Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses

Comprehensive evaluation of deep neck infections: A retrospective analysis of 111 cases

Purpose

Our study will analyze patients' clinical characteristics, treatment strategies, and complications with deep neck infection (DNI) using their medical records for five years.

Methods

The present study included 111 patients diagnosed with DNI in our clinic between January 2018 and March 2023. The patients' complaints at admission, sociodemographic characteristics, season of diagnosis, findings from laboratory tests, radiological imaging performed at the time of first diagnosis, abscess localization, medical and surgical treatment methods used, and complications developing during follow-up were retrospectively examined.

Results

The mean age of the patients included in the study was 38.51 ± 16.92 (6-87 years). There was a significant correlation between chronic disease, smoking behaviours, oral hygiene, and DNI among patients based on their sociodemographic characteristics and medical history (p < .005). DNI development did not differ by season (p > .005). Physical examination findings predominantly revealed neck masses (39.6%) and peritonsillar abscesses (32.4%), and patients with peritonsillar abscesses had a shorter length of hospital stay than those with other localizations. No severe complications occurred during the clinical follow-up.

Conclusion

Chronic diseases, smoking, and poor oral hygiene are the primary risk factors for developing DNIs. If an abscess is located in a critical area, it may require extended hospitalization and surgery under general anesthesia. Therefore, addressing these risk factors and encouraging good oral hygiene practices are crucial to preventing DNIs and reducing the need for intensive treatment.

S, J. Shah N. Use of Navigation System in the Management of Deep Neck Space Infection-A Case Report

Deep neck space infections are an ENT (Ear, Nose, Throat) emergency. Navigation system (NS) can be utilized to assist in locating the exact site of pathology and avoiding iatrogenic injury especially in paediatric patients. This manuscript explores the importance of NS in managing retro pharyngeal abscess (RPA) in an 11 month old baby.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-04406-9.

CT-guided transcutaneous drainage of peritonsillar abscess after failed ultrasound-guided drainage: A case report

Peritonsillar abscess (PTA) is the most common deep neck infection in the United States. Timely treatment of PTA with antibiotics and aspiration or drainage is paramount, as delay in management may lead to further complications. The oral approach is the preferred route of drainage however may not always be accessible, warranting consideration of other routes of drainage. To the best of our knowledge, CT guidance for aspiration or drainage of a PTA has not been previously described. We present a 50-year-old patient with a PTA who initially presented with throat pain and dysphagia, rapidly developed upper airway obstruction, and required intubation. After the failure of clinical improvement and unsuccessful PTA aspiration via the conventional oral route, successful CT-guided percutaneous needle aspiration was performed by neuroradiology. Shortly thereafter, the patient clinically improved and was discharged with an oral course of antibiotics and follow-up on an as-needed basis. Total hospital length of stay was seven days. The complex patient may not allow for simple incision and drainage or needle aspiration of a suspected PTA. Assistance with ultrasound guidance is often utilized, however, challenges may persist depending on the anatomical location of the PTA and patient comorbidities. In cases where external drainage is considered and conventional ultrasound imaging is particularly challenging, CT-guided percutaneous aspiration may provide a useful alternative. PTAs are common with the possibility of complication. Although the usual route of drainage is oral, there are instances in which this cannot be performed. This case exhibits an uncommon approach to PTA aspiration via an external CT-guided percutaneous approach with rapid subsequent clinical improvement, exhibiting the utility of CT guidance.

Emerging findings for the assessment and treatment of pediatric deep neck abscesses

PURPOSE OF REVIEW

The purpose of this review is to summarize new literature regarding the description, diagnosis, and treatment of pediatric deep neck abscesses.

RECENT FINDINGS

Providers should include multi-inflammatory syndrome in children (MIS-C) in a differential diagnosis in children suspected of having a retropharyngeal abscess. MRI may guide the proper management of children with deep neck abscesses by more accurately detecting free fluid compared to computed tomography imaging. Factors that may predict the need for surgical management include elevations in white blood cell counts and abscess size more than 3 cm. However, future investigation is necessary to establish consistent guidelines. Medical management is effective in many children, with a new study indicating success using a combination of cefotaxime and rifampicin.

SUMMARY

Anatomical and age-related risk factors predispose children to the development of deep neck abscesses. Findings from recent studies may aid providers in making an accurate diagnosis and providing proper medical or surgical management of children with these infections.

Maxillofacial infections in lithuanian hospitalised children and adolescents: a 17-years retrospective study

PURPOSE

To analyse the epidemiology, treatment, and microbiological findings of hospitalised Lithuanian children and adolescents admitted due to maxillofacial infections over a 17-years period.

METHODS

428 medical records of paediatric (under the age of 18) patients hospitalised at Vilnius University Hospital from 2003 to 2019 due to a maxillofacial infection were reviewed. The data concerning patient sociodemographic characteristics, aspects related to a hospital stay, treatment modalities, microbiological findings, and sensitivity to antibiotics, were collected and analysed.

RESULTS

The most prevalent condition was odontogenic maxillofacial space infection (28.7%), followed by lymphadenitis (21.7%). The mean (sd) age was 10.86 (4.8) years and the male-to-female ratio was 1.37:1. The majority of patients (83.4%) underwent surgical treatment. The mean (sd) hospital stay was 5.49 (2.9) days. The longest hospital stay was observed in the case of odontogenic maxillofacial space infections. A longer period of hospitalisation was generally associated with the presence of anaerobes and their resistance to antibiotics as well as multiple space involvement in deep neck space infections and a permanent causative tooth in odontogenic cases. The most commonly isolated microbiological species was Staphylococcus aureus spp.

