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Ratnapalan S, Thevaranjan J, Perera N, Nassarallah B, Wolter NE. Retropharyngeal and parapharyngeal infections in children: A retrospective analysis. Pediatr Neonatol 2024:S1875-9572(24)00118-9. [PMID: 39019720 DOI: 10.1016/j.pedneo.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/31/2023] [Accepted: 12/13/2023] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES To describe presentations, management and outcomes of retropharyngeal and parapharyngeal infections in children presenting to a tertiary care pediatric emergency department. METHODS A retrospective chart review of children with deep neck infections such as retropharyngeal or parapharyngeal infection from January 2008 to December 2018 was conducted at a pediatric hospital. RESULTS There were 176 retropharyngeal, 18 parapharyngeal and 6 with both retropharyngeal and parapharyngeal infections treated during the 10-year study period. Males were 60% of the cohort and the mean age was 4.3 (SD: 3.2) years. No significant differences in age or sex ratio or presentations were seen in children with retropharyngeal infections compared with parapharyngeal infections. All received parenteral antibiotics; 42% (84/200) of children underwent surgery and four of them had more than one surgical drainage. Age <12 months and the diagnosis of parapharyngeal infections were associated with significantly higher rates of surgical treatment. Children under 12 months of age were sicker at presentation and had a high complication rate of 23% compared with 1% in the older children (p = 0.002). Seven children had co-existence of Kawasaki disease with deep neck infections. CONCLUSIONS Early diagnosis of retropharyngeal and parapharyngeal infections especially in infants under a year of age is important as they are more likely to have complications and need surgical management. Most paediatric patients with retropharyngeal and parapharyngeal infections have a phlegmon or very small abscesses and are treated non-operatively with parenteral antibiotics.
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Hasjim BJ, Ostowari A, Holmes WN, Yu Y, Yu P, Reyna T, Bhatt J, Awan S, Goodman LF. Methicillin-resistant staphylococcus aureus descending necrotizing mediastinitis in an infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Sturgill L, Fadil A, Hinthorn D, Schrepfer T. Salmonella Retropharyngeal Abscess Linked to Backyard Poultry Exposure in a 12-Month-Old Girl. Cureus 2022; 14:e28375. [PMID: 36171844 PMCID: PMC9508688 DOI: 10.7759/cureus.28375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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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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Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses. CHILDREN 2022; 9:children9050618. [PMID: 35626793 PMCID: PMC9139861 DOI: 10.3390/children9050618] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/14/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022]
Abstract
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.
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Malia L, Sivitz A, Chicaiza H. A novel approach: Point-of-care ultrasound for the diagnosis of retropharyngeal abscess. Am J Emerg Med 2020; 46:271-275. [PMID: 33046324 DOI: 10.1016/j.ajem.2020.07.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Laurie Malia
- Department of Emergency Medicine, Columbia University Medical Center/Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, United States of America.
| | - Adam Sivitz
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Children's Hospital of New Jersey, Newark, NJ, United States of America
| | - Henry Chicaiza
- Department of Pediatric Emergency Medicine, Connecticut Children's Medical Center, Hartford, CT, United States of America
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Bal KK, Unal M, Delialioglu N, Oztornaci RO, Ismi O, Vayisoglu Y. Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients. Braz J Otorhinolaryngol 2020; 88:511-522. [PMID: 32868223 PMCID: PMC9422577 DOI: 10.1016/j.bjorl.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/20/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Kemal Koray Bal
- University of Health Sciences Adana City Hospital, Department of Otorhinolaryngology & Head and Neck Surgery, Adana, Turkey.
| | - Murat Unal
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Nuran Delialioglu
- University of Mersin, Faculty of Medicine, Department of Microbiology, Mersin, Turkey
| | - Ragip Onur Oztornaci
- University of Mersin, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Mersin, Turkey
| | - Onur Ismi
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Yusuf Vayisoglu
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
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Peacock ZS, Krishnan DG. Advances in Imaging Over 100 Years: The Impact on Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2018; 76:1387-1399. [DOI: 10.1016/j.joms.2018.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 01/08/2023]
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Yuan H, Gao R. Infrahyoid involvement may be a high-risk factor in the management of non-odontogenic deep neck infection: Retrospective study. Am J Otolaryngol 2018; 39:373-377. [PMID: 29673728 DOI: 10.1016/j.amjoto.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/03/2018] [Indexed: 10/17/2022]
Abstract
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.
