A New Trend in the Management of Pediatric Deep Neck Abscess: Achievement of the Medical Treatment Alone.

Abstract

Albeit the traditional opinion that advocates a routine surgical drainage for the treatment of an abscess, the case series presenting high success rates of the medical therapy alone is increasing in deep neck abscesses of childhood. This research focuses on children whose deep neck abscess fully disappeared after only medical treatment. In a retrospective study, we evaluated medical records of 12 pediatric (<18 years old) cases diagnosed with deep neck abscess or abscess containing suppurative lymphadenitis and treated with only medical therapy between 2010 and 2015 for age, gender, treatment modality, parameters related to antimicrobial agents, location of the infection, etiology, symptoms, duration of hospital stay, characteristics of the radiological and biochemical examination findings, and complications. The mean age of 10 male and two female children was 5.9 years (range, 1-17 years). Baseline and the last control's mean values of white blood cell (WBC), C-reactive protein, and erythrocyte sedimentation rate were 18,050/μL, 99.8 mg/L, 73.1 mm/h, and 8,166/μL, 34.1 mg/L, 35.3 mm/h, respectively. Contrast-enhanced neck computed tomography demonstrated an abscess in seven cases and an abscess containing suppurative lymphadenitis in five cases. The largest diameter of the abscess was 41 mm. All cases were given broad-spectrum empirical antibiotherapy (penicillin+metronidazole, ceftriaxone+metronidazole, or clindamycin). No medical treatment failure was experienced. Independent of age and abscess size, if the baseline WBC is ≤25.200/μL, if only two or less than two cervical compartments are involved, if there are no complications in the admission, and if the etiological reason is not a previous history of trauma, surgery, foreign body, and malignancy, pediatric deep neck abscess can be treated successfully with parenteral empirical wide-spectrum antibiotherapy.