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Shareef M, Ghosn Y, Khdhir M, El Annan T, Alam R, Hourani R. Critical infections in the head and neck: A pictorial review of acute presentations and complications. Neuroradiol J 2024; 37:402-417. [PMID: 35188822 PMCID: PMC11366201 DOI: 10.1177/19714009211059122] [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] [Indexed: 11/15/2022] Open
Abstract
Non-traumatic head and neck emergencies include several disease processes such as infectious, inflammatory, and malignant. Infections are among the most common pathological processes that affect the head and neck, and are particularly important due to their acute, severe, and potentially life-threatening nature. Radiologists need to be well acquainted with these entities because any delay or misdiagnosis can lead to significant morbidity and mortality. Having a general understanding of such diseases is crucial, their prevalence, clinical presentation, common causative pathogens, route of spread, potential complications, and multimodality radiological appearance. Furthermore, understanding the relevant anatomy of the region, including the various fascial planes and spaces, is essential for radiologists for accurate image interpretation and assessment of potential complications. Our aim is to review the most common severe infections affecting the head and neck as well as other rare but potentially life-threatening infections. We will also describe their imaging features while focusing on the anatomy of the regions involved and describing their potential complications and treatment options.
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Affiliation(s)
| | - Youssef Ghosn
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
| | - Mihran Khdhir
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
| | - Tamara El Annan
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
| | - Raquelle Alam
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
| | - Roula Hourani
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
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Petrová B, Šikolová S, Bartoš M, Jančíková J, Jabandžiev P, Klabusayová E, Urík M. Extensive Parapharyngeal Abscess in a 4-Month-Old Infant. EAR, NOSE & THROAT JOURNAL 2024; 103:357-360. [PMID: 34714174 DOI: 10.1177/01455613211049854] [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] [Indexed: 11/15/2022] Open
Abstract
Parapharyngeal abscess in an infant is a very rare condition. We present the case of a 4-month-old girl with large masses on the neck's left side. Computed tomography showed an extensive parapharyngeal abscess. Left tonsillectomy was performed under general anesthesia from a transoral approach, followed by an incision and evacuation of the abscess from the parapharyngeal space. Microbiological analysis identified a massive occurrence of Streptococcus intermedius.
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Affiliation(s)
- Barbora Petrová
- Department of Pediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Soňa Šikolová
- Department of Pediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Bartoš
- Department of Pediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Jančíková
- Department of Pediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Jabandžiev
- Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eva Klabusayová
- Department of Pediatric Anesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Milan Urík
- Department of Pediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Zhao X, Ma J, Wu X, Wei C. Parapharyngeal Abscess: Antibiotic-only or Open Surgical Drainage? EAR, NOSE & THROAT JOURNAL 2023:1455613231185041. [PMID: 37464765 DOI: 10.1177/01455613231185041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Objective:Many problems of parapharyngeal abscess (PPA), such as etiology, predisposing factors, and therapeutic methods, are still controversial. We aim to investigate the characteristics of PPA to better understand the therapeutic effects of the disease. Methods: We retrospectively collated the medical record reviews of 49 PPA patients who were treated as PPA inpatients when a patient was hospitalized and diagnosed with PPA, and empiric antibiotics were used. Only if the drug treatment was ineffective, the abscess was large, or the disease continued to progress, and surgical treatment was adopted. Results: In total, 49 patients who met the research criteria were identified. Streptococcus was the most common organism in PPA patients. The morbidity of diabetes in PPA patients was higher than the prevalence of diabetes in the overall population. Interestingly, the length of hospital stay was shorter in the antibiotic-only group than in the surgery group (P < 0.05). Furthermore, the duration from onset to treatment in the antibiotic-only group was shorter than in the surgery group. Conclusion: Our treatment protocol is effective. Antibiotic-only method is also recommended for the PPA which was effective for the empiric antibiotics and localized. Early diagnosis and treatment of PPA could ultimately reduce the severity of PPA.
