Defining the role of surgical drainage in paediatric deep neck space infections

A Rare Case of Retropharyngeal Abscess in a 3 Month Old Male Infant: Case Report and Review of Literature

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.

Etiology and Complications of Deep Neck Space Infections: A Hospital Based Retrospective Study

Infections of the deep spaces of the neck often present a true clinical challenge to a Head and Neck surgeon which may rapidly spread due to the various connections between the spaces resulting in morbidity and mortality. This study aims to obtain knowledge about various DNSI's and their predisposing factors.. It was a hospital based retrospective cross-sectional study done in Goa Medical College, India. A total of 300 patients who presented with DNSI's over the past 7 years were studied. Simple proportions and percentages were calculated and Chi-square test was used to study associations. A total of 300 patients were evaluated and male preponderance was seen. Most of the patients were seen belonging to the pediatric age group (26%). Infections of dental origin (45.67%) were the most common etiological factor associated with poor oral hygiene and tobacco chewing (12.67%). Major comorbidities were anemia (34%) and diabetes (19.3%) which were directly related to the complications. The most common complication was airway compromise (14.66%) which was treated by tracheostomy. DNSI should be treated like a medical as well as a surgical emergency which can be life-threatening especially in diabetics and elderly who are immunocompromised and need special attention. Odontogenic infections associated with poor oral hygiene and tobacco chewing could be prevented by educating the population about oral hygiene.

Predictive value of serum interleukin-6 to determine surgical drainage of deep neck space infection in adults

PURPOSE

The aim of this study was to determine whether interleukin-6 (IL-6) could be used as a predictor for surgical drainage in deep neck space infection (DNSI).

METHODS

A retrospective study was conducted to analyze 69 adult patients newly diagnosed as DNSI from January 2017 to December 2021 at a single center. The patients were treated with either surgical drainage or not. The following clinical data including age, gender, maximum diameter of abscess (MDA), laboratory data, therapeutic modalities, comorbidities, duration of hospitalization and complications were collected and evaluated.

RESULTS

Patients in drained group had significantly elevated MDA, IL-6, procalcitonin, C-reactive protein and neutrophil to lymphocyte ratio compared to patients in non-drained group (all P < 0.01). Significant predictors for surgical drainage were IL-6 and MDA as independent factors, with the optimum cutoff values of 52.5 pg/mL and 14.4 mm, respectively. Moreover, the IL-6 had a wider area under the curve than MDA for prediction of surgical drainage in DNSI.

CONCLUSIONS

IL-6 as a promising predictor of the need for surgical drainage can be effectively used for routine assessment in the early stage of DNSI to determine the optimal treatments.

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.

Paediatric Deep Neck Infection—The Risk of Needing Intensive Care

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.

The Efficacy of Pyogenic Cavity Aerobic Therapy with Negative Pressure Drainage in the Treatment of Deep Neck Space Infections

Objective

To determine the effectiveness of pyogenic cavity aerobic therapy with negative pressure drainage in the treatment of deep neck space infections (DNSI).

Methods

The study was a prospective, observational analysis of 36 cases of DNSI at a tertiary care center. The patients were divided into two groups according to the treatment method. Group A was treated with pyogenic cavity aerobic therapy with negative pressure drainage and included 13 patients (6 males and 7 females), while group B was treated with traditional incision debridement drainage and included 23 patients (12 males and 11 females). The average hospitalization days and doctors’ workload (ie, average days of postoperative dressing changes) were analyzed and compared between the two groups.

Results

The mean hospitalization days in the traditional dressing group were 26.74 ± 3.39 days, while the average days of postoperative dressing change were 25.91 ± 3.43 days. In contrast, the averages for hospitalization days and days of postoperative dressing changes in the pyogenic cavity aerobic therapy plus negative pressure drainage were 11.08 ± 2.11 and 3.69 ± 0.21 days, respectively. All 36 patients were cured. Compared with the group B, group A had a shorter hospital stays and lower doctor workloads (P < 0.001).

