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Luo C, Li Q. Risk factor analysis and model construction for fish bone foreign body in children's pharynx. Am J Otolaryngol 2024; 45:104364. [PMID: 38761674 DOI: 10.1016/j.amjoto.2024.104364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/27/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVES This study aimed to assess the risk factors for predicting the presence of fish bone foreign bodies and to develop a risk prediction model. METHODS Data of 1405 children who underwent video-guided laryngoscope for suspected fish bone foreign body ingestion were retrospectively analyzed. Multi-factor logistic regression analyses were performed to analyze the risk factors for the presence of fish bone foreign body in patients, and a risk prediction model was established based on the results of the logistic regression analysis. RESULTS The results of the statistical analysis showed the presence of an ulcerated surface increased the risk of having a fishbone foreign body in the pharynx by approximately 55.36-fold (95 % confidence interval (CI): 15.78-194.24), followed by a clear chief complaint site, which increased the risk of having a fishbone foreign body in the pharynx by approximately 7.963-fold (95 % CI: 4.820-13.15), and a tingling sensation, which increased the risk of having a fishbone foreign body by approximately 7-fold (95 % CI: 3.483, 14.233). A clinical prediction model (nomogram) was developed and its validation was performed using receiver operating characteristic (ROC) curve analysis, in which an area under the curve (AUC) value of 0.808 indicated that the model had a great prediction capability. CONCLUSION The predictive capability of a logistic regression model for the detection of fish bone foreign bodies following ingestion is significant. Clinicians can concentrate on monitoring these risk factors and implementing appropriate interventions to reduce the risks of patients presenting with fish bone foreign bodies.
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Affiliation(s)
- ChenXi Luo
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Jiangsu, China
| | - Qi Li
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Jiangsu, China.
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Begum R B, Sanker V, Fatima N, Menon VR, Sivanandam LK, Dave T. Retropharyngeal abscess with mediastinal extension - A mausoleum of mumps: A case report. IDCases 2024; 37:e02006. [PMID: 38988685 PMCID: PMC11233903 DOI: 10.1016/j.idcr.2024.e02006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 05/23/2024] [Accepted: 06/04/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Retropharyngeal abscess is a fatal infection that is uncommon, yet serious, especially in young children below 5 years. Oropharyngeal infections, in particular, can cause it as a complication of upper respiratory infections. They can also lead to respiratory depression and acute upper airway blockage and other complications. Case presentation The unusual case of large retropharyngeal abscess in a 2-year-old child, secondary to mumps infection who presented to us with impending airway compromise is reported. Discussion Retropharyngeal abscess secondary to mumps is a rare occurrence.The child initially had a bilateral parotid enlargement with fever and upper respiratory tract infection, which was diagnosed clinically as mumps by primary care physician and later confirmed by IgM antibody testing. The child was initially treated conservatively as the symptoms were mild at the beginning, however, the child worsened progressively and presented o our institute with acute retropharyngeal abscess in stridor. Emergency tracheostomy and intraoral abscess drainage were done under general anesthesia followed by appropriate intravenous antibiotics therapy. Conclusion A dramatic recovery was observed following the treatment approach. Although it is rare to see such a large RPA in this antibiotic era, it is imperative to maintain a high index of suspicion.
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Affiliation(s)
| | - Vivek Sanker
- Team Erevnites, India
- Department of Neurosurgery, Trivandrum Medical College, Trivandrum, India
| | - Nabeela Fatima
- Team Erevnites, India
- Nizam Institute of Pharmacy, JNTUH, India
| | | | | | - Tirth Dave
- Team Erevnites, India
- Bukovinian State Medical University, Chernivtsi, Ukraine
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Karakaya D, Güngör T, Çakıcı EK, Yazılıtaş F, Çelikkaya E, Yücebaş SC, Bülbül M. Predictors of rapidly progressive glomerulonephritis in acute poststreptococcal glomerulonephritis. Pediatr Nephrol 2023; 38:3027-3033. [PMID: 36929388 DOI: 10.1007/s00467-023-05935-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Acute post-streptococcal glomerulonephritis (APSGN) is an immune-mediated inflammatory respsonse in the kidneys caused by nephritogenic strains of group A β-hemolytic streptococcus (GAS). The present study aimed to present a large patient cohort of APSGN patients to determine the factors that can be used for predicting the prognosis and progression to rapidly progressive glomerulonephritis (RPGN). METHODS The study included 153 children with APSGN that were seen between January 2010 and January 2022. Inclusion criteria were age 1-18 years and follow-up of ≥ 1 years. Patients with a diagnosis that could not be clearly proven clinically or via biopsy and with prior clinical or histological evidence of underlying kidney disease or chronic kidney disease (CKD) were excluded from the study. RESULTS Mean age was 7.36 ± 2.92 years, and 30.7% of the group was female. Among the 153 patients, 19 (12.4%) progressed to RPGN. The complement factor 3 and albumin levels were significantly low in the patients who had RPGN (P = 0.019). Inflammatory parameters, such as C-reactive protein (CRP), platelet-to-lymphocyte ratio, CRP/albumin ratio, and the erythrocyte sedimentation rate level at presentation were significantly higher in the patients with RPGN (P < 0.05). Additionally, there was a significant correlation between nephrotic range proteinuria and the course of RPGN (P = 0.024). CONCLUSIONS We suggest the possibility that RPGN can be predicted in APSGN with clinical and laboratory findings. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Deniz Karakaya
- Department of Pediatric Nephrology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - Tülin Güngör
- Department of Pediatric Nephrology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Evrim Kargın Çakıcı
- Department of Pediatric Nephrology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Fatma Yazılıtaş
- Department of Pediatric Nephrology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Evra Çelikkaya
- Department of Pediatric Nephrology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Sait Can Yücebaş
- Faculty of Engineering, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Mehmet Bülbül
- Department of Pediatric Nephrology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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Luo C, Huang Z, Li Q. Is a fish bone at a parallel angle in the throat more likely to fall out automatically?. Int J Pediatr Otorhinolaryngol 2023; 170:111582. [PMID: 37182362 DOI: 10.1016/j.ijporl.2023.111582] [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: 12/13/2022] [Revised: 03/29/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE To investigate the factors influencing the spontaneous expulsion of fish bone foreign bodies in the throat of children. METHODS A retrospective cohort study was conducted between January 2018 and December 2021 of children hospitalized with fishbone foreign bodies in the throat, and subsequent electronic rhinolaryngoscopy to analyze the factors influencing the spontaneous expulsion of these foreign bodies. RESULTS The effect of foreign body angle on the rate of dislodgement was found to be statistically significant. Parallel angle was more likely to dislodge relative to vertical (RR = 2.495, 95% CI 1.515-4.109, P = 0.000); inclined angle was more likely to dislodge relative to vertical (RR = 2.121, 95% CI 1.284-3.505, P = 0.003). For the three fish bone foreign body angles (vertical, inclined, and parallel), the percentage of dislodgement showed a linear trend (0.278, 0.600, and 0.723), indicating that the percentage of dislodgement appeared to increase with the increase of fish bone foreign body inclination angle (Ptrend = 0.000). CONCLUSION There is a high rate of natural expulsion of fish bone foreign body from children's throat, and the rate of expulsion increases with the increase of the foreign body inclination angle.