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Affiliation(s)
- Xiaoyun Zhao
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Jingru Ma
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Xiufa Wu
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Chunsheng Wei
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China
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Konishi T, Sakata A, Inokuchi H, Kumazawa R, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Treatments and outcomes of adult parapharyngeal and retropharyngeal abscess: 1882 cases from a Japanese nationwide database. Am J Otolaryngol 2023; 44:103770. [PMID: 36577172 DOI: 10.1016/j.amjoto.2022.103770] [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: 11/25/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Although parapharyngeal and retropharyngeal abscesses are potentially fatal deep neck abscesses, there is limited evidence for the treatment courses for adult patients with these abscesses. We aimed to describe the practice patterns and clinical outcomes of adult patients undergoing an emergency surgery for parapharyngeal or retropharyngeal abscesses using a nationwide database. MATERIALS AND METHODS We identified patients aged ≥18 years who underwent emergency surgery for parapharyngeal (para group, n = 1148) or retropharyngeal (retro group, n = 734) abscesses from July 2010 to March 2020, using a nationwide inpatient database. We performed between-group comparisons of the baseline characteristics, treatment course, and outcomes. RESULTS Compared with the retro group, the para group was more likely to be older (median, 66 vs. 60 years; P < 0.001) and have several comorbidities, such as diabetes (21 % vs 16 %; P = 0.010) and epiglottitis (33 % vs. 26 %; P = 0.002), except for peritonsillar abscess (14 % vs. 22 %; P < 0.001) and tonsillitis (2.1 % vs. 13 %; P < 0.001). Regarding intravenous drugs administered within 2 days of admission, approximately half of the patients received steroids, non-antipseudomonal penicillins, and lincomycins. The para group received more comprehensive treatments, such as tracheostomy, intensive care unit admissions, and swallowing rehabilitation, within total hospitalization than the retro group. Moreover, it demonstrated higher in-hospital mortality (2.7 % vs. 1.1 %; P = 0.017) and morbidity (16 % vs. 9.7 %; P < 0.001), and longer length of hospitalization than the retro group. CONCLUSION The current nationwide study provided an overview of the characteristics, treatments, and outcomes for patients who underwent an emergency surgery for parapharyngeal or retropharyngeal abscess.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Aki Sakata
- Department of Otorhinolaryngology, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, Tokyo 158-8531, Japan
| | - Haruhi Inokuchi
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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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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Rajeev M, Wallace ML, Schmiedt CW, Grimes JA. Surgical treatment of deep neck infections in 19 dogs. J Am Vet Med Assoc 2022; 260:1820-1826. [DOI: 10.2460/javma.22.04.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
OBJECTIVE
Describe clinical features, treatment, and outcomes in dogs with deep neck infections.
ANIMALS
19 dogs undergoing surgical treatment of deep neck infections from January 1, 2015, through December 31, 2020.
PROCEDURES
Retrospective record review was conducted, with data collected including clinical signs; neutrophil-to-lymphocyte ratio (NLR); diagnostic imaging, surgical, and histopathologic findings; and follow-up. Spearman correlation and Wilcoxon rank sum were used to compare variables to NLR.
RESULTS
All dogs had cervical swelling, and 9 were febrile. On CT, a distinct mass or abscess (7/13) or abscessed lymph node (4/13) was common, with contrast enhancement (10/13), fluid tracking (8/13), and displacement of the trachea, pharynx, or larynx (6/13) also frequently seen. Foreign material was suspected on CT for 4 dogs and was identified at surgery or histopathology for 4 dogs, only 1 of which was suspected on CT. Histopathology most commonly revealed pyogranulomatous inflammation (14/15). Increasing NLR was moderately correlated to a decreased duration of clinical signs before presentation (ρ = –0.548; P = .035) and an increased length of hospitalization (ρ = 0.645; P = .009). Bacterial culture was submitted for all dogs, and polymicrobial infections were common (8/19). Broad-spectrum empirical antimicrobials were commonly prescribed. Change in antimicrobial treatment based on culture was uncommon (3/19). All dogs survived to hospital discharge; 18 dogs with long-term follow-up had complete resolution of clinical signs.
