Comparison of the sensitivity of lateral neck radiographs and computed tomography scanning in pediatric deep-neck infections

Retropharyngeal and parapharyngeal infections in children: A retrospective analysis

OBJECTIVES

To describe presentations, management and outcomes of retropharyngeal and parapharyngeal infections in children presenting to a tertiary care pediatric emergency department.

METHODS

A retrospective chart review of children with deep neck infections such as retropharyngeal or parapharyngeal infection from January 2008 to December 2018 was conducted at a pediatric hospital.

RESULTS

There were 176 retropharyngeal, 18 parapharyngeal and 6 with both retropharyngeal and parapharyngeal infections treated during the 10-year study period. Males were 60% of the cohort and the mean age was 4.3 (SD: 3.2) years. No significant differences in age or sex ratio or presentations were seen in children with retropharyngeal infections compared with parapharyngeal infections. All received parenteral antibiotics; 42% (84/200) of children underwent surgery and four of them had more than one surgical drainage. Age <12 months and the diagnosis of parapharyngeal infections were associated with significantly higher rates of surgical treatment. Children under 12 months of age were sicker at presentation and had a high complication rate of 23% compared with 1% in the older children (p = 0.002). Seven children had co-existence of Kawasaki disease with deep neck infections.

CONCLUSIONS

Early diagnosis of retropharyngeal and parapharyngeal infections especially in infants under a year of age is important as they are more likely to have complications and need surgical management. Most paediatric patients with retropharyngeal and parapharyngeal infections have a phlegmon or very small abscesses and are treated non-operatively with parenteral antibiotics.

Salmonella Retropharyngeal Abscess Linked to Backyard Poultry Exposure in a 12-Month-Old Girl

We report a rare complication of nontyphoidal Salmonella infection in a 12-month-old girl with a retropharyngeal abscess. The patient presented with a four-day history of nasal congestion, cough, decreased oral intake, and increased irritability. She was admitted for a suspected deep neck infection. Computed tomography confirmed a retropharyngeal abscess with airway narrowing. Incision and drainage was performed, and intraoperative cultures grew nontyphoidal Salmonella. Epidemiologic investigation revealed exposure to a backyard flock of chickens. The patient had little direct contact with chickens but did go with family to collect eggs, riding on a vehicle that likely became contaminated. This case highlights the risks to infants and young children in contact with live poultry or contaminated environments.

Role of steroids in conservative treatment of parapharyngeal and retropharyngeal abscess in children

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.

Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses

Deep neck infections (DNIs) include all the infections sited in the potential spaces and fascial planes of the neck within the limits of the deep layer of the cervical fascia. Parapharyngeal and retropharyngeal infections leading to parapharyngeal abscess (PPA) and retropharyngeal abscess (RPA) are the most common. DNIs remain an important health problem, especially in children. The aim of this narrative review is to describe the management of peritonsillar, retropharyngeal and parapharyngeal abscesses in pediatric age. Despite relatively uncommon, pediatric DNIs deserve particular attention as they can have a very severe course and lead to hospitalization, admission to the intensive care unit and, although very rarely, death. They generally follow a mild upper respiratory infection and can initially present with signs and symptoms that could be underestimated. A definite diagnosis can be made using imaging techniques. Pus collection from the site of infection, when possible, is strongly recommended for definition of diseases etiology. Blood tests that measure the inflammatory response of the patient may contribute to monitor disease evolution. The therapeutic approach should be targeted toward the individual patient. Regardless of the surgical treatment, antibiotics are critical for pediatric DNI prognosis. The diagnostic-therapeutic procedure to be followed in the individual patient is not universally shared because it has not been established which is the most valid radiological approach and which are the criteria to be followed for the differentiation of cases to be treated only with antibiotics and those in which surgery is mandatory. Further studies are needed to ensure the best possible care for all children with DNIs, especially in this era of increased antimicrobial resistance.

Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients

Introductıon

Deep neck infections are a group of diseases with serious complications and mortality, which can occur as a result of common diseases in the community and which have surgical and medical treatment options.