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Affiliation(s)
- ChenXi Luo
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Jiangsu, PR China
| | - ZhengHua Huang
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Jiangsu, PR China
| | - Qi Li
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Jiangsu, PR China.
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Alougly S, Alhsony A, Elarwah A, Elbragathy S. Acute Retropharyngeal Abscess in Libyan Children: Case Series and Literature Review. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2022. [DOI: 10.1055/s-0042-1760303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
Background A retropharyngeal abscess (RPA) is a deep neck infection that considers a medical emergency because of the possibility of serious complications including life-threatening upper airway obstruction, mediastinitis, and sepsis.
Materials and Methods We present our experience in Benghazi Children's Hospital, describing the clinical presentations, diagnostic workup, management, and the outcome of four children presented during the time period between November 2017 and November 2021 as cases of RPA secondary to penetrating trauma to the posterior pharyngeal wall either due to ingestion of a foreign body or due to manipulation of tonsils by the traditional therapist.
Results All cases presented with fever, poor feeding, and hyperextension of the neck. All were diagnosed by ultrasound and they needed surgical drainage of RPA, as they did not improve with medical treatment alone.
Conclusion A high index of suspicion is necessary for the early diagnosis and treatment of RPA. Two of our cases were presented following the manipulation of tonsils by a traditional therapist, so we attempted to emphasize this life-threatening consequence after traditional therapy, as well as the unnecessary morbidity and mortality associated with this ongoing traditional treatment in our country.
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Affiliation(s)
- Shirin Alougly
- Pediatrics Intensive Care Unit, Benghazi Children's Hospital, Benghazi, Libya
- Pediatric Department, Faculty of Medicine, Benghazi University, Benghazi, Libya
| | - Alia Alhsony
- Pediatrics Intensive Care Unit, Benghazi Children's Hospital, Benghazi, Libya
- Pediatric Department, Faculty of Medicine, Benghazi University, Benghazi, Libya
| | - Aisha Elarwah
- Pediatrics Intensive Care Unit, Benghazi Children's Hospital, Benghazi, Libya
- Pediatric Department, Faculty of Medicine, Benghazi University, Benghazi, Libya
| | - Suliman Elbragathy
- Pediatrics Intensive Care Unit, Benghazi Children's Hospital, Benghazi, Libya
- Pediatric Department, Faculty of Medicine, Benghazi University, Benghazi, Libya
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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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Alkhodair AA, Alkusayer MM, Albadah AA. Retropharyngeal abscess: A rare complication of nasogastric tube insertion. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Donà D, Gastaldi A, Campagna M, Montagnani C, Galli L, Trapani S, Pierossi N, De Luca M, D'Argenio P, Tucci FM, De Vincentiis G, Grotto P, Da Mosto MC, Frigo AC, Volo T, Emanuelli E, Martini A, Da Dalt L. Deep Neck Abscesses in Children: An Italian Retrospective Study. Pediatr Emerg Care 2021; 37:e1358-e1365. [PMID: 32097379 DOI: 10.1097/pec.0000000000002037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Retropharyngeal and parapharyngeal abscesses (RPAs, PPAs) usually affect young children. Surgical drainage and/or antibiotic therapy are treatment of choice, but no specific guidelines exist. In order to reduce the risk of severe complications, appropriate diagnosis and therapy are necessary. The aims of the study were to review diagnosis and management of children with RPAs/PPAs and to compare surgical versus medical approach. METHODS This is a multicenter retrospective study including all patients younger than 15 years admitted at 4 Italian pediatric hospitals of Florence, Padua, Rome, and Treviso, with International Classification of Diseases, Ninth Revision discharge diagnosis code of RPAs and PPAs, from January 1, 2008, to December 31, 2016. RESULTS One hundred fifty-three children were included. The median age was 4.4 years, with overall male predominance. Heterogeneous signs and symptoms (fever, neck cervical, lymphadenopathy, pain, and stiff neck most frequently) and a large mixture of bacteria from pus cultures were detected. Computer tomography (66.7%) and magnetic resonance imaging (27.5%) were performed to confirm the presence of abscess. Fifty-one percent of abscesses were greater than 3 cm. Eighty-seven patients (56.9%) underwent surgery, and 66 (43.1%) were treated with antibiotics alone (mostly ceftriaxone, metronidazole, amikacin, and clindamycin) with median days of therapy of 26.5 days and length of therapy of 16.0 days of median. Median length of stay was 11 days. None had severe complications. Multivariate analysis indicated as independent predictive factors of surgery abscess of 3 cm or greater, high white blood cell count, and-most of all-the hospital of admission. CONCLUSIONS Deep neck abscesses mostly affect patients in early childhood, with a combination of nonspecific signs and symptoms, and it still emerges as a heterogeneous approach in diagnosis and management of these infections. Thus, common shared protocols represent an essential tool in order to standardize care and improve patients' outcomes.
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Affiliation(s)
- Daniele Donà
- From the Division of Pediatric Infectious Diseases
| | - Andrea Gastaldi
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua
| | - Marta Campagna
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua
| | - Carlotta Montagnani
- Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence
| | | | - Sandra Trapani
- Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence
| | - Nicola Pierossi
- Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence
| | - Maia De Luca
- Unit of Immune and Infectious Diseases, University Department of Pediatrics, Bambino Gesù Children's Hospital
| | - Patrizia D'Argenio
- Unit of Immune and Infectious Diseases, University Department of Pediatrics, Bambino Gesù Children's Hospital
| | - Filippo Maria Tucci
- Unit of Otolaryngology-Head and Neck Surgery, Bambino Gesù Children's Hospital Research Institute, Rome
| | - Giovanni De Vincentiis
- Unit of Otolaryngology-Head and Neck Surgery, Bambino Gesù Children's Hospital Research Institute, Rome
| | - Paolo Grotto
- Division of Pediatrics, S. Maria of Ca' Foncello
| | - Maria Cristina Da Mosto
- Department of Neurosciences, University of Padua, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, Treviso
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences
| | - Tiziana Volo
- Department of Otolaryngology and Endoscopic Surgery of the Upper Airways, University of Padua, Padua, Italy
| | - Enzo Emanuelli
- Department of Otolaryngology and Endoscopic Surgery of the Upper Airways, University of Padua, Padua, Italy
| | - Alessandro Martini
- Department of Otolaryngology and Endoscopic Surgery of the Upper Airways, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua
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Ohnishi T, Sato S, Asanuma S, Ikeda S, Suganuma E. Retropharyngeal abscess due to Staphylococcus aureus complicated by bilateral neck and intraabdominal abscesses in an immunocompetent infant. IDCases 2021; 25:e01209. [PMID: 34307046 PMCID: PMC8258633 DOI: 10.1016/j.idcr.2021.e01209] [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: 06/21/2021] [Revised: 06/27/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022] Open
Abstract
This is a rare case of multiple neck abscesses in an immunocompetent infant. Symptoms were only fever and neck swelling. Patient was successfully treated with antibiotics supported by surgical drainage.
