Алгоритм диагностики и лечения парафарингеальных абсцессов у детей

Abstract

Parapharyngeal abscesses (PPA) are a pressing problem in modern pediatric otorhinolaryngology. The disease is quite rare and difficult to diagnose and treat. Objective. To develop an algorithm for the diagnosis and treatment of parapharyngeal abscesses in children. Materials and methods. Medical histories, CT scan data, surgical protocols were retrospectively studied in children discharged from the otolaryngology department of the Morozov Children’s City Clinical Hospital in the period from January 1, 2015, to December 31, 2022, with a diagnosis of J39,0 (ICD-10) Retropharyngeal and parapharyngeal abscess. Results. The study included 183 children with parapharyngeal abscess. The typical manifestations include a triad of symptoms: sore throat, forced head position, fever and symptoms of intoxication. If PPA is suspected, all patients are advised to undergo a contrast-enhanced CT scan of the neck. We analyzed the frequency of detection of PPA at various levels of the pharynx, which helps determine treatment tactics. Conservative treatment of PPA is possible if it is small in size (up to 20 mm in diameter). 30 patients (16,4%) were successfully treated conservatively; the majority – 153 (83,6%) patients required opening of the abscess. The main bacterial pathogen identified when inoculating material obtained from PPA was group A beta-hemolytic streptococcus. Conclusion. Based on the experience of treating PPA in 183 children, an algorithm for diagnosis and selection of surgical or conservative treatment was proposed.