Objectives

Patients ages, genders, complaints, physical examination findings, hospitalization complaints, history of antibiotic use before the application, additional diseases, radiological tests and analysis of examinations, type of treatment method, antibiotic agents selected in treatment, bacterial culture results, duration of hospitalization, complications, mortality rates were systematically recorded. In the study, anaerobic bacterial factors, which are difficult to produce in routine, were produced by considering special transport conditions and culture media.

Methods

A total of 74 patients who were hospitalized in the Department of Otorhinolaryngology, University of Mersin, between 01.07.2016 and 01.07.2017 for deep neck infection were evaluated prospectively. The study included 37 female and 37 male patients. The ages of the patients ranged from 1 to 69 and the mean age was 31 years.

Results

According to the analysis of the obtained data, there was a statistically significant relationship between the patients with additional diseases and the treatment modalities of the patients (p = 0.017). The surgical treatment rate was increased in this group of patients. In patients with a history of antibiotic use, it was found that patients in the pediatric group were in hospital longer in terms of length of stay compared to adults (p = 0.036). In adult patients who underwent surgery, the absorptive long axis was found to be longer in mm than in patients receiving isolated medical treatment (p = 0.008).

Conclusions

Deep neck infections is a disease group that seriously concerns public health, with significant mortality and morbidity. Ensuring airway safety of patients should be the first intervention. Abscesses located lateral to the tonsil capsule may not drain adequately without concomitant tonsillectomy.

Infrahyoid involvement may be a high-risk factor in the management of non-odontogenic deep neck infection: Retrospective study

OBJECTIVES

This study sought to investigate the impact of involvement of the infrahyoid neck space on the management of non-odontogenic DNI.

METHOD

Eighty-one patients treated for non-odontogenic DNI over 5 years were retrospectively recruited into this study. Demographics, etiology, radiology results, treatments, duration/cost of hospital stay, and complications were recorded. Differences between DNIs with and without infrahyoid involvement, as defined based on an anatomical chart, were analyzed.

RESULTS

Sixty-two male and 19 female patients with a median age of 46.22 years were included. Fifteen patients had cellulitis, and 66 patients had abscesses. Streptococcus was the most commonly observed bacterium. Compared with DNIs only in suprahyoid spaces (n = 60, 74.07%), DNIs with infrahyoid space involvement (n = 21, 25.93%) were associated with higher incidences of the involvement of ≥3 spaces (85.71%, P = 0.000), mediastinitis (38.10%, P = 0.000), tracheostomy (28.57%, P = 0.008), surgery using a transcervical approach (66.67%, P = 0.000), and intensive care unit therapy (19.05%, P = 0.004), as well as longer hospital stays (16 days, P = 0.000) and higher costs ($2872, P = 0.000).

CONCLUSION

Infrahyoid involvement should be regarded as a high-risk factor in the management of deep neck infection (DNI). A relatively aggressive plan that includes transcervical surgery and tracheostomy should be considered at earlier stages for DNI with infrahyoid involvement.

Pediatric lateral neck infections - Computed tomography vs ultrasound on initial evaluation

OBJECTIVE

Review the evaluation of children with a deep lateral neck infection and define the impact of initial imaging modality on outcomes and costs.

METHOD

Case series, pediatric patients <18 years of age admitted to a tertiary care hospital with lateral neck infection between 01/01/14-05/31/16 as identified by ICD-9 and ICD-10 codes: 289.3 (lymphadenitis, unspecified), 682.1 (cellulitis and abscess of neck), 683 (acute lymphadenitis), I88.9 (nonspecific lymphadenitis, unspecified), L02.11 (cutaneous abscess of neck), L03.221 (cellulitis of neck), and L03.222 (acute lymphangitis of neck). Patients were divided into two groups based on initial imaging modality: primary ultrasound or primary computed tomography. Differences in length of stay, type and total number of imaging studies obtained, number of procedures, hospital readmission, and hospital cost were compared between cohorts.