Retropharyngeal abscess is a serious condition, with potentially high morbidity and mortality if not detected early. The patient, a previously healthy 10-month-old girl, was admitted due to retropharyngeal and bilateral cervical lymph node abscesses. The neck abscesses recurred, despite surgical drainage and treatment with intravenous ampicillin-sulbactam. Methicillin-susceptible Staphylococcus aureus was identified from the abscess culture. A mesenteric abscess was also found during treatment. Intravenous ampicillin-sulbactam was switched to intravenous cephazolin and metronidazole, and the patient was successfully treated without further surgical intervention. No recurrence was observed throughout the 1-year follow-up period. Immune function testing, especially neutrophil function, did not reveal any abnormality. Neck abscesses can spread to the deep or shallow neck spaces directly or through the lymph node chains, even in immunocompetent hosts. Clinicians should consider deep neck infection in patients with cervical lymph node abscess, even if they present without the typical signs and symptoms of retropharyngeal abscess.
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Affiliation(s)
- Takuma Ohnishi
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama-shi, Saitama, 330-8777, Japan
| | - Satoshi Sato
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama-shi, Saitama, 330-8777, Japan
| | - Satoshi Asanuma
- Division of Otorhinolaryngology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama-shi, Saitama, 330-8777, Japan
| | - Sho Ikeda
- Department of Pediatrics, Soka Municipal Hospital, Saitama, 2-21-1 Soka, Soka-shi, Saitama, 340-8560, Japan
| | - Eisuke Suganuma
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama-shi, Saitama, 330-8777, Japan
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Sanz Sánchez CI, Morales Angulo C. Retropharyngeal Abscess. Clinical Review of Twenty-five Years. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Keïta A, Diallo I, Fofana M, Diallo MA, Diallo MMR, Balde O, Camara A, Sacko S. [Retropharyngeal abscess: case study of 5 cases and literature review]. Pan Afr Med J 2020; 36:360. [PMID: 33224426 PMCID: PMC7664136 DOI: 10.11604/pamj.2020.36.360.24282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/30/2020] [Indexed: 11/18/2022] Open
Abstract
Nous rapportons 5 cas d´abcès rétropharyngés que nous avons corrélé avec la littérature. Il y avait des enfants ainsi que des adultes. Le corps étranger à type d´arête de poisson a été l´étiologie la plus dominante. La dysphagie accompagnée de douleur, la fièvre et le torticolis ont été les symptômes fréquents. L´abcès rétropharyngé siégeait beaucoup plus en région oropharyngée et hypopharyngée. L´imagerie notamment la tomodensitométrie nous a permis d´avoir des informations précises chez les 3 patients qui en ont bénéficié. L´obstruction des voies aéro-digestives a été retrouvé chez la plupart de nos patients. Seulement 4 patients ont bénéficié d´une incision drainage. Tous les patients ont bénéficié d´un traitement médical. Nous avons enregistré le décès de l´enfant de 2 ans dans un tableau de choc septique à J5 post-opératoire. Nous avons constaté la rareté de cette affection dans notre contexte mais engageant le pronostic vital si le diagnostic et le traitement retardent.
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Affiliation(s)
- Abdoulaye Keïta
- Service Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital National Donka, Centre Hospitalier et Universitaire de Conakry, Conakry, Guinée
| | - Ibrahima Diallo
- Service Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital National Donka, Centre Hospitalier et Universitaire de Conakry, Conakry, Guinée
| | - Mamady Fofana
- Service Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Régional de Kankan, Kankan, Guinée
| | - Mamadou Aliou Diallo
- Service Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital National Donka, Centre Hospitalier et Universitaire de Conakry, Conakry, Guinée
| | - Mamadou Mouctar Ramata Diallo
- Service Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital National Donka, Centre Hospitalier et Universitaire de Conakry, Conakry, Guinée
| | - Oughaïlou Balde
- Service Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital National Donka, Centre Hospitalier et Universitaire de Conakry, Conakry, Guinée
| | - Alseny Camara
- Service Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital National Donka, Centre Hospitalier et Universitaire de Conakry, Conakry, Guinée
| | - Sory Sacko
- Unité Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Régional de Mamou, Mamou, Guinée
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Sideris G, Nikolopoulos T, Papadimitriou N. Spontaneous, Non-Traumatic Retropharyngeal Abscess Complicated by Spinal Osteomyelitis and Epidural Abscess in Immunocompetent Adult: Management and Proposal Pathophysiological Mechanism. Cureus 2020; 12:e9028. [PMID: 32775107 PMCID: PMC7406186 DOI: 10.7759/cureus.9028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Retropharyngeal abscess (RPA) in adults is a potentially life-threatening condition that relates in most of the cases with local trauma. Non-traumatic RPA complicated by spinal osteomyelitis and epidural abscess is a rare entity in immunocompetent adults and represents an emergency medical condition when the patient develops neurologic symptoms. This article presents a case of non-traumatic RPA complicated by spinal osteomyelitis and epidural abscess in a 77-year-old male with the free past medical history. We highlight the importance of early and meticulous daily drainage as well as sequential MRI scanning for early diagnosis, treatment and follow-up for signs of vertebral involvement. The patient had a full recovery and was subsequently discharged with per os four-month antibiotic treatment. The definitive mechanism is unclear for non-traumatic cases with “hematogenous path” being the closest description. Spontaneous RPA can develop from bacteria infection spread of adjacent structures, local inflammatory process and microthrombosis formation can impair the blood supply of vertebral and intervertebral disks.
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Sanz Sánchez CI, Morales Angulo C. Retropharyngeal Abscess. Clinical Review of Twenty-five Years. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:71-79. [PMID: 32487430 DOI: 10.1016/j.otorri.2020.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/06/2019] [Accepted: 01/03/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Retropharyngeal abscess is a serious condition. Its rare occurrence, thus sharing symptoms with other processes, make it a diagnostic challenge for the clinician. Therefore, it is critical to make an early diagnosis to prevent delaying treatment and avoid complications. OBJECTIVES To gain knowledge of the epidemiology, pathogenesis, clinical manifestations, the most commonly implicated microorganisms, the type of treatment used, morbidity and mortality of retropharyngeal abscesses at a tertiary institution over the last 25 years. METHODS A retrospective study was conducted by reviewing medical records of all patients diagnosed with retropharyngeal abscess in a single centre between 1 January 1990 and 31 February 2016. Thirty-three patients were included in our study. Data such as personal history, present illness, diagnoses and treatment procedures were collected from the medical records. RESULTS The incidence during the years of study was 0.2 cases/100 000 inhabitants/year. Personal medical histories most often associated were alcoholism, smoking, diabetes and obesity. The most common aetiology found was impaction of a foreign body (especially fishbone). The most common presenting symptoms were odynophagia and neck pain accompanied by fever. Preventive tracheotomy was performed in the initial management of the patient in 9 cases (27%). The most frequent complication was descending necrotizing mediastinitis. Surgical drainage of the abscess was required in 27 patients (82%), especially with external approaches (17 cases). Two patients had sequelae: paralysis of unilateral vocal cord and Horner's syndrome. No mortality was observed in the patients of the study. CONCLUSION Retropharyngeal abscesses must be considered medical-surgical emergencies as they are likely to produce serious complications. We must pay attention to the warning symptoms such as odynophagia and cervical pain, associated or otherwise with dyspnoea, stridor, trismus, and neck stiffness. Advances in diagnostic and therapeutic procedures together with advances in critical care have been a key factor in improving the prognosis and mortality of these patients.