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Quinn NA, Olson JA, Meier JD, Baskin H, Schunk JE, Thorell EA, Hodo LN. Pediatric lateral neck infections - Computed tomography vs ultrasound on initial evaluation. Int J Pediatr Otorhinolaryngol 2018; 109:149-153. [PMID: 29728170 DOI: 10.1016/j.ijporl.2018.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
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.
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Affiliation(s)
- Nicholas A Quinn
- Department of Surgery, Division of Otolaryngology, 50 N Medical Drive, University of Utah, Salt Lake City UT 84132, USA; Primary Children's Hospital, Salt Lake City, UT 84113, USA.
| | - Jared A Olson
- Department of Pharmacy, Primary Children's Hospital, 100 Mario Capecchi Drive, Salt Lake City, UT 84113, USA; Department of Pediatrics, Division of Infectious Diseases, University of Utah, Salt Lake City, UT 84132, USA
| | - Jeremy D Meier
- Department of Surgery, Division of Otolaryngology, 50 N Medical Drive, University of Utah, Salt Lake City UT 84132, USA; Primary Children's Hospital, Salt Lake City, UT 84113, USA
| | - Hank Baskin
- Intermountain Pediatric Imaging, Intermountain Healthcare, 100 Mario Capecchi Drive, Salt Lake City, UT 84113, USA; Department of Radiology, 50 N. Medical Drive, University of Utah, Salt Lake City, UT 84132, USA
| | - Jeff E Schunk
- Primary Children's Hospital, Salt Lake City, UT 84113, USA; Department of Pediatrics, Division of Emergency Medicine, 50 N Medical Drive, University of Utah, Salt Lake City, UT 84132, USA
| | - Emily A Thorell
- Department of Pediatrics, Division of Infectious Diseases, 50 N Medical Drive, University of Utah, Salt Lake City, UT 84132, USA; Primary Children's Hospital, Salt Lake City, UT 84113, USA
| | - Laura N Hodo
- Department of Pediatrics, Division of Inpatient Medicine, 50 N Medical Drive, University of Utah, Salt Lake City, UT 84132, USA; Primary Children's Hospital, Salt Lake City, UT 84113, USA
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Joshua J, Scholten E, Schaerer D, Mafee MF, Alexander TH, Crotty Alexander LE. Otolaryngology in Critical Care. Ann Am Thorac Soc 2018; 15:643-654. [PMID: 29565639 PMCID: PMC6207134 DOI: 10.1513/annalsats.201708-695fr] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/22/2018] [Indexed: 01/02/2023] Open
Abstract
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.
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Affiliation(s)
- Jisha Joshua
- Pulmonary and Critical Care Section, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; and
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Eric Scholten
- Pulmonary and Critical Care Section, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; and
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | | | - Mahmood F. Mafee
- Division of Neuroradiology, Department of Radiology, University of California–San Diego, San Diego, California
| | | | - Laura E. Crotty Alexander
- Pulmonary and Critical Care Section, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; and
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
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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. The Journal of Laryngology & Otology 2017; 132:53-59. [PMID: 29103390 DOI: 10.1017/s0022215117002201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
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.