RESULTS

There were 40 (31%) primary ultrasound and 88 (69%) primary computed tomography patients (128 total). Median length of stay was 46 (IQR: 25,90) hours (1.9 days) for primary ultrasound and 63 (IQR: 39,88) hours (2.6 days) for primary computed tomography patients (p = 0.33). Drainage was performed in 48% of both groups. Additional imaging occurred in 17 (43%) primary ultrasound and 18 (20%) primary computed tomography patients (p = 0.02). Readmission occurred in 8 patients (6.3%). Retropharyngeal infection was encountered in 13 patients (10%); this was only discovered in patients who had a computed tomography performed. Median cost per primary ultrasound patients was $5363 (IQR: 3011, 7920) and $5992 (IQR: 3450, 8060) for primary computed tomography patients.

CONCLUSIONS

The primary imaging modality (ultrasound or computed tomography) used to work-up children with a lateral neck infection did not impact length of stay or hospital cost. However, a significant subset had a coexisting retropharyngeal infection that was only identified on computed tomography. Future studies are needed to identify appropriate criteria for imaging in the work-up of lateral neck infections.

Otolaryngology in Critical Care

Diseases affecting the ear, nose, and throat are prevalent in intensive care settings and often require combined medical and surgical management. Upper airway occlusion can occur as a result of malignant tumor growth, allergic reactions, and bleeding events and may require close monitoring and interventions by intensivists, sometimes necessitating surgical management. With the increased prevalence of immunocompromised patients, aggressive infections of the head and neck likewise require prompt recognition and treatment. In addition, procedure-specific complications of major otolaryngologic procedures can be highly morbid, necessitating vigilant postoperative monitoring. For optimal outcomes, intensivists need a broad understanding of the pathophysiology and management of life-threatening otolaryngologic disease.

How to avoid life-threatening complications following head and neck space infections: an algorithm-based approach to apply during times of emergency. When and why to hospitalise a neck infection patient

BACKGROUND

Head and neck space infections present with a potential mortality rate of 40-50 per cent. This paper proposes an algorithm-based management of head and neck space infection to prevent life-threatening events.

METHODS

A total of 225 patients with head and neck space infection were prospectively analysed at our institution. An experimental scoring system determined the level of clinical risk for the development of major complications. Accordingly, patients were classified into three risk groups: low-, intermediate- and high-risk.

RESULTS

Only intermediate- and high-risk patients were hospitalised. Intermediate-risk patients received intravenous medical therapy with daily re-evaluation; 18 of them required delayed surgery. Of the high-risk patients, three required immediate surgical treatment and five received delayed surgery, while in five cases medical therapy was the only treatment received. Low-risk patients were treated in an out-patient setting.

CONCLUSION

The algorithm-based management of head and neck space infection was successful in enabling the avoidance of lethal complications onset.

Defining the Morphology and Distribution of the Alar Fascia

Objectives:

This study aims to delineate the morphology, integrity, and distribution of the alar fascia using dissection and E12 sheet plastination. This is the first study that employs E12 sheet plastination to investigate the alar fascia and its adjacent potential spaces.

Methods:

Twenty-nine manual dissections and 3 sets of E12 sheet plastinations were used to examine the posterior pharyngeal region for the architecture and distribution of the alar fascia. Specimens were examined from the inferior nuchal line to C6.

Results:

The alar fascia originated as a well-defined midline structure at the level of C1 and could be identified down to C6. There was no evidence of the alar fascia between the inferior nuchal line and the base of the skull. Notably, the alar fascia permitted resistance to manual traction.

Conclusions:

E12 sheet plastination allowed for visualization of the alar fascia’s superior attachments within the deep cervical region. Resistance to traction suggests that the alar fascia may be more than just a loose fibroareolar matrix. The findings in this study suggest an alternative point of entry into the danger space. Understanding the continuity of this fascial layer is critically important with regard to the pathophysiology of deep neck space infections.

Management of intratonsillar abscess in children

BACKGROUND

The aim of this study was to assess outcomes of medical and surgical treatment of intratonsillar abscess in children.