CLINICAL RELEVANCE
CT was useful to plan for surgery, and surgical treatment resulted in resolution of clinical signs in all dogs with long-term follow-up available. Empirical antimicrobial treatment, such as amoxicillin–clavulanic acid or ampicillin-sulbactam, should be considered.
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Affiliation(s)
- Meenakshi Rajeev
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Mandy L. Wallace
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Chad W. Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Janet A. Grimes
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
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Kharel B, Shahi K, Gurung U. Antibiotic Resistance Pattern in Pediatric Deep Neck Space Infection. Int Arch Otorhinolaryngol 2022; 26:e585-e591. [DOI: 10.1055/s-0042-1744042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/20/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Neck space infection in the pediatric age group is common but can be life-threatening if not diagnosed properly. Since it is a polymicrobial disease, antibiotic usage should be guided by culture sensitivity pattern.
Objectives To assess the microbiology, antibiotic resistance pattern and the outcome of the medical and surgical management of deep neck space infection in children.
Methods This was a prospective study of children admitted for management of neck space infection from August 2017 to August 2018. The age, gender, organisms isolated, sensitivity and resistance to antibiotics, length of hospital stay, complications, and recurrence were noted. The descriptive data were analyzed.
Results Out of 108 cases, there were 51 males (47.2%) and 57 females (52.8%) ranging from 1 month to 15 years, with a mean age of 5.32 +/− 4.35 years. The mean period of hospitalization was 6.98 days. Staphylococcus aureus was the most common organism isolated with less coagulase-negative staphylococci and streptococci. Clindamycin was the most sensitive drug (82.35%) followed by vancomycin and cloxcillin, while amoxicillin/ampicillin, a commonly used drug, was the least sensitive (20.58%). The abscess recurrence rate was 9.28%. The outcomes of either medical treatment or a combined medical or surgical treatment in properly selected cases were comparable.
Conclusion Clindamycin or cloxacillin can be used as a first-line option for neck infection in children. Ampicillin/amoxicillin alone has a small role in neck abscess because of high resistance to this type of antibiotic.
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Affiliation(s)
- Bijaya Kharel
- Department of ENT - Head and Neck Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Kapil Shahi
- Department of ENT - Head and Neck Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Urmila Gurung
- Department of ENT - Head and Neck Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
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Chen SL, Chin SC, Wang YC, Ho CY. Factors Affecting Patients with Concurrent Deep Neck Infection and Cervical Necrotizing Fasciitis. Diagnostics (Basel) 2022; 12:diagnostics12020443. [PMID: 35204533 PMCID: PMC8870768 DOI: 10.3390/diagnostics12020443] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Abstract
Deep neck infection (DNI) is a severe disease of the deep neck spaces, which has the potential for airway obstruction. Cervical necrotizing fasciitis (CNF) is a fatal infection of the diffuse soft tissues and fascia with a high mortality rate. This study investigated risk factors in patients with concurrent DNI and CNF. A total of 556 patients with DNI were included in this study between August 2016 and December 2021. Among these patients, 31 had concurrent DNI and CNF. The relevant clinical variables were assessed. In univariate analysis, age (> 60 years, odds ratio (OR) = 2.491, p = 0.014), C-reactive protein (CRP, OR = 1.007, p < 0.001), blood sugar (OR = 1.007, p < 0.001), and diabetes mellitus (DM, OR = 4.017, p < 0.001) were significant risk factors for concurrent DNI and CNF. In multivariate analysis, CRP (OR = 1.006, p < 0.001) and blood sugar (OR = 1.006, p = 0.002) were independent risk factors in patients with concurrent DNI and CNF. There were significant differences in the length of hospital stay and therapeutic management (intubation, tracheostomy, incision and drainage) between DNI patients with and without CNF (all p < 0.05). While there were no differences in pathogens between the DNI alone and concurrent DNI and CNF groups (all p > 0.05), the rate of specific pathogen non-growth from blood cultures was 16.95% (89/525) in the DNI alone group, in contrast to 0% (0/31) in the concurrent DNI and CNF group (p = 0.008). Higher CRP and blood sugar levels were independent risk factors for the concurrence of DNI and CNF. With regard to prognosis, there were significant differences in the length of hospital stay and therapeutic management between the groups with and without CNF. While there were no significant differences in pathogens (all p > 0.05), no cases in the concurrent DNI and CNF group showed specific pathogen non-growth, in contrast to 89/525 patients in the group with DNI alone.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou 333, Taiwan;
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.-C.C.); (C.-Y.H.)
