Abstract
IntroductionAlthough the incidence of Deep Cervical Abscess (DCA) has decreased mainly for the availability of antibiotics, this infection still occurs with considerable frequency and can be associated with high morbidity and mortality. ObjectiveThis study aimed to present our clinical-surgical experience with deep neck abscesses. MethodsA retrospective study analyzed 101 patients diagnosed with deep neck abscesses caused by multiple etiologies, assisted at a medical school hospital during 6 years. One hundred one patients were included and 27 (26.7%) were younger than 18 years old (the children group), 74 patients (73.3%) were older than 18 years old (the adults group). The following clinical features were analyzed and compared: age, gender, clinical symptoms, leukocyte count, the affected cervical area, lifestyle habits, antibiotic therapy, comorbidities, etiology, bacterial culture, time of hospitalization, the need of tracheostomy and complications. ResultsThere was predominance in the male gender (55.5%) and young people (mean age 28.1 years). All of the 51 patients with associated disease comorbidity were adults. The most frequent etiologies were bacterial tonsillitis (31.68%) and odontogenic infections (23.7%). The most common cervical areas affected were the peritonsillar (26.7%), submandibular/mouth floor (22.7%) and parapharyngeal spaces (18.8%). In children group, the site most commonly involved was the peritonsillar space (10 patients, 37%). In adults group, the site most commonly involved was multispace (31 patients, 41.8%). Streptococcus pyogenes (23.3%) was the most common microorganism present. Amoxicillin associated with clavulanate (82.1%) was the more used antibiotic. The main complications of abscesses were septic shock (16.8%), pneumonia (10.8%) and mediastinitis (1.98%). Tracheostomy was necessary in 16.8% of patients. The mortality rate was 1.98%. ConclusionThe clinical features and severity of DCA varied according to different age groups, perhaps due to the location of the infection and a higher incidence of comorbidity in adults. Thus, DCA in adults is more facile to have multispace involvement and lead to complications and seems to be more serious than that in children.
Highlights
The incidence of Deep Cervical Abscess (DCA) has decreased mainly for the availability of antibiotics, this infection still occurs with considerable frequency and can be associated with high morbidity and mortality
Despite the improvements in diagnostic tests and the availability of modern antibiotic therapy, those infections continue to cause significant morbidity and mortality rates, especially when there is no early treatment.[2]. It occurs with considerable frequency and its severity and extent may be underestimated, making this entity diagnostic challenge to emergency physicians, pediatricians, otolaryngologists and head and neck surgeon, because clinical signs and symptoms often overlap with those of other common clinical pictures, in children, in whom physical examination may be more difficult than in adults
This study aimed to report our clinical experience of submission of deep neck space infections by the description of 101 patients diagnosed in the last 6 years
Summary
The incidence of Deep Cervical Abscess (DCA) has decreased mainly for the availability of antibiotics, this infection still occurs with considerable frequency and can be associated with high morbidity and mortality. DCA can be categorized into retropharyngeal, peritonsillar, masseteric, pteropalatine maxillary, parapharyngeal, submandibular, parotid and floor of mouth abscesses.[1] Despite the improvements in diagnostic tests and the availability of modern antibiotic therapy, those infections continue to cause significant morbidity and mortality rates, especially when there is no early treatment.[2] It occurs with considerable frequency and its severity and extent may be underestimated, making this entity diagnostic challenge to emergency physicians, pediatricians, otolaryngologists and head and neck surgeon, because clinical signs and symptoms often overlap with those of other common clinical pictures (i.e. pharyngitis, tonsillitis and torticollis), in children, in whom physical examination may be more difficult than in adults.
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