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Lawrence R, Bateman N. Controversies in the management of deep neck space infection in children: an evidence-based review. Clin Otolaryngol 2016; 42:156-163. [DOI: 10.1111/coa.12692] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/27/2022]
Affiliation(s)
- R. Lawrence
- Department of Otolaryngology; Queen's Medical Centre; Nottingham UK
| | - N. Bateman
- Department of Otolaryngology; Royal Manchester Children's Hospital; Manchester UK
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Agbara R, Obiadazie AC, Ediagbini S, Ernest I. A fatal case of empyema thoracis: the price for underestimating odontogenic infections. ORAL AND MAXILLOFACIAL SURGERY CASES 2016. [DOI: 10.1016/j.omsc.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Scali F, Nash LG, Pontell ME. Defining the Morphology and Distribution of the Alar Fascia. Ann Otol Rhinol Laryngol 2015; 124:814-9. [DOI: 10.1177/0003489415588129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- Frank Scali
- American University of the Caribbean School of Medicine, Cupecoy, St. Maarten
| | - Lance G. Nash
- Department of Anatomy, American University of the Caribbean School of Medicine, Cupecoy, St Maarten
| | - Matthew E. Pontell
- Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
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Ulualp SO, Koral K, Margraf L, Deskin R. Management of intratonsillar abscess in children. Pediatr Int 2013; 55:455-60. [PMID: 23701269 DOI: 10.1111/ped.12141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 02/10/2013] [Accepted: 03/12/2013] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Seckin O Ulualp
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas 75390-9035, USA.
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Maroldi R, Farina D, Ravanelli M, Lombardi D, Nicolai P. Emergency imaging assessment of deep neck space infections. Semin Ultrasound CT MR 2013; 33:432-42. [PMID: 22964409 DOI: 10.1053/j.sult.2012.06.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
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.
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Affiliation(s)
- Roberto Maroldi
- Department of Radiology, University of Brescia, Brescia, Italy.
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Kim E, Jeon JH, Shim YH, Lee KS, Kim SY, Kim ER. Masticator space abscess in a 47-day-old infant. KOREAN JOURNAL OF PEDIATRICS 2011; 54:350-3. [PMID: 22087203 PMCID: PMC3212706 DOI: 10.3345/kjp.2011.54.8.350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 01/07/2011] [Accepted: 03/01/2011] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Eunhee Kim
- Department of Pediatrics, Gwang-Myeong Sung-Ae General Hospital, Gwangmyeong, Korea
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Boscolo-Rizzo P, Stellin M, Muzzi E, Mantovani M, Fuson R, Lupato V, Trabalzini F, Da Mosto MC. Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol 2011; 269:1241-9. [PMID: 21915755 DOI: 10.1007/s00405-011-1761-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 08/26/2011] [Indexed: 12/15/2022]
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Nour YA, Hassan MH, Gaafar A, Eldaly A. Deep Neck Infections of Congenital Causes. Otolaryngol Head Neck Surg 2010; 144:365-71. [DOI: 10.1177/0194599810391629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Yasser Ahmed Nour
- Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt
| | | | - Alaa Gaafar
- Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt
| | - Ahmed Eldaly
- Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt
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Abstract
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.
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Affiliation(s)
- Teresa V Chan
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9035, USA.
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Chang L, Chi H, Chiu NC, Huang FY, Lee KS. Deep Neck Infections in Different Age Groups of Children. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2010; 43:47-52. [DOI: 10.1016/s1684-1182(10)60007-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 02/10/2009] [Accepted: 02/23/2009] [Indexed: 11/25/2022]
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Daramola OO, Flanagan CE, Maisel RH, Odland RM. Diagnosis and treatment of deep neck space abscesses. Otolaryngol Head Neck Surg 2009; 141:123-30. [PMID: 19559971 DOI: 10.1016/j.otohns.2009.03.033] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 03/12/2009] [Accepted: 03/30/2009] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Opeyemi O. Daramola
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN
| | - Carrie E. Flanagan
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, MN
- Department of Otolaryngology–Head and Neck Surgery, Hennepin County Medical Center, Minneapolis, MN
| | - Robert H. Maisel