- Correspondence: ; Tel.: +886-3-3281200 (ext. 3972); Fax: +886-3-3979361
| | - Shy-Chyi Chin
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.-C.C.); (C.-Y.H.)
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou 333, Taiwan
| | - Yu-Chien Wang
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou 333, Taiwan;
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.-C.C.); (C.-Y.H.)
- Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - Chia-Ying Ho
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.-C.C.); (C.-Y.H.)
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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Klug TE, Andersen C, Hahn P, Danstrup CS, Petersen NK, Mikkelsen S, Døssing H, Christensen AL, Rusan M, Kjeldsen A, Greve T. Clinical evaluation of antibiotic regimens in patients with surgically verified parapharyngeal abscess: a prospective observational study. Eur Arch Otorhinolaryngol 2021; 279:2057-2067. [PMID: 34196735 DOI: 10.1007/s00405-021-06962-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to evaluate the effectiveness of different antibiotic regimens for the treatment of parapharyngeal abscess (PPA) and characterize patients, who suffered potentially preventable complications (defined as death, abscess recurrence, spread of infection, or altered antibiotic treatment because of insufficient progress). METHODS Sixty adult patients with surgically verified PPA were prospectively enrolled at five Danish Ear-nose-throat departments. RESULTS Surgical treatment included internal incision (100%), external incision (13%), and tonsillectomy (88%). Patients were treated with penicillin G ± metronidazole (n = 39), cefuroxime ± metronidazole (n = 16), or other antibiotics (n = 5). Compared to penicillin-treated patients, cefuroxime-treated patients were hospitalized for longer (4.5 vs 3.0 days, p = 0.007), were more frequently admitted to intensive care (56 vs 15%, p = 0.006), underwent external incision more frequently (31 vs 5%, p = 0.018), and suffered more complications (50 vs 18%, p = 0.022), including re-operation because of abscess recurrence (44 vs 3%, p < 0.001). Nine patients suffered potentially preventable complications. These patients displayed significantly higher C-reactive protein levels, received antibiotics prior to admission more frequently, underwent external incision more commonly, and were admitted to intensive care more frequently compared to other patients. CONCLUSION The majority of patients with PPA were effectively managed by abscess incision, tonsillectomy, and penicillin G ± metronidazole. Cefuroxime-treated patients were more severely ill at time of admission and had worse outcome compared to penicillin-treated patients. We recommend penicillin G + metronidazole as standard treatment for patients with PPA, but in cases with more risk factors for potentially preventable complications, we recommend aggressive surgical and broadened antibiotic therapy, e.g. piperacillin-tazobactam.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
| | - Camilla Andersen
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Pernille Hahn
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Lillebaelt, Vejle, Denmark
| | - Christian Sander Danstrup
- Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Krintel Petersen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Sophie Mikkelsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Døssing
- Department of Otorhinolaryngology, Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Anne-Louise Christensen
- Department of Otorhinolaryngology, Head and Neck Surgery, Regional Hospital, Holstebro, Denmark
| | - Maria Rusan
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Anette Kjeldsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
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Sudhanthar S, Garg A, Gold J, Napolova O. Parapharyngeal abscess: A difficult diagnosis in younger children. Clin Case Rep 2019; 7:1218-1221. [PMID: 31183097 PMCID: PMC6552945 DOI: 10.1002/ccr3.2209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/23/2019] [Accepted: 04/28/2019] [Indexed: 11/08/2022] Open
Abstract
Parapharyngeal abscess is a difficult diagnosis to make in the pediatric population. Children <3 years of age present with fever, often the only sign at the initial presentation, thus causing a delay in diagnosis until the patient presents with more focal findings, such as a painful neck mass. Repeated follow-up visits with the patient until the diagnosis is confirmed are critically important to prevent complications.
