ÇOCUKLARDA DERİN BOYUN ENFEKSİYONLARI; ÜÇÜNCÜ BASAMAK HASTANESİ VERİLERİ

Abstract

OBJECTIVE: Deep neck infections (DNIs) are the infections developing in potential spaces between the layers of deep servical fascia. Clinical course may progress from early manifestations such as cellulite, myositis to serious DNI such as phlegmon and abscess. DNIs have crucial importance because of delayed diagnosis, fast progression, and severe complications. In this descriptive study, we aimed to present our seven-year experience about pediatric DNIs based on the clinical and laboratory characteristic of our patients.MATERIAL AND METHODS: Data of 58 hospitalized children who diagnosed with DNI between January 2010 and January 2017 in Pediatric Infectious Diseases Clinic were analysed retrospectively. Patients’ medical history and physical examination findings, laboratory and radiological imaging results, treatment modalities, and clinical courses were evaluated by reviewing medical records.RESULTS: Thirty (51.7%) of the patients were male, average age was 5.6±4.9 years. The most common symptom and physical finding was neck swelling (96.5%). Rates of C-reactive protein elevation, leucocytosis, and sedimentation elevation were 93%, 89%, and 72% respectively. By considering clinical condition, ultrasound scan was performed on patients with nonserious DNI (=cellulite phase) (n=26), computed tomography scan was performed on patients with serious DNI (= abscess) (n=28), and magnetic resonance imagination was performed (n=4) if CT scanner is out of order. In patients with abscess formation parapharyngeal localization (75%) was the most common. According to ultrasound scan, submandibular involvement (%46) was the most frequent region. The most common two etiology were acute tonsillopharyngitis (34%) and odontogenic factors (10%), and unknown etiology rate was 51%. Average duration of hospitalization was 9.7±5.9 days, 55% of patients were treated with intravenous ampicillin-sulbactam whereas 43% were treated with intravenous clindamycin. Twenty-two (38%) patients healed with medical treatment. Surgical drainage was performed on 36 (62%) patients in addition to medical treatment. There were bacterial growths in 18 (50%) drainage material cultures. Two (3.4%) patients were complicated with airway obstruction and mediastinitis while there was no mortality.CONCLUSIONS: Children with neck swelling and fever should be evaluated in terms of DNI, and also dental and tonsillar examinations should be done carefully. Contrast CT scan should be