METHODS

The medical charts of children with intratonsillar abscess were reviewed to obtain information on history and physical examination, imaging, management, and follow-up assessment.

RESULTS

Eleven children (six male, five female; age range, 4-18 years) were identified. The common complaints included sore throat, fever, and odynophagia. Asymmetric tonsil hypertrophy was present in nine patients and erythema of tonsils in all patients. Peritonsillar fullness was present in three patients. One patient needed emergency intubation due to respiratory compromise. Computed tomography indicated unilateral intratonsillar abscess in nine patients, bilateral intratonsillar abscess in one, and unilateral phlegmon in one. Inflammatory changes were observed in the parapharyngeal space in all patients, retropharyngeal space in one, and pyriform sinus and aryepiglottic folds in two. Antibiotic treatment included clindamycin in seven patients, ampicillin/sulbactam in one, and clindamycin plus ceftriaxone in three. The patients with respiratory compromise underwent surgery prior to antibiotic treatment. Patients with isolated intratonsillar abscess or phlegmon had resolution of their symptoms with i.v. antibiotic treatment. Patients with combination of intratonsillar and peritonsillar abscess required incision and drainage of peritonsillar abscess.

CONCLUSIONS

Clinically stable children with intratonsillar abscess or phlegmon respond to i.v. antibiotic therapy. Surgical drainage can accomplish clinical resolution in the presence of a combination of intra- and peri-tonsillar abscess, airway compromise, or unresponsiveness to medical treatment.

Emergency imaging assessment of deep neck space infections

Deep neck space infection may lead to severe and potentially life-threatening complications, such as airway obstruction, mediastinitis, septic embolization, dural sinus thrombosis, and intracranial abscess. The clinical presentation is widely variable, and often early symptoms do not reflect the disease severity. The complication risk depends on the extent and anatomical site: diseases that transgress fascial boundaries and spread along vertically oriented spaces (parapharyngeal, retropharyngeal, and paravertebral space) have a higher risk of complications and require a more aggressive treatment compared with those confined within a nonvertically oriented space (peritonsillar, sublingual, submandibular, parotid, and masticator space). Imaging has 5 crucial roles: (1) confirm the suspected clinical diagnosis, (2) define the precise extent of the disease, (3) identify complications, (4) distinguish between drainable abscesses and cellulitis, and (5) monitor deep neck space infection progression. Ultrasonography is the gold standard to differentiate abscesses from cellulitis, for the diagnosis of lymphadenitis. and to identify internal jugular thrombophlebitis in the infrahyoid neck. However, field-of-view limitation and poor anatomical information confine the use of ultrasonography to the evaluation of superficial lesions and to image-guided aspiration or drainage. Computed tomography (CT) combines fast image acquisition and precise anatomical information without field-of-view limitations. For these reasons, it is the most reliable technique for the evaluation of deep and multicompartment lesions and for the identification of mediastinal and intracranial complications. Contrast agent administration enhances the capability to differentiate fluid collections from cellulitis and allows the detection of vascular complications. Magnetic resonance imaging is more time-consuming than CT, limiting its use to selected indications. It is the technique of choice for assessing the epidural space involvement in pre- and paravertebral space infections and complements CT in the evaluation of the infections reaching the skull base.

Masticator space abscess in a 47-day-old infant

A 47-day-old male infant presented with fever, poor oral intake, irritability, and right-sided bluish buccal swelling. Contrast-enhanced computed tomography of the neck showed a round mass lesion of about 2.0×1.5 cm that suggested abscess formation in the right masticator space. Ultrasound-guided extraoral aspiration of the abscess at the right masseter muscle was successful. Staphylococcus aureus was identified in the culture from the aspirated pus and blood. Appropriate antibiotics were given and the patient recovered. The patient underwent follow-up ultrasonography that showed an improved state of the previously observed right masseter muscle swelling at about 1 month after hospital discharge. A masticator space abscess usually originates from an odontogenic infection in adults. We report a case of masticator space abscess in a 47-day-old infant in whom septicemia without odontogenic infection was suspected.