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Affiliation(s)
- Sathyanarayan Sudhanthar
- Department of Pediatrics and Human Development, College of Human MedicineMichigan State UniversityEast LansingMichigan
| | - Anjali Garg
- Department of Pediatrics and Human Development, College of Human MedicineMichigan State UniversityEast LansingMichigan
- Present address:
UH Rainbow Babies and Children's Hospital11100 Euclid Avenue, RB&C Suite 838ClevelandMI44106‐1716
| | - Jonathan Gold
- Department of Pediatrics and Human Development, College of Human MedicineMichigan State UniversityEast LansingMichigan
| | - Olga Napolova
- Department of Pediatrics and Human Development, College of Human MedicineMichigan State UniversityEast LansingMichigan
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Simard RD, Socransky S, Chenkin J. Transoral Point-of-Care Ultrasound in the Diagnosis of Parapharyngeal Space Abscess. J Emerg Med 2018; 56:70-73. [PMID: 30391146 DOI: 10.1016/j.jemermed.2018.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/07/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parapharyngeal space abscesses (PPSA) are deep-space neck infections that are associated with significant morbidity and, rarely, mortality if not promptly diagnosed and treated. The diagnosis is often difficult, as the clinical presentation can mimic peritonsillar abscesses (PTA). Transoral point-of-care ultrasound (POCUS) may be a useful tool to help distinguish PTAs from other deep-space infections such as PPSAs. CASE REPORT A woman presented to the Emergency Department (ED) with fever, sore throat, trismus, and unilateral tonsillar swelling from a walk-in clinic with a preliminary diagnosis of PTA for drainage. A POCUS performed by the emergency medicine resident in the ED demonstrated normal tonsils. However, it revealed evidence of a PPSA. A computed tomography scan was performed, which confirmed the diagnosis. The patient was admitted to the otolaryngology service for antibiotics and steroids, with subsequent improvement and discharge home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In this case, the use of POCUS in the ED avoided an unnecessary invasive procedure, and facilitated the correct diagnosis of an uncommon condition.
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Affiliation(s)
| | - Steve Socransky
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Jordan Chenkin
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
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Infections of the Upper and Middle Airways. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152082 DOI: 10.1016/b978-0-323-40181-4.00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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Côrte FC, Firmino-Machado J, Moura CP, Spratley J, Santos M. Acute pediatric neck infections: Outcomes in a seven-year series. Int J Pediatr Otorhinolaryngol 2017; 99:128-134. [PMID: 28688554 DOI: 10.1016/j.ijporl.2017.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/18/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to analyse the epidemiology, clinical presentation, diagnostic clues, as biochemical parameters and imaging studies, of children with acute neck infections (ANI) to identify possible independent prognostic factors leading to complications and prolonged hospitalization. METHODS Records of children admitted to a tertiary university hospital from January 2008 to December 2014 with a diagnosis of ANIs were reviewed retrospectively. Diseases were categorized according to the site of infection and patients were divided into two groups: children (aged<10 years) and adolescents (aged 10-18 years). RESULTS A total of 102 patients belonged to the children's group and 57 were adolescents. Forty-nine patients (27.2%) received antibiotics prior to presentation. The most frequent ANI was peritonsillar abscess (n = 72). Four peritonsillar abscesses progressed to parapharyngeal and retropharyngeal abscesses (n = 2 respectively). An association between age and type of abscess was found, with most of the retropharyngeal abscesses occurring in children (p = 0.05), and the submandibular abscesses in adolescents (p < 0.001). The most frequent symptoms/signs were fever (63.9%) and odynophagia (50.6%). Upon admission, all patients received intravenous antibiotics and 86.8% underwent drainage of the abscess. Cultures were harvested in 87 abscesses and the most frequent pathogen isolated was Streptococcus pyogenes. Signs of airway obstruction occurred in two patients with submandibular abscess, one with peritonsillar and one with parapharyngeal abscess. There were no cases of death or severe sequelae. Recurrent ANIs were observed in eight patients including two infected branchial cysts. Children, presence of multiple abscesses and palpable cervical mass on admission, absence of odynophagia and pharyngeal bulging, surgery with general anaesthesia and surgery after 24 h, were associated with prolonged hospitalization. Presence of toothache and neck pain on admission were identified as predictors of complications. CONCLUSIONS The present study found, that often, the diagnosis and treatment of neck abscesses in paediatric patients is not straightforward, but can achieve a favourable outcome. The primary location of the ANI appears to vary in different paediatric age groups. Younger age, presence of multiple abscesses or a palpable cervical mass on admission, were associated with prolonged hospitalization. Presence of toothache and neck pain on admission was identified as possible predictors of complications.