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Affiliation(s)
| | - Carmelo Morales Angulo
- Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, España
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Weldetsadik AY, Bedane A, Riedel F. Retropharyngeal Tuberculous Abscess: A Rare Cause of Upper Airway Obstruction and Obstructive Sleep Apnea in Children: A Case Report. J Trop Pediatr 2019; 65:642-645. [PMID: 31006004 DOI: 10.1093/tropej/fmz018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Retropharyngeal tuberculous abscess (RPTBA) is a rare manifestation of tuberculosis (TB) even in high TB burden areas. It rarely manifests as a cause of upper airway obstruction and obstructive sleep apnea (OSA) in children with few case reports in the literature. We report a 22 months old toddler who presented with upper airway obstruction and OSA and was diagnosed with RPTBA. The child recovered completely and growing normally after intra-oral aspiration and 6 months of anti-tuberculosis treatment.
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Affiliation(s)
| | - Alemayehu Bedane
- Radiology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Frank Riedel
- Pediatric Pulmonology, Hamburg University, Hamburg, Germany
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Ali NES, Alyono JC, Koltai PJ. Neonatal retropharyngeal abscess with complications: Apnea and cervical osteomyelitis. Int J Pediatr Otorhinolaryngol 2019; 126:109613. [PMID: 31382216 DOI: 10.1016/j.ijporl.2019.109613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the clinical presentation and management strategies for neonatal retropharyngeal abscess (RPA). METHODS Retrospective chart review was performed, and literature reviewed. RESULTS We report two cases of neonatal RPA, with one complicated by cervical osteomyelitis, and the other presenting with apparent life-threatening events (ALTEs). A 6-week-old female underwent transoral drainage of an RPA, which grew methicillin sensitive Staphylococcus aureus. She had a prolonged recovery course and was found to have developed osteomyelitis of the dens and atlas. She was treated with 14 weeks of IV antibiotics and rigid collar fixation for spinal cord instability. A 2-month-old female was admitted after multiple ALTEs with episodes of apnea and pallor. Direct laryngoscopy revealed a bulging RPA, which was drained transorally. This grew multiple organisms including methicillin resistant Staphylococcus aureus, Streptococcal oralis and Prevotella species. CONCLUSIONS Uncommon in neonates, RPA can present in this age group without fever, and are is likely to have airway complications than in older children. In cases with prolonged recovery, additional diagnostic intervention is recommended to rule out rare complications such as osteomyelitis. Emphasis in such complex cases is placed on a multidisciplinary approach to patient care, coordinating neonatologists, infectious disease specialists, neurosurgeons, and otolaryngologists.
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Affiliation(s)
- Noor-E-Seher Ali
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer C Alyono
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter J Koltai
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Balfour-Lynn IM, Wright M. Acute Infections That Produce Upper Airway Obstruction. KENDIG'S DISORDERS OF THE RESPIRATORY TRACT IN CHILDREN 2019. [PMCID: PMC7152287 DOI: 10.1016/b978-0-323-44887-1.00023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This chapter discusses the common and potentially serious infective causes of acute upper airway obstruction in children. The laryngeal anatomy of young children makes them particularly susceptible to upper airway obstruction, and during acute infections this is exacerbated by inflammation and edema of the airway mucosa. The most common cause of infective upper airway obstruction in children is viral laryngotracheobronchitis, or croup, which is usually a mild and self-limiting illness, but management with corticosteroids may still be necessary. Bacterial causes of upper airway obstruction have fortunately become rare since the introduction of the Haemophilus influenzae B (HiB) immunization, but a few cases of epiglottitis do still occur due to nonimmunization, vaccine failure, and infection with non-HiB organisms. These cases constitute a medical emergency due to the risk of rapid progression to complete airway obstruction. Other rare conditions are discussed including bacterial tracheitis, diphtheria, retropharyngeal, and peritonsillar abscesses. Key learning points in this chapter include the main discriminating factors of the various causes of infective upper airway obstruction, the importance of a calm and minimally distressing approach to the child presenting with stridor, and the need for early anesthetic team involvement in cases with a suspected bacterial etiology or signs of impending airway obstruction.
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17
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Allison C, Holmes J, Pearce E. Woman With Neck Pain. Ann Emerg Med 2018; 72:722-734. [PMID: 30454795 DOI: 10.1016/j.annemergmed.2018.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Indexed: 10/27/2022]
Affiliation(s)
| | - Jeffrey Holmes
- Department of Emergency Medicine, Maine Medical Center, Boston, MA; Tufts University School of Medicine, Portland, ME
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18
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Freeman R. An apparently simple case of fever and sore throat. Arch Dis Child Educ Pract Ed 2018; 103:194-196. [PMID: 28500023 DOI: 10.1136/archdischild-2016-312234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/25/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Richard Freeman
- Children's Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, UK
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19
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Huang Z, Li P, Xie L, Li J, Zhou H, Li Q. Related factors of outcomes of pharyngeal foreign bodies in children. SAGE Open Med 2017; 5:2050312117724057. [PMID: 28839938 PMCID: PMC5560513 DOI: 10.1177/2050312117724057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/10/2017] [Indexed: 12/13/2022] Open
Abstract
Objective: This study aimed to identify factors related to outcomes of the pharyngeal foreign bodies in children and to improve the management protocol of this disease. Methods: The medical records of 131 children with pharyngeal foreign bodies hospitalized in the hospital were retrospectively reviewed. Results: Significant differences were observed between the two groups (dislodgement and removal group) with respect to location of pharyngeal foreign bodies and age, while sex, time of pharyngeal foreign bodies, and nature of pharyngeal foreign bodies had no significant differences. Moreover, results suggested that location of pharyngeal foreign bodies and nature of pharyngeal foreign bodies were risk factors correlated with complications. Conclusion: Pharyngeal foreign body in children has a high rate of dislodgement (>50%). Foreign bodies in the oropharynx were more likely to dislodge compared with the foreign bodies in the laryngopharynx. Younger children were more likely to dislodge compared with older children. Although the risk of complications was very low, attention needs to be paid to the potential risks: local infection, deep abscess, and migration of foreign bodies. Because the possibility of complications caused by bone fragments and foreign bodies in the laryngopharynx increase obviously, hence, it is suggested to remove these kinds of foreign bodies as soon as possible to prevent complications.