CONCLUSION

The most common origin of maxillofacial infection was odontogenic among investigated Lithuanian children and adolescents. In the majority of cases, a penicillin group antibiotic was prescribed. Streptococci were the predominant bacteria in the cases of odontogenic infection, while Staphylococci were the most prevalent among non-odontogenic cases. Nearly 40.0% of isolated microorganisms were resistant to penicillin. High resistance to metronidazole was identified among anaerobic bacteria.

Clinical and Microbiological Characteristics of Deep Neck Abscesses in Pediatrics: Analysis of a Case Series from a 3rd Level Pediatric Hospital

As there is currently no consensus on managing deep neck infections in pediatric populations, we report a case series from a large pediatric hospital. Clinical data of patients discharged from Istituto Gaslini-Children's Hospital from January 2014 to June 2020 with peritonsillar, parapharyngeal, or retropharyngeal abscess diagnoses were collected. A total of 59 patients were identified. Patients underwent surgical drainage in 47% of cases. Streptococcus mitis/oralis was the most isolated pathogen. Surgically treated patients did have larger abscesses compared to others, but there were no differences in the duration of hospitalization. Children who received NSAIDs at home had significant delays in diagnosis (median 4 vs. 1.5 days, p = 0.008). In our experience, clinical presentation of DNIs is often evocative, but evaluation should include imaging with CT/MRI. Surgery is effective in larger abscesses, allowing for etiological diagnosis with consequent antibiotic adjusting. From an anamnestic point of view, home medications such as NSAIDs could delay diagnosis.

Pictorial Review of MRI Findings in Acute Neck Infections in Children

Pediatric neck infections and their complications, such as abscesses extending to deep neck compartments, are potentially life-threatening acute conditions. Medical imaging aims to verify abscesses and their extensions and exclude other complications. Magnetic resonance imaging (MRI) has proven to be a useful and highly accurate imaging method in acute neck infections in children. Children and adults differ in terms of the types of acute infections and the anatomy and function of the neck. This pictorial review summarizes typical findings in pediatric patients with neck infections and discusses some difficulties related to image interpretation.

Acute Retropharyngeal and Parapharyngeal Abscesses: A Case Series

OBJECTIVE

The purpose of this study was to evaluate the diagnosis circumstances, predisposing factors, investigations, and therapeutic management of retropharyngeal and parapharyngeal abscesses.

METHODS

A retrospective chart review of patients diagnosed with retropharyngeal or parapharyngeal abscess from 2001 to 2021 was performed. Epidemiological characteristics, clinical signs, investigations, medical treatment, and surgical interventions were analyzed for each patient.

RESULTS

A total of 30 patients with retropharyngeal or parapharyngeal abscess were identified. Computed tomography was performed in all cases, and magnetic resonance imaging was performed in three cases. Twelve patients had a "pure" retropharyngeal abscess, nine patients had a prestyloid abscess, one patient had a prestyloid abscess associated with a peritonsillar abscess, three patients had a retrostyloid abscess, and five patients had a prestyloid abscess associated with a retropharyngeal abscess or a retrostyloid abscess. The median long axis of the abscess was 42 cm. All patients received intravenous antibiotics for a median period of 8 days [4-30]. Seventeen patients required surgical trans-cervical drainage. Other patients underwent transoral or transnasal drainage. The pus culture revealed no growth in six cases, streptococcus (four cases), methicillin-sensitive Staphylococcus aureus (two cases), Klebsiella (two cases), Enterobacter (one case), Fungi (two cases), and Mycobacterium tuberculosis (a twelve-year-old boy). It was not documented in twelve cases. Histological examination revealed caseofollicular tuberculosis in a 53-year-old man. In 25 patients, no adverse events were observed during follow-up. Five patients had an unfavorable outcome.

CONCLUSION

We have found an increase in the incidence of these infections in recent years. Computed tomography is the best imaging examination for the diagnosis and follow-up of retropharyngeal and parapharyngeal abscess. Early drainage and antimicrobial therapy are essential for rapid recovery and prevention of complications of these abscesses.

Management of Deep Neck Space Infections: A Large Tertiary Center Experience

INTRODUCTION

Deep neck space infections (DNIs) represent serious bacterial infections affecting the deep cervical space and fascial planes of the neck. This study aims to describe our clinical and surgical experience in the management of DNIs, emphasizing the importance of appropriate imaging in the diagnostic setting and the role of the multidisciplinary approach according to the severity of the infection.

METHODS

In this retrospective study, we describe 85 patients affected by DNIs coming to the Otolaryngology department observation from the Emergency Room of San Camillo Forlanini Hospital in Rome from January 2006 to December 2021 and treated both by pharmacological and surgical therapy.

RESULTS

54 patients (64%) were male, and 31 (36%) were female, with a mean age of 50.5 years. The most common cause of DNI was odontogenic, accounting for 70% of all collected cases. In 68 patients (80% of all cases), the surgical approach consisted of an extended unilateral cervicotomy, whereas in 17 patients (20% of all cases), a bilateral cervicotomy was performed. Surgical revision was required in 15 cases (18%). A tracheostomy was necessary in seven cases. The overall survival rate was 96.5%.

CONCLUSIONS

DNI represents a serious and life-threatening condition, remaining a constant challenge for the head and neck surgeon. Contrast-enhanced computed tomography is critical for therapeutic planning, which requires both a surgical approach and antibiotic therapy. Surgical treatment should be performed as soon as possible. In severe cases, the multidisciplinary approach is advisable.