Conclusion

Pyogenic cavity aerobic therapy is an effective and simple method for changing dressings after DNSI. This therapy, when combined with negative pressure drainage, shortens hospitalization days and days that require a dressing change. This has reduced the workload of clinical doctors and pain experienced by patients. This therapy also has a high degree of safety and a very satisfactory curative effect.

Corticosteroids in the Treatment of Pediatric Retropharyngeal and Parapharyngeal Abscesses

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.

Ear, Nose, Throat: Beyond Pharyngitis: Retropharyngeal Abscess, Peritonsillar Abscess, Epiglottitis, Bacterial Tracheitis, and Postoperative Tonsillectomy

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.

Early surgical intervention enhances recovery of severe pediatric deep neck infection patients

PURPOSE

Pediatric deep neck space infection (DNI) is a relatively rare but potentially life-threatening condition and requires prompt and accurate management. This study retrospectively reviews our experience in a tertiary referral hospital from 2004 to 2019.

METHODS

Systematic data collection from medical records using ICD10 codes between 2004 and 2019.

INCLUSION CRITERIA

age ≤16 years, DNI requiring hospitalization and/or surgery. EXCLUSION: peritonsillar abscess without complications.

RESULTS

We identified 42 patients, 21 boys and 21 girls, with a median age of 4.9 years. Most of the patients had severe symptoms, the most common of which were neck swelling (n = 39; 92.9%), neck pain (n = 39; 92.9%) and fever (n = 32; 76.2%). Twenty-two (52.4%) had torticollis, and the mean duration of symptoms before hospitalization was 4.95 days. Diagnosis was confirmed by MRI (n = 24), contrast-enhanced CT (n = 11) or ultrasonography (n = 6), except in one case. Twenty-three (54.8%) required an open neck incision, ten (23.8%) patients had intraoral surgery and nine were treated conservatively. Twelve (28.6%) patients were admitted to the pediatric ICU. Median hospitalization duration was six days. The infection most commonly had tonsillopharyngeal etiology (n = 18) and a retropharyngeal location (n = 17). Staphylococcus Aureus (n = 7) and Streptococcus pyogenes (n = 7) were the most frequent pathogens. We compared the early surgical intervention group (<2 days of intravenous antibiotics; n = 18; 42.9%) to the late surgery group (n = 15; 35.7%) and the conservatively treated groups (n = 9; 21.4%). The overall length of stay (LOS) was lower in the shorter preoperative medication group (mean 4.4 vs. 7.2; p = 0.009). The size of the abscess did not differ between the groups (mean 28 mm; 30 mm; 21 mm; p = 0.075) and the neck incision rate was similar in the operated groups.

CONCLUSION

Early surgical intervention is associated with decreased LOS among severe pediatric DNI patients.

Odontogenic Head and Neck Region Infections Requiring Hospitalization: An 18-Month Retrospective Analysis

The aim of this study was to comprehensively review our experience with odontogenic infections in the head and neck region requiring treatment at a national referral center. We retrospectively reviewed 85 patients treated at the Chair and Clinic of Maxillofacial Surgery of the University Hospital in Wrocław between January 2018 and June 2019. We excluded patients with nonondontogenic infections or other than purulent clinical forms of dentivitis in the head and neck region. Several demographic, clinicopathological, and treatment variables were assessed. The majority of patients were men who were referred for inpatient treatment by a dentist or family doctor, presented to the Hospital Emergency Ward (SOR) by themselves, or transported to the SOR by paramedics SOR from their home or another hospital. All patients were treated in accordance with the current guidelines for head and neck region odontogenic infections. An incision was made and the abscess was drained. The odontogenic cause was removed followed by the collection of tissue for microbiological examination. The course of infection was monitored by means of laboratory parameters such as leukocyte counts and c-reactive protein levels. Odontogenic infections in the head and neck region are a persistent and common problem. Rapid, accurate diagnosis and treatment minimizes the risk of life-threatening complications, shortens the hospitalization period, and lowers treatment costs.