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Affiliation(s)
- Filipa Camacho Côrte
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal.
| | | | - Carla Pinto Moura
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal; Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Jorge Spratley
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal
| | - Margarida Santos
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal
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Park C, Marchiori E, Barber J, Cardon C. Orbital fracture leading to severe multifascial space infection including the parapharyngeal space: a report of a case and review of the literature. Craniomaxillofac Trauma Reconstr 2014; 7:237-44. [PMID: 25136414 DOI: 10.1055/s-0034-1371974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/07/2013] [Indexed: 10/25/2022] Open
Abstract
Orbital trauma can result in periorbital and orbital infections. Orbital infections have been classified by Chandler et al in 1970 to their anatomic location and boundaries. This case report describes a patient who developed a severe orbital infection following orbital fractures. The infection progressed to the parapharyngeal space. The patient required multiple incision and drainage surgeries and tissue debridements to have clinical resolution. To our knowledge, there has not been a case described in the literature of an orbital infection progressing to the parapharyngeal space. A literature review of orbital trauma leading to infection discusses the pathogenesis of the infections. This case demonstrates that close clinical follow-up and appropriate medical management of comorbidities that put a patient at higher risk of developing an infection is of the utmost importance in the treatment of maxillofacial trauma patients.
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Affiliation(s)
- Chan Park
- Department of Oral and Maxillofacial Surgery, University of the Pacific, San Francisco, California
| | - Erica Marchiori
- Department of Oral and Maxillofacial Surgery, University of the Pacific, San Francisco, California
| | - Jacob Barber
- Department of Oral and Maxillofacial Surgery, University of the Pacific, San Francisco, California
| | - Curtis Cardon
- Department of Oral and Maxillofacial Surgery, University of the Pacific, San Francisco, California
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Characteristics of deep neck infection in children according to weight percentile. Clin Exp Otorhinolaryngol 2014; 7:133-7. [PMID: 24917911 PMCID: PMC4050086 DOI: 10.3342/ceo.2014.7.2.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 12/19/2012] [Accepted: 01/07/2013] [Indexed: 12/03/2022] Open
Abstract
Objectives To evaluate the effect of weight percentile on deep neck infections in children. Methods A retrospective evaluation of 79 patients who were treated for deep neck infections. The patients were divided into six groups according to weight percentile. Patients who had systemic and/or congenital disease were excluded. Their demographics, etiology, localization, laboratory, and treatment results were reviewed. Results In total, 79 pediatric patients were recorded: 48.1% were females and 51.9% were males, with a mean age of 7.3 years. In total, 60 patients were under the 50th percentile according to their weight versus all children. The anteroposterior triangle (29.1%) and submandibular (26.5%) spaces were most commonly involved with deep neck infection. However, the anteroposterior triangle space was the highest in the group below the 3rd percentile (44.4%). In the blood analysis, white blood cell levels in patients with at percentile values of 75-50 were higher than other groups (P<0.05). Significant differences were found between C-reactive protein and hemoglobin levels and diameter of abscesses. The need for surgical drainage in patients in lower percentiles was higher. The patients who needed surgical drainage consisted of 56 patients (93.3%) below the 50th percentile and 9 patients (100%) below the 3rd percentile. Conclusion Deep neck infection is more insidious and dangerous in low-weight-percentile children, especially those having low white blood cell counts, low hemoglobin levels, and high C-reactive protein in laboratory results.