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, MN
- Department of Otolaryngology–Head and Neck Surgery, Hennepin County Medical Center, Minneapolis, MN
| | - Rick M. Odland
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, MN
- Department of Otolaryngology–Head and Neck Surgery, Hennepin County Medical Center, Minneapolis, MN
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Boscolo-Rizzo P, Da Mosto MC. Submandibular space infection: a potentially lethal infection. Int J Infect Dis 2009; 13:327-33. [DOI: 10.1016/j.ijid.2008.07.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 06/19/2008] [Accepted: 07/14/2008] [Indexed: 11/16/2022] Open
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Meyer AC, Kimbrough TG, Finkelstein M, Sidman JD. Symptom duration and CT findings in pediatric deep neck infection. Otolaryngol Head Neck Surg 2009; 140:183-6. [DOI: 10.1016/j.otohns.2008.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 11/05/2008] [Accepted: 11/05/2008] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Abby C. Meyer
- From the Childrens Hospitals and Clinics of Minnesota (Drs Meyer, Kimbrough, and Sidman, and Ms Finkelstein), and the Department of OtolaryngologyHead and Neck Surgery (Drs Meyer, Kimbrough, and Sidman), University of Minnesota, Minneapolis, MN
| | - Tyler G. Kimbrough
- From the Childrens Hospitals and Clinics of Minnesota (Drs Meyer, Kimbrough, and Sidman, and Ms Finkelstein), and the Department of OtolaryngologyHead and Neck Surgery (Drs Meyer, Kimbrough, and Sidman), University of Minnesota, Minneapolis, MN
| | - Marsha Finkelstein
- From the Childrens Hospitals and Clinics of Minnesota (Drs Meyer, Kimbrough, and Sidman, and Ms Finkelstein), and the Department of OtolaryngologyHead and Neck Surgery (Drs Meyer, Kimbrough, and Sidman), University of Minnesota, Minneapolis, MN
| | - James D. Sidman
- From the Childrens Hospitals and Clinics of Minnesota (Drs Meyer, Kimbrough, and Sidman, and Ms Finkelstein), and the Department of OtolaryngologyHead and Neck Surgery (Drs Meyer, Kimbrough, and Sidman), University of Minnesota, Minneapolis, MN
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Clinical aspects, diagnosis and treatment of the phlegmons of maxillofacial area and deep neck infections. Otolaryngol Pol 2008; 62:545-8. [PMID: 19004254 DOI: 10.1016/s0030-6657(08)70311-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Deep Neck Infections: Clinical Considerations in Aggressive Disease. Oral Maxillofac Surg Clin North Am 2008; 20:367-80. [DOI: 10.1016/j.coms.2008.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lack of association of CT findings and surgical drainage in pediatric neck abscesses. Int J Pediatr Otorhinolaryngol 2008; 72:235-9. [PMID: 18082900 DOI: 10.1016/j.ijporl.2007.10.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 10/16/2007] [Accepted: 10/18/2007] [Indexed: 10/22/2022]
Abstract
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.
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Courtney MJ, Mahadevan M, Miteff A. MANAGEMENT OF PAEDIATRIC RETROPHARYNGEAL INFECTIONS: NON-SURGICAL VERSUS SURGICAL. ANZ J Surg 2007; 77:985-7. [DOI: 10.1111/j.1445-2197.2007.04295.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
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.
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Affiliation(s)
- Michael C Hurley
- Division of Neuroradiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, BC, Canada V5Z 1M9
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Courtney MJ, Miteff A, Mahadevan M. Management of pediatric lateral neck infections: Does the adage "... never let the sun go down on undrained pus ..." hold true? Int J Pediatr Otorhinolaryngol 2007; 71:95-100. [PMID: 17097155 DOI: 10.1016/j.ijporl.2006.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2006] [Revised: 09/21/2006] [Accepted: 09/24/2006] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Mark J Courtney
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Starship Hospital and University of Auckland, Auckland, New Zealand.
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Sato K, Izumi T, Toshima M, Nagai T, Muroi K, Komatsu N, Ozawa K. Retropharyngeal abscess due to methicillin-resistant Staphylococcus aureus in a case of acute myeloid leukemia. Intern Med 2005; 44:346-9. [PMID: 15897650 DOI: 10.2169/internalmedicine.44.346] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Kazuya Sato
- Division of Hematology, Department of Medicine, Jichi Medical School, Tochigi
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Sennes LU, Imamura R, Angélico Júnior FV, Simoceli L, Frizzarini R, Tsuji DH. Infecções dos espaços cervicais: estudo prospectivo de 57 casos. ACTA ACUST UNITED AC 2002. [DOI: 10.1590/s0034-72992002000300014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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