Deep Neck Infections of Congenital Causes

Objectives. To review cases of deep neck infections with underlying congenital etiology with special emphasis on their clinical presentations and the computed tomographic findings and to discuss the various therapeutic modalities employed for such lesions.

Study Design. Case series with chart review.

Settings. Alexandria University Hospital, Egypt.

Subjects and Methods. The authors retrospectively reviewed the clinical, imaging, and operative records of deep neck infection cases presented to their department in the past 10 years. Deep neck infection cases due to congenital causes were included in the study.

Results. Of the 249 cases of deep neck infections admitted to the authors’ department in the past 10 years, 39 patients were diagnosed with deep neck infections due to congenital causes. Patients were classified into 2 groups. In group 1 (29 patients), computed tomography revealed the presence of infected cystic swelling in the neck that was classified as second branchial cyst (16 patients), third and fourth branchial cysts (8 patients), and thyroglossal cyst (5 patients). Group 2 (10 patients) presented with recurrent attacks of deep neck infection with a history of incision and drainage several times. Radiological and operative findings revealed the presence of congenital pyriform fossa sinus.

Conclusion. Computed tomography is helpful in diagnosing infected congenital cysts and its types. Infected congenital cysts could be excised completely under an umbrella of antibiotics. Recurrence of deep neck infections should alert the physician to the possibility of underlying congenital lesions. Thorough clinical and radiological assessment is mandatory to rule out the possibility of a congenital pyriform fossa sinus.

The patient with sore throat

Sore throat is a common medical complaint seen by the emergency practitioner, internist, pediatrician, and otolaryngologist. The differential for sore throat is vast. However, with a directed history this can often be narrowed down to 2 to 3 possible diagnoses. By paying particular attention to the associated symptoms and duration of symptoms, common self-limited etiologies like viral pharyngitis and nonstreptococcal tonsillitis can be distinguished from those that require more investigation, such as supraglottitis and tonsillar cancer. A sore throat is most commonly caused by an infectious, inflammatory, or neoplastic etiologic factor.

Diagnosis and treatment of deep neck space abscesses

Objective: To review our experience with deep neck abscesses and identify unique trends in our patient population.

Study Design: Case series with chart review.

Subjects and Methods: Evaluation of patients with deep neck space abscesses between 2001 and 2006. Peritonsillar abscess, superficial craniocervical infection, and salivary gland infections were excluded from selection of study population. A total of 106 cases were reviewed.

Results: Dental infections were the most common cause of deep neck abscesses (49.1%). Comorbidities included substance abuse (53.7%), psychiatric illness (10.4%), hypertension (9.4%), head and neck cancer (6.6%), and diabetes mellitus (5.7%). All patients received systemic antibiotics, eight patients required tracheotomy, 85 patients underwent surgical drainage in the operating room, and 11 had bedside drainage. Median and lower quartile of time in hospital was 2 and 3 days, respectively, whereas upper quartile was 4 days (range, 1 to 27 days). Patients with comorbidities or concurrent illness tended to stay longer ( P < 0.05, Mann-Whitney test). There were six complications and no mortality.

Conclusion: Substance abuse and poor orodental hygiene are important predisposing factors to deep neck abscesses. Appropriate management continues to favor a combination of early surgical drainage and systemic antibiotics.

Symptom duration and CT findings in pediatric deep neck infection

Objective: To investigate whether children with less than 48 hours of localized symptoms of deep neck infection are less likely to have an abscess on CT scan.

Study Design: Case series.

Subjects and Methods: The charts of children seen in a tertiary children's hospital for deep neck infections between 2000 and 2007 were reviewed.

Results: Of 179 children identified, 167 (93.3%) underwent a CT scan of the neck of which 102 (61.1%) were positive for abscess. There was no significant difference in the rate of abscess on CT between children with less than 48 hours of localizing symptoms and 48 or more hours of symptoms at 58.1 percent and 58.3 percent, respectively ( P = 0.98). Furthermore, there was no significant difference in age, gender, C-reactive protein levels, disease location, or length of stay between children with and without abscess on CT. White blood cell counts were significantly higher in the abscess group ( P = 0.01); however, the median white blood cell count in both groups was above normal.