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Wahab D, Bichard J, Shah A, Mann B. Just a sore throat? Uncommon causes of significant respiratory disease. BMJ Case Rep 2013; 2013:bcr-2013-008739. [PMID: 23632177 DOI: 10.1136/bcr-2013-008739] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present two uncommon underlying causes of a sore throat which, if missed or delayed in diagnosis, can lead to disastrous consequences. Our first case is of Lemierre's syndrome diagnosed in a 21-year-old man presenting with a 5-day history of sore throat, fever, right-sided pleuritic chest pain and bilateral pulmonary nodules on CT imaging. Fusobacterium necrophorum cultured from peripheral blood and an occluded left internal jugular vein on ultrasound lead to an eventual diagnosis. Our second case presents a 29-year-old woman with a 5-day history of sore throat, fever and right-sided pleuritic chest pain. A left-sided quinsy was diagnosed and aspirated and the patient was discharged home. She represented shortly with worsening pleuritic pain and was found to have a right-sided pleural effusion with descending mediastinitis originating from the tonsillar abscess. Delayed diagnosis resulted in open thoracotomy, decortication and prolonged intravenous antibiotics.
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Affiliation(s)
- Dalia Wahab
- Department of Respiratory, Royal Brompton Hospital, London, UK.
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Hegde AN, Mohan S, Pandya A, Shah GV. Imaging in Infections of the Head and Neck. Neuroimaging Clin N Am 2012; 22:727-54. [DOI: 10.1016/j.nic.2012.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Accuracy of ultrasonography versus computed tomography scan in detecting parapharyngeal abscess in children. Pediatr Emerg Care 2012; 28:780-2. [PMID: 22858751 DOI: 10.1097/pec.0b013e3182627cff] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Significant morbidity and rarely mortality have been described in parapharyngeal space infections in children; hence, the decision on the timing of surgical intervention might be crucial. The aim of this study was to compare the accuracy of plain x-rays, ultrasonography (US), and contrast-enhanced computed tomography (CT) in demonstrating a parapharyngeal abscess. METHODS A retrospective study on all patients with parapharyngeal abscess admitted and operated on from January 1996 to December 2000 was carried out. Charts were reviewed for patients' demographics, symptoms and signs, details of workup, intraoperative findings, and culture results. The CT scans were reviewed for the presence of a rim enhancement, a presence of a definable wall, and fluid-fluid level and were correlated with the plain x-rays and US results and intraoperative findings. RESULTS Eighteen patients with proven parapharyngeal infection were included: 10 with proven abscess and 8 with cellulitis. The sensitivity and specificity of lateral neck radiograph and US were low compared with a specificity of 87.5 while evaluating fluid-fluid level seen on the CT scan, sensitivity of 58.3% for the presence of a definable abscess wall, and a sensitivity of 100% for the presence of a prominent wall. CONCLUSIONS Our study demonstrates good rates of accuracy of CT scan for diagnosing a parapharyngeal abscess. Our study suggest that it is appropriate to obtain a CT scan upon presentation in all children with suspected parapharyngeal abscess and that a CT scan is proven to be a useful diagnostic tool in establishing a treatment plan.
