Abstract
Objective To identify clinical features associated with unsuccessful medical therapy in children with deep space neck infections (DSNIs). Study Design Consecutive case series with chart review. Setting Tertiary-care, academic children’s hospital. Subjects and Methods One hundred seventy-eight pediatric patients treated for retropharyngeal or parapharyngeal infections between July 1, 2007, and May 23, 2012. Results Median age was 34.5 months (2.9 years; range, 2-142 months); two-thirds were male. Increased surgical drainage was found in children age ≤15 months ( P = .002) and for abscesses >2.2 cm ( P = .0001). Risk factors associated with increased likelihood of medical therapy failure included age ≤51 months, intensive care unit admission, and computed tomography findings consistent with abscess size >2.2 cm. Methicillin-resistant Staphylococcus aureus infections were found more often in younger children, with the highest incidence in those ≤15 months of age ( P = .001). All children had resolution of infection. Conclusion Deep space neck infections in children can often be successfully managed with medical therapy alone, but life-threatening complications may occur. We recommend that young patients be managed cautiously.
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Affiliation(s)
- Jeffrey Cheng
- Division of Pediatric Otolaryngology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lisa Elden
- Division of Pediatric Otolaryngology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wong DKC, Brown C, Mills N, Spielmann P, Neeff M. To drain or not to drain - management of pediatric deep neck abscesses: a case-control study. Int J Pediatr Otorhinolaryngol 2012; 76:1810-3. [PMID: 23089190 DOI: 10.1016/j.ijporl.2012.09.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 08/29/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED Optimal management of deep neck abscesses has been the subject of debate for more than a century: surgical drainage has been the mainstay of treatment, but recently many centres have reported successful non-operative management in selected cases. OBJECTIVES Our objective was to review the management of deep neck abscesses in our institution and to identify characteristics that would predict successful non-operative management. METHODS A retrospective chart review from January 2001 to August 2010 was performed. Children up to age fifteen years with a CT-confirmed diagnosis of retropharyngeal or parapharyngeal abscess were included. A case-control study of small deep space neck abscesses (≤ 25 mm maximal diameter) was performed, comparing antibiotic treatment alone with antibiotics plus abscess drainage. RESULTS 54 children met the inclusion criteria, of whom half had abscesses ≤ 25 mm diameter. Younger children within the group with smaller abscesses were more likely to need surgical drainage (p<0.05). Of 13 children requiring operative management, ten underwent a period of antibiotic treatment and observation prior to surgery, eight (80%) had fever beyond 48 h compared with three (23%) in the non-surgical group (p<0.01). 27 children had an abscess > 25 mm diameter on CT scan, four (15%) of whom responded quickly to antibiotics and were managed non-operatively, while the rest underwent surgery. There were no significant differences between the surgical and non-surgical group characteristics with larger abscesses. CONCLUSION High dose intravenous antibiotics are an effective treatment for deep space neck abscesses and may obviate the need for surgical drainage, particularly in smaller abscesses. Children who do not respond quickly to antibiotics are more likely to require surgery to achieve resolution. Children with larger abscesses may respond to antibiotic therapy alone but should be closely observed. A trial of high dose intravenous antibiotics in stable children with close observation is warranted as first line treatment, especially for small deep space neck abscesses.
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Affiliation(s)
- Danny K C Wong
- Department of Paediatric Otolaryngology, Starship Children's Hospital, Auckland, New Zealand
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