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Affiliation(s)
- Zhenghua Huang
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Peng Li
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Lisheng Xie
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Jing Li
- Department of Gastroenterology, Jiaozuo Renmin Hospital, Jiaozuo, P.R. China
| | - Honggen Zhou
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Qi Li
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Nanjing, P.R. China
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20
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A rare adult case of poststreptococcal acute glomerulonephritis with a retropharyngeal abscess. CEN Case Rep 2017; 6:118-123. [PMID: 28509140 DOI: 10.1007/s13730-017-0256-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022] Open
Abstract
Retropharyngeal abscess is an infection involving the retropharyngeal space which is posterior to the pharynx and oesophagus, and it results as a complication of a primary infection elsewhere in the head and neck including the nasopharynx, paranasal sinuses, or middle ear, which drain lymph to the retropharyngeal lymph nodes. Their lymph nodes are prominent in children and atrophy with age. Therefore, retropharyngeal abscess is most frequently encountered in children, with 75% of cases occurring before the age of 5 years, and often in the first year of life. We experienced a rare adult case of poststreptococcal acute glomerulonephritis with a retropharyngeal abscess, and conservative therapy ameliorated them. According to past reports, only one child with a retropharyngeal abscess and poststreptococcal acute glomerulonephritis has been presented at a conference to date; this is the first adult case of poststreptococcal acute glomerulonephritis with a retropharyngeal abscess. Retropharyngeal abscess can be fatal including airway compression, so it is important to remember retropharyngeal abscess in a case of poststreptococcal acute glomerulonephritis with severe symptoms of neck.
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Khudan A, Jugmohansingh G, Islam S, Medford S, Naraynsingh V. The effectiveness of conservative management for retropharyngeal abscesses greater than 2 cm. Ann Med Surg (Lond) 2016; 11:62-65. [PMID: 27761237 PMCID: PMC5065001 DOI: 10.1016/j.amsu.2016.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/02/2016] [Accepted: 10/02/2016] [Indexed: 11/06/2022] Open
Abstract
Objectives Conservative management for retropharyngeal abscesses <2 cm is now a first line option. It is unclear if conservative management can be used to manage larger abscesses without increased morbidity and mortality. Study design A prospective case series was performed from 2012 to 2015 by the Otolaryngology department of the San Fernando General Hospital involving pediatric patients who presented with retropharyngeal abscesses. All patients were initially treated with antibiotics alone. Methods Patients with clinical features and CT scan confirmation of a retropharyngeal abscess were included in the study. Those who improved clinically and biochemically within 48 h continued to be treated conservatively and those who deteriorated had surgical intervention. Results Sixteen patients fulfilled the inclusion criteria. Most patients were Afro Trinidadian males between the ages of two and five who were also found to be iron deficient. Drooling was a sensitive predictor for the presence of an abscess but did not indicate the need for drainage. Hoarseness was the clinical feature that prompted surgical intervention. Sixty three percent of patients had an abscess >2 cm of which 90% improved within 48 h. One patient required surgical drainage with no increase in morbidity or mortality. Conclusion Conservative management of retropharyngeal abscesses >2 cm can be offered to patients during the first 48 h. If the patient demonstrates clinical and biochemical improvement, antibiotics alone can be continued. If the patient deteriorates, surgical drainage can be subsequently performed with no increase in morbidity and mortality. The retropharyngeal abscess is a deep neck space infection commonly seen in the pediatric population. Drainage of these abscesses is associated with multiple complications. Patient presenting with hoarseness requires surgical intervention. Conservative management can be successfully performed in patients who have abscesses that are greater than 2 cm. Patients treated with antibiotic alone need to be closely followed up for lack of improvement or deterioration.
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Affiliation(s)
- A Khudan
- Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - G Jugmohansingh
- Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - S Islam
- Department of General Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - S Medford
- Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - V Naraynsingh
- Department of Clinical Surgical Sciences, University of West Indies, St. Augustine, Trinidad and Tobago
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22
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Intraoral drainage under surgical microscopy with tonsillectomy for parapharyngeal abscesses. The Journal of Laryngology & Otology 2015; 129:595-7. [DOI: 10.1017/s0022215115000791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:An intraoral approach combined with tonsillectomy has been used to access the parapharyngeal space. However, the utility of this technique for parapharyngeal abscesses in paediatric patients has not been investigated. This paper describes an intraoral drainage technique combined with tonsillectomy for treating children with a parapharyngeal abscess that obviates the need for skin incision.Methods:Clinical case records are presented, along with a description of the surgical procedure accompanied by a video clip.Results:Both cases encountered involved paediatric parapharyngeal space abscesses that extended to the skull base. The patients underwent an intraoral approach combined with tonsillectomy performed under surgical microscopy; this resulted in a good post-operative course without complications.Conclusion:To our knowledge, no previous reports have addressed the use of surgical microscopy to help access the parapharyngeal space. The procedure described herein, performed under surgical microscopy, was specifically helpful in enabling access to these challenging spaces; it also meant that surgical procedures could be recorded clearly and findings shared with other medical staff.
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Raffaldi I, Le Serre D, Garazzino S, Scolfaro C, Bertaina C, Mignone F, Peradotto F, Tavormina P, Tovo PA. Diagnosis and management of deep neck infections in children: the experience of an Italian paediatric centre. J Infect Chemother 2014; 21:110-3. [PMID: 25456894 DOI: 10.1016/j.jiac.2014.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/20/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
Abstract
Deep neck infection (DNI) is a severe occurrence in children. We've examined the presenting signs and symptoms, the value of single diagnostic procedures, the rate of complications and the impact of the therapeutic options on the final outcome, in children with a DNI. We retrospectively evaluated patients, aged 0-18 years, who were admitted for a DNI, from January 2006 through December 2012, at Regina Margherita Children's Hospital, Turin, Italy. We subdivided them on the basis of type of treatment: pharmacological treatment alone or antimicrobial treatment plus surgery. An univariate analysis has been performed to examine the differences between the two groups. Sixty patients (32 males, 28 females) with diagnosis of DNI were enrolled; 33 children only received medical treatment (group 1), whereas 27 patients underwent also surgical interventions (group 2). The mean abscess size was significantly higher in group 2 than in group 1 (p = 0.01). The predominant organisms were Streptococcus sp. (11 cases, 52.4%, mostly Streptococcus pyogenes). The most frequent antibiotic regimen was a β lactam alone (either III generation cephalosporin or amoxicillin/clavulanate). The duration of intravenous antibiotic varied between the two groups, without statistical significance (p = 0.052); whereas the oral antibiotic administration was significantly shorter in group 1 than in group 2 (p = 0.0003). Three patients (5%) developed complications. This research confirms that the medical approach, with high doses of intravenous antibiotics for a minimum of 5 days, could be a tolerable and safe option for the treatment of patients with stable condition and/or small DNIs.