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Deep neck abscesses: the Singapore experience. Eur Arch Otorhinolaryngol 2010; 268:609-14. [DOI: 10.1007/s00405-010-1387-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 09/06/2010] [Indexed: 12/16/2022]
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Parapharyngeal and retropharyngeal infections in children: argument for a trial of medical therapy and intraoral drainage for medical treatment failures. Int J Pediatr Otorhinolaryngol 2009; 73:761-5. [PMID: 19297031 DOI: 10.1016/j.ijporl.2009.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 02/04/2009] [Accepted: 02/11/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review the outcomes of parapharyngeal infections (PPI) and retropharyngeal infections (RPI) in children after medical and surgical management. METHODS The charts of all children who presented to a tertiary-care pediatric hospital between March 2005 and February 2007 with a diagnosis of parapharyngeal infection or retropharyngeal infection were reviewed. Thirty-two patient records were analyzed. RESULTS The mean age of our patients was 4.4 years, 63% of whom were boys. The majority of patients presented during the winter months with some combination of fever, neck stiffness, and neck swelling. Ten patients had surgery less than 1 day after admission (early surgical intervention). Twenty-two patients were given a trial of at least 24h of intravenous (IV) antibiotics (medical trial group), nine of whom were treated exclusively with IV antibiotics (medical therapy alone). The remaining 13 patients failed medical therapy, and went on to surgical drainage (late surgical intervention). All patients requiring surgical drainage were treated successfully with an intraoral approach. Patients given a trial of IV antibiotics had an average hospital stay of 3.3 days (3.0 days for medical therapy alone and 3.5 days for late surgical intervention). Patients with early surgical intervention stayed 2.7 days. All patients were discharged home with oral antibiotics. There was no statistically significant difference in the length of stay between the medical trial and early intervention groups. Those who failed medical therapy had significantly larger abscesses than those who responded to medical therapy (1.53 versus 5.38 cm(2)). CONCLUSIONS A trial of IV antibiotics does not adversely affect outcome and may obviate the need for surgery, particularly for patients with smaller abscesses. When surgery is required, an intraoral procedure is usually adequate.
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Page C, Biet A, Zaatar R, Strunski V. Parapharyngeal abscess: diagnosis and treatment. Eur Arch Otorhinolaryngol 2008; 265:681-6. [PMID: 18004583 DOI: 10.1007/s00405-007-0524-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 10/29/2007] [Indexed: 11/29/2022]
Abstract
To study the circumstances of diagnosis, predisposing factors, bacteriology and therapeutic management of parapharyngeal abscesses. This retrospective study over a period of 7 years concerned 16 patients hospitalized in an ENT and Head and Neck surgery department for parapharyngeal abscess. All patients were treated by intravenous antibiotics and steroids for 5-7 days. The length of hospital stay was 6-15 days. Parapharyngeal abscesses associated with peritonsillar and retropharyngeal abscess were all initially aspirated transorally for evacuation and bacteriologic examination. Five patients underwent surgical drainage (two via cervical incision, three by immediate tonsillectomy techniques and one by intra-oral drainage). Two patients presented jugular vein thrombosis. No life-threatening complication was observed. Patients were considered to be cured when cervical CT scan performed on D21-45 was normal. Parapharyngeal abscess is the second most common deep neck abscess after peritonsillar abscess. The diagnosis is both clinical and radiologic. CT scan is the best imaging examination for diagnosis and follow-up of parapharyngeal abscess. Non-complicated parapharyngeal abscesses require first-line medical management (intravenous antibiotics (amoxicillin and clavulanic acid) combined with steroids) and follow-up CT scan.
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Affiliation(s)
- C Page
- ENT and Head and Neck Surgery Department, University Hospital of Amiens, Amiens, France.
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Deep Neck Infections: Clinical Considerations in Aggressive Disease. Oral Maxillofac Surg Clin North Am 2008; 20:367-80. [DOI: 10.1016/j.coms.2008.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jeong IM, Woo CH, Kim HS, Kwak IS, Mun SH, Kim HS, Kim KM. Retropharyngeal Laceration during Nasotracheal Intubation - A case report -. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.5.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Il Man Jeong
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Korea
| | - Chul Ho Woo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Korea
| | - Hyeong Seok Kim
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Korea
| | - In Suk Kwak
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Korea
| | - Sung Ha Mun
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Hyun Soo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Kwang Min Kim
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Korea
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