Conclusion: Because duration of symptoms does not predict finding of abscess on CT, it is appropriate to obtain a CT scan upon presentation in all children with symptoms concerning for neck abscess.

Clinical aspects, diagnosis and treatment of the phlegmons of maxillofacial area and deep neck infections

INTRODUCTION

The problem of maxillofacial and neck tissue inflammatory diseases constantly draws attention of otolaryngologists and maxillofacial surgeons in assosiation with steady frequency of pathology. Despite a modern antibiotic therapy, there still exist cases in which an initial delay in diagnosis and treatment may result in a life-threatening situation.

MATERIAL AND METHODS

We have analyzed a clinical picture of 219 patients aged from 5 up to 91 years. The patients have been distributed according to the spread of purulent process and the laboratory research data into the following groups.

RESULTS AND DISCUSSION

In inoculations from a wound during the primary surgical treatment in 67.6% of patients 1 microorganism has been revealed, in 7.9%--2 microorganisms, in 5%--3 and more microorganisms, in 19.4% of patients microorganisms have not been revealed. The most frequent cultures extracted from wound contents, were staphylococci and streptococci (61.2%). The presence of mixed (aerobic and anaerobic) microflora in the inflammation center has been marked recently. We have analyzed 64 MRI and X-CT at suspicion on diffusion of purulent process in deep neck cellular space. In 52 patients the process was localized within the limits of neck spaces and in 12 patients--the pyoinflammatory process extended on mediastinum though the clinical suspicion on mediastinitis was only in 10 patients.

CONCLUSIONS

The treatment of maxillofacial and neck pyoinflammatory diseases and their complications remains a complex and difficult problem. Alongside with clinical methods of diagnosis of maxillofacial and neck pyoinflammatory diseases it is necessary to use accessory methods such as X-CT and MRI which clinical-diagnostic efficiency is very high. An antimicrobial therapy plays a significant role in the treatment of maxillofacial phlegmons. Antimicrobial regiments have been recommended and should cover the polymicrobial etiology.

Lack of association of CT findings and surgical drainage in pediatric neck abscesses

OBJECTIVE

To evaluate the relationship between neck abscess characteristics on computerized tomography (CT) scan and surgical drainage in pediatric patients.

METHODS

Retrospective data warehouse review identified 43 children younger than 19 years admitted to a tertiary care pediatric hospital during the first quarters of 2000 through 2003 who underwent CT imaging for suspicion of head and neck abscesses involving the neck; face; and peritonsillar, retropharyngeal, and parapharyngeal spaces. A total of 45 scans were graded by a radiologist blinded to management. Thickness of the prevertebral soft tissue; location, dimensions, and degree of enhancement of the abscess; patient age; steroid and preadmission antibiotic use; and surgical intervention were recorded.

RESULTS

Surgical drainage was performed in 32 of 43 patients (74%). We found no significant correlation between prevertebral soft tissue thickness, abscess dimensions or enhancement on CT scan, and surgical drainage. There was no significant association between surgical drainage and patient age, administration of steroids, or preadmission antibiotic use.

CONCLUSIONS

Neck abscess appearance on CT scan did not predict surgical drainage, although prevertebral soft tissue thickness and abscess dimensions may be important features. Abscess enhancement, patient age, and the use of steroids and prehospitalization antibiotics were not found to correlate with surgical drainage.

Imaging Studies for Head and Neck Infections

Imaging the head and neck presents a unique challenge because of the dense concentration of complex anatomy and the importance of lesion localization in formulating the differential diagnosis and prognosis. Critical imaging features such as the ability to define fascial borders of soft tissue neck compartments, the demonstration of intricate anatomy such as the temporal bones and paranasal sinuses, and the noninvasive assessment of vascular integrity have improved greatly in recent years in parallel with the rapid technologic advances in multidetector CT and MRI. After comparing the available imaging techniques, this article explores the imaging findings by anatomic region.