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Affiliation(s)
- Irene Raffaldi
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy.
| | - Daniele Le Serre
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Silvia Garazzino
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Carlo Scolfaro
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Chiara Bertaina
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy; Unit of Immunology and Infectious Diseases, University-Hospital Pediatric Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Federica Mignone
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Federica Peradotto
- Department of Paediatric Otolaryngology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Paolo Tavormina
- Department of Paediatric Otolaryngology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Pier-Angelo Tovo
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy
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24
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Life-Threatening Diseases of the Upper Respiratory Tract. Pediatr Crit Care Med 2014. [PMCID: PMC7121250 DOI: 10.1007/978-1-4471-6356-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
This article outlines infections in the submandibular, lateral pharyngeal, retropharyngeal, danger, and prevertebral spaces, in conjunction with infections of the sinuses and mediastinum. By understanding the anatomy and pathophysiology, the reader will gain insight into the rationale for various therapeutic options.
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Affiliation(s)
- Denise Jaworsky
- Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia V5Z 1M9, Canada
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Shin JH, Sung SI, Kim JK, Jung JM, Kim ES, Choi SH, Kim YJ, Ahn KM, Chang YS, Park WS. Retropharyngeal abscess coinfected with Staphylococcus aureus and Mycobacterium tuberculosis after rhinoviral infection in a 1-month-old infant. KOREAN JOURNAL OF PEDIATRICS 2013; 56:86-9. [PMID: 23482861 PMCID: PMC3589596 DOI: 10.3345/kjp.2013.56.2.86] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/01/2012] [Accepted: 09/26/2012] [Indexed: 12/24/2022]
Abstract
A retropharyngeal abscess is a rare disease entity in young infants but can develop after nasopharyngeal viral infection. Group B Streptococcus and Staphylococcus aureus are the most common pathogens in young infants, however, Mycobacterium tuberculosis is very rare. We report the case of retropharyngeal abscess and coinfection with S. aureus and M. tuberculosis in a very young infant presenting with respiratory symptoms due to upper airway obstruction. Usually tuberculous retropharyngeal abscesses are caused by the direct invasion of the bacteria from the spine via anterior longitudinal ligament of the spine. However, in this case, no associated spinal disease was observed.
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Affiliation(s)
- Jeong Hee Shin
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
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Lee JH, Park JW, Kwon BS, Ryu KH, Lee HJ, Park YG, Chang JH, Sim KB. Dysphagia due to Retropharyngeal Abscess that Incidentally Detected in Subarachnoid Hemorrhage Patient. Ann Rehabil Med 2013; 36:861-5. [PMID: 23342321 PMCID: PMC3546191 DOI: 10.5535/arm.2012.36.6.861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 12/07/2011] [Indexed: 11/05/2022] Open
Abstract
Cerebral hemorrhage is one of the most common causes of dysphagia. In many cases, dysphagia gets better once the acute phase has passed. Structural lesions such as thyromegaly, cervical hyperostosis, congenital web, Zenker's diverticulum, neoplasm, radiation fibrosis, and retropharyngeal abscess must be considered as other causes of dysphagia as well. Retropharyngeal abscess seldom occur in adults and if it does so, a search for a prior dental procedure, trauma, head and neck infection is needed. The symptoms may include neck pain, dysphagia, sore throat, and in rare cases, dyspnea accompanied by stridor. We present a case and discuss a patient who had dysphagia and neck pain after a cerebral hemorrhage. Testing revealed a retropharyngeal abscess. The symptoms were successfully treated after the administration of antibiotics.
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Affiliation(s)
- Jung Hwan Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Dongguk University, Goyang 410-773, Korea
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28
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Balfour-Lynn IM, Davies JC. Acute Infections that Produce Upper Airway Obstruction. KENDIG & CHERNICKÂS DISORDERS OF THE RESPIRATORY TRACT IN CHILDREN 2012. [PMCID: PMC7151954 DOI: 10.1016/b978-1-4377-1984-0.00025-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Croche Santander B, Prieto Del Prado A, Madrid Castillo M, Neth O, Obando Santaella I. Abscesos retrofaríngeo y parafaríngeo: experiencia en hospital terciario de Sevilla durante la última década. An Pediatr (Barc) 2011; 75:266-72. [DOI: 10.1016/j.anpedi.2011.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 03/08/2011] [Accepted: 03/09/2011] [Indexed: 10/17/2022] Open
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Chen CH, Wang CJ, Lien R, Chou YH, Chang CC, Chiang MC. Mediastinal and retropharyngeal abscesses in a neonate. Pediatr Neonatol 2011; 52:172-5. [PMID: 21703562 DOI: 10.1016/j.pedneo.2011.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 08/03/2010] [Accepted: 08/16/2010] [Indexed: 12/11/2022] Open
Abstract
Mediastinal abscess following retropharyngeal abscess is a rare entity. We report the first neonate presenting with a large mediastinal abscess as a complication of a retropharyngeal abscess. The initial manifestations of this newborn were fever and stridor. The chest sonography revealed a mediastinal mass, and the neck and chest computed tomography showed multiple abscesses in the retropharyngeal space, parapharyngeal space, and superior mediastinum. The mediastinal cystic mass was excised, and antibiotic treatment was completed for 7 weeks. She did well without any sequelae at follow-up clinic. Pediatricians should consider retropharyngeal and mediastinal abscesses among the differential diagnoses when confronting a newborn with fever and stridor.
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Affiliation(s)
- Chien-Han Chen
- Department of Pediatric and Adolescent Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
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Multiplanar CT and MRI of Collections in the Retropharyngeal Space: Is It an Abscess? AJR Am J Roentgenol 2011; 196:W426-32. [DOI: 10.2214/ajr.10.5116] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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32
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Grisaru-Soen G, Komisar O, Aizenstein O, Soudack M, Schwartz D, Paret G. Retropharyngeal and parapharyngeal abscess in children--epidemiology, clinical features and treatment. Int J Pediatr Otorhinolaryngol 2010; 74:1016-20. [PMID: 20598378 DOI: 10.1016/j.ijporl.2010.05.030] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 05/23/2010] [Accepted: 05/25/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the clinical presentation, diagnosis, management and complications of children with retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs). METHODS A retrospective chart review was conducted at two tertiary care, pediatric hospitals in Israel. The medical records of all children <18 years who had been admitted with a diagnosis of RPA or PPA during an 11-year period (January 1997 to February 2008) were reviewed. Data on demographics, presenting symptoms, physical examination findings, imaging studies and interpretation, laboratory results, hospital course, medical treatment and surgical interventions were retrieved. RESULTS A total of 39 children were diagnosed as having RPA (n=26, 67%) or PPA (n=13, 33%). There was a predominance of boys (61.5%). The mean age of all the children at diagnosis was 4 years. The annual incidence increased over the 11-year period. The most common symptoms at presentation included fever (n=27, 70%) and neck pain (n=24, 62%). The physical examination revealed cervical lymphadenopathy in 30 children (77%), limitation of neck movements in 25 (64%), torticollis in 21 (54%), drooling in three (8%), and stridor in two (5%). Computerized tomographic (CT) scanning with contrast was performed in 37 patients (95%), of whom 17 underwent surgical drainage. Thirteen children were positively diagnosed as having an abscess by the finding of pus at surgery, of whom 12 had been found to have an abscess on their CT scan. All the patients received intravenous antibiotics. There was no significant difference in the duration of hospital stay between those who underwent surgery and those who were treated with antibiotics alone. There were no treatment failures and no complications in either of the two groups. CONCLUSION Children with RPA most commonly present with restricted neck movements, fever and cervical lymphadenopathy, and rarely with respiratory distress or stridor. Many patients with RPA and PPA can be treated successfully without surgery. CT scans are helpful in diagnosing and assessing the extent of the infection, but they are not always accurate.
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Affiliation(s)
- Galia Grisaru-Soen
- Pediatric Infectious Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Falup-Pecurariu O, Leibovitz E, Pascu C, Falup-Pecurariu C. Bacteremic methicillin-resistant Staphylococcus aureus deep neck abscess in a newborn--case report and review of literature. Int J Pediatr Otorhinolaryngol 2009; 73:1824-7. [PMID: 19804915 DOI: 10.1016/j.ijporl.2009.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Accepted: 09/06/2009] [Indexed: 10/20/2022]
Abstract
We describe an unusual localization of methicillin-resistant Staphylococcus aureus infection (MRSA) in a very young newborn. A 3-week-old male infant was admitted with fever, irritability, sialorrhea and stiffed left neck. The ENT examination revealed a deep neck mass and an ultrasound examination showed diffuse swelling of the left latero-pharyngeal area. A CT examination confirmed a deep neck abscess with difficult-to-define borders. Blood and nasopharyngeal cultures returned positive for MRSA. Treatment was started with intravenous teicoplanin and continued for 14 days with a marked decrease in abscess's dimensions and improvement in patient's general condition. MRSA should be suspected in the etiology and treatment of neck abscesses in newborns, infants and young children.
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Affiliation(s)
- Oana Falup-Pecurariu
- Department of Pediatrics, Children's Hospital, Faculty of Medicine, Transilvania University Braşov, Romania
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Schuler PJ, Cohnen M, Greve J, Plettenberg C, Chereath J, Bas M, Koll C, Scheckenbach K, Wagenmann M, Schipper J, Hoffmann TK. Surgical management of retropharyngeal abscesses. Acta Otolaryngol 2009; 129:1274-9. [PMID: 19863324 DOI: 10.3109/00016480802642088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Retropharyngeal abscess (RPA) is a rare, potentially life-threatening disease, requiring appropriate otorhinolaryngologic as well as radiologic diagnostics, and medical and surgical intervention by a transoral, transcervical or transnasal approach in a multidisciplinary setting. OBJECTIVES The risks and benefits of surgical intervention in patients with RPA were assessed. The main outcome measure was the clinical resolution of the abscess. PATIENTS AND METHODS A retrospective chart review was performed at a tertiary care university hospital over a period of 28 months. Eleven patients aged 1 to 68 years with the diagnosis of RPA were included. RESULTS All patients presented with restricted cervical mobility and all patients had CT and/or MRI scan on admission. The mean abscess volume was 9.4 cm(3). Surgical intervention was performed in all cases, including transoral (n=5), transcervical (n=3) or combined transoral and transcervical (n=2) drainage. In one patient RPA close to the skull base was drained by an MRI-guided transnasal approach. All patients recovered; however, there was one recurrence and in one case surgical tracheotomy was unavoidable during the course of disease. Growth of streptococcal species was verified in six of the examined abscesses. Abscessing lymphadenitis, infection of a cervical cyst, and previous ganglionar local opioid analgesia treatment were identified as causative factors.
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Affiliation(s)
- Patrick J Schuler
- Department of Otorhinolaryngology and Head and Neck Surgery, Heinrich-Heine-University Hospital, Moorenstrasse 5,Duesseldorf, Germany.
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Infections rétro- et parapharyngées : vers une harmonisation des pratiques. Arch Pediatr 2009; 16:1225-32. [DOI: 10.1016/j.arcped.2009.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 01/26/2009] [Accepted: 05/30/2009] [Indexed: 11/23/2022]
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Reynolds SC, Chow AW. Severe soft tissue infections of the head and neck: a primer for critical care physicians. Lung 2009; 187:271-9. [PMID: 19653038 DOI: 10.1007/s00408-009-9153-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 05/11/2009] [Indexed: 11/28/2022]
Abstract
Patients with severe infections of the potential spaces of the head and neck are commonly managed in the ICU. These infections may present with devastating complications such as airway obstruction, jugular septic thrombophlebitis, lung abscess, upper airway abscess rupture with asphyxiation, mediastinitis, pericarditis, and septic shock. A thorough understanding of the anatomy and microbiology of these infections is essential for proper management of these patients. Retropharyngeal, danger, prevertebral, lateral pharyngeal, and submandibular space infections and their site-specific clinical manifestations, complications, and therapeutic interventions are discussed.
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Affiliation(s)
- Steven C Reynolds
- Division of Critical Care, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Abstract
Infections of the airway in children may present to the anesthetist as an emergency in several locations: the Emergency Department, the Operating Department or on Intensive Care. In all of these locations, relevant and up to date knowledge of presentations, diagnoses, potential complications and clinical management will help the anesthetist and the surgical team, not only with the performance of their interventions, but also in buying time before these are undertaken, avoiding complications and altering the eventual outcome for the child. Diseases such as epiglottitis and diphtheria may show diminished incidence but they have not gone away and their clinical features and essential management remain unchanged. Paradoxically, perhaps, some conditions such as Lemierre's syndrome appear to be making a comeback. In these instances, clinicians need to be alert to these less common conditions, not only in regard to the disease itself but also to potentially serious complications. This article describes those infections of the airway that are most likely to present to the anesthetist, their attendant complications and recommendations for treatment.
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Abcès rétro- et parapharyngés de l’enfant : facteurs prédictifs d’échec du traitement médical. ACTA ACUST UNITED AC 2009; 126:112-9. [DOI: 10.1016/j.aorl.2009.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 03/24/2009] [Indexed: 11/15/2022]
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Byramji A, Gilbert JD, Byard RW. Fatal retropharyngeal abscess: a possible marker of inflicted injury in infancy and early childhood. Forensic Sci Med Pathol 2009; 5:302-6. [DOI: 10.1007/s12024-009-9077-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2009] [Indexed: 11/30/2022]
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Abstract
The acute dental abscess is frequently underestimated in terms of its morbidity and mortality. The risk of potential serious consequences arising from the spread of a dental abscess is still relevant today with many hospital admissions for dental sepsis. The acute dental abscess is usually polymicrobial comprising facultative anaerobes, such as viridans group streptococci and the Streptococcus anginosus group, with predominantly strict anaerobes, such as anaerobic cocci, Prevotella and Fusobacterium species. The use of non-culture techniques has expanded our insight into the microbial diversity of the causative agents, identifying such organisms as Treponema species and anaerobic Gram-positive rods such as Bulleidia extructa, Cryptobacterium curtum and Mogibacterium timidum. Despite some reports of increasing antimicrobial resistance in isolates from acute dental infection, the vast majority of localized dental abscesses respond to surgical treatment, with antimicrobials limited to spreading and severe infections. The microbiology and treatment of the acute localized abscess and severe spreading odontogenic infections are reviewed.