Management of pediatric lateral neck infections: Does the adage "... never let the sun go down on undrained pus ..." hold true?

OBJECTIVES

Pediatric neck infections are frequently treated by Otolaryngologists, Head and Neck surgeons. The relative role of medical versus surgical treatment of pediatric neck infections is debated. The aims of this study are to analyze the management of pediatric neck infections with respect to clinical assessment, radiological assessment and treatment.

METHODS

Medical records from January 1999 to June 2005 were reviewed and analyzed.

RESULTS

Two hundred and five children with lateral neck infections were included in the study. The clinical diagnosis correlated with the radiology finding in 73.6% with a sensitivity of 28% and a specificity of 92% for lateral neck abscess recognition. The ultrasound finding correlated with the surgical finding in 65.2% with a sensitivity of 70% and a specificity of 33%. When an ultrasound scan was used it changed the intended treatment plan in 10.5% of children.

CONCLUSIONS

Accurate clinical assessment of lateral neck infections is poor, generally under estimating suppuration. However, when an abscess is diagnosed clinically this correlates highly with the surgical finding. Radiological assessment has inaccuracy in identifying suppuration and this should be borne in mind when being used as a diagnostic tool for neck infections.

Retropharyngeal abscess due to methicillin-resistant Staphylococcus aureus in a case of acute myeloid leukemia

We describe a case of acute myeloid leukemia (AML) complicated with retropharyngeal abscess (RPA) due to methicillin-resistant Staphylococcus aureus (MRSA) in a 56-year-old man. After administration of vancomycin and lavage of the retropharyngeal space with gentamicin, complete resolution of the RPA was observed. Despite their lower frequency, deep neck infections are associated with high mortality rates. The possibility of RPA should be considered in patients who present with fever, dysphagia and limitation of neck extension. Lavage of the retropharyngeal abscess with gentamicin may be optimal in cases of large RPA.

Infecções dos espaços cervicais: estudo prospectivo de 57 casos

Objetivo: apesar da antibioticoterapia, as infecções dos espaços cervicais profundos continuam a ter grande importância, tanto por sua alta incidência, como pelo risco de complicações. Forma de estudo: clínico, prospectivo. Material e método: descrevem-se neste estudo 57 casos de pacientes com diagnóstico de infecção cervical (celulite, abscesso e fasceíte necrotizante) internados na Enfermaria de Otorrinolaringologia do Hospital das Clínicas da Faculdade de Medicina da USP entre janeiro de 1999 e janeiro de 2001. Cinqüenta pacientes (87,7%) apresentavam abscesso cervical, cinco (8,8%), celulite e dois pacientes (3,5%), fasceíte necrotizante. A infecção odontogênica foi o foco de origem mais prevalente, responsável por 24 casos (42%), seguida das amigdalites (17,5%) e linfadenites (15,8%). Os espaços cervicais mais acometidos foram o submandibular (57,9%), o sublingual (26,3%) e o parafaríngeo (24,6%). Em 53 pacientes realizaram-se culturas das quais 71,7% foram positivas, sendo que 20,8% destas apresentaram flora mista. Os microorganismos mais prevalentes dentre os aeróbicos foi o Streptococcus viridans (41,5%) e, dentre os anaeróbios, Peptostreptococcus micros e Peptostreptococcus sp (5,7% e 3,8%, respectivamente). A associação entre penicilina cristalina e metronidazol foi o tratamento preconizado em 31 pacientes (54,3%). Nos demais, diversos antibióticos como clindamicina, cefalosporinas de terceira geração, cloranfenicol e oxacilina foram utilizados. Cinqüenta e quatro pacientes (94,7%) evoluíram satisfatoriamente, dois (3,5%) apresentaram deiscência da ferida cirúrgica e um (1,7%) foi a óbito por mediastinite. Conclusão: os abscessos cervicais ainda configuram uma importante causa de morbidade em nossa população e suas complicações requerem vigilância para a prevenção e abordagem oportunas, especialmente pelo tratamento mais adequado.