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Affiliation(s)
- D. Robertson
- Department of Restorative Dentistry, University of Glasgow, Medical Faculty, Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK
| | - A. J. Smith
- Infection and Immunity Section, University of Glasgow, Medical Faculty, Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK
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Abstract
The foreign bodies ingestion are common among the patients admitting to the ENT Emergency Unit. Usually the treatment does not cause too much trouble, however, the symptoms and possible complications might be potentially life threatening. The 64 years old female suffering from severe pain in the hypopharynx and dysphagia was introduced to the ENT Emergency Unit of the F. Raszeja City Hospital in Poznań. The laryngological examination showed the piece of the needle protruding from the back wall of the hypopharynx. The CT scans indicated the tip of the needle, touching the transverse processes of the C3 and C4 vertebrae. Unfortunately the analysis of the CT scans could not clearly exclude the injury of the vertebral artery.
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Chen TH, Chen CC, Hwang KP, Chung MY, Chuang HC. Retropharyngeal abscess with extensive mediastinitis in a 2-day-old neonate. J Paediatr Child Health 2008; 44:154-5. [PMID: 18307424 DOI: 10.1111/j.1440-1754.2007.01282.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Reynolds SC, Chow AW. Life-threatening infections of the peripharyngeal and deep fascial spaces of the head and neck. Infect Dis Clin North Am 2007; 21:557-76, viii. [PMID: 17561083 DOI: 10.1016/j.idc.2007.03.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article reviews life-threatening infections of the head and neck. It discusses the anatomic boundaries, pathophysiologic processes, clinical manifestations, potential complications, and suggested therapies of infections of the submandibular, lateral pharyngeal, retropharyngeal, prevertebral, and danger spaces.
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Affiliation(s)
- Steven C Reynolds
- Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver Hospital, ICU2, JPPN 2nd Floor, Room 2438, 855 West 12th Ave., Vancouver, BC V5Z 1M9, Canada
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Allotey J, Duncan H, Williams H. Mediastinitis and retropharyngeal abscess following delayed diagnosis of glass ingestion. Emerg Med J 2006; 23:e12. [PMID: 16439726 PMCID: PMC2564068 DOI: 10.1136/emj.2004.020867] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Foreign body ingestion is a common occurrence in childhood. We report the outcome of an infant who swallowed a piece of glass. The absence of a foreign body on chest radiograph led to delayed diagnosis and then to the well documented complications of retropharyngeal abscess and mediastinitis. She was admitted to the paediatric intensive care unit a week after her initial presentation, subjected to multiple invasive and non-invasive procedures, and 6 weeks after her initial presentation to the accident and emergency department, was discharged back to her referring hospital having re-established oral feeds.
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Affiliation(s)
- J Allotey
- Birmingham Children's Hospital, Birmingham, UK.
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Audebert S, Vic P, Feuvrier Y, Blondin G, Guérin-Develay S, Rivoal E, Chergui A, Broussine L. [Radiological quiz of the month]. Arch Pediatr 2005; 11:1472, 1495-7. [PMID: 15596340 DOI: 10.1016/j.arcped.2004.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 09/23/2004] [Indexed: 10/26/2022]
Affiliation(s)
- S Audebert
- Service de pédiatrie, centre hospitalier de Cornouaille, BP 1757, 29107 Quimper, France
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Brook I. Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg 2005; 62:1545-50. [PMID: 15573356 DOI: 10.1016/j.joms.2003.12.043] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This review describes the microbiology, diagnosis, and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses in children. Predominant anaerobic organisms isolated in peritonsillar, lateral pharyngeal, and retropharyngeal abscesses are Prevotella, Porphyromonas, Fusobacterium and Peptostreptococcus spp.; aerobic organisms are group A streptococcus ( Streptococcus pyogenes ), Staphylococcus aureus and Haemophilus influenzae . Anaerobic bacteria can be isolated from most abscesses whenever appropriate techniques for their cultivation have been used, while S. pyogenes is isolated in only about one third of cases. More than two thirds of deep neck abscesses contain beta-lactamase producing organisms. Management of tonsillar, peritonsillar, and retropharyngeal abscesses is similar. Systemic antimicrobial therapy should be given in large doses whenever the diagnosis is made. However, when pus is formed, antimicrobial therapy is effective only in conjunction with adequate surgical drainage. Untreated abscesses can rupture spontaneously into the pharynx, causing catastrophic aspiration. Other complications are extension of infection laterally to the side of the neck or dissection into the posterior mediastinum through facial planes and the prevertebral space. Death can occur from aspiration, airway obstruction, erosion into major blood vessels, or extension to the mediastinum.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, Washington, DC 20016, USA.
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Daya H, Lo S, Papsin BC, Zachariasova A, Murray H, Pirie J, Laughlin S, Blaser S. Retropharyngeal and parapharyngeal infections in children: the Toronto experience. Int J Pediatr Otorhinolaryngol 2005; 69:81-6. [PMID: 15627452 DOI: 10.1016/j.ijporl.2004.08.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2002] [Revised: 08/11/2004] [Accepted: 08/13/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To review the Hospital of Sick Children, Toronto's experience of the diagnosis and management of retropharyngeal and parapharyngeal infections with particular emphasis on the role of computed tomography (CT) imaging in diagnosing the presence of an abscess. METHODS A retrospective analysis of all patients diagnosed with retropharyngeal and parapharyngeal infections from 1987 to 1999 was performed. Demographic data, presenting symptoms, season of presentation, management and complications were reviewed. The CT scans of 27 patients who underwent surgical treatment were retrospectively examined by two neuroradiologists who were blinded to the patient's history and outcome. The sensitivity, specificity and predictive values for the specific features and overall assessment were calculated. RESULTS Fifty-four children were identified. There were 46 retropharyngeal infections, 6 parapharyngeal infections and 2 patients had both retropharyngeal and parapharyngeal infections. All patients were treated with parenteral antibiotics. Thirty-seven patients underwent surgical drainage and in 27 there was a positive finding of pus. The retrospectively assessed CT scans of the 21 patients who underwent surgery were found to have a sensitivity of 81% in detecting an abscess by CT scan but the specificity was 57%. There were four complications including mediastinitis, aspiration pneumonia, internal jugular vein thrombosis and common carotid artery aneurysm. All patients recovered but abscess recurred in five patients. CONCLUSION Not all patients with retropharyngeal and parapharyngeal abscesses require surgery. Whilst CT scans are helpful in diagnosing and assessing the extent of these infections they are not always accurate in detecting an abscess. A decision to drain an abscess should therefore not be made based solely on the CT findings.
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Affiliation(s)
- Hamid Daya
- Department of Otolaryngology, St. George's Hospital Medical School, Blackshaw Road, London SW17 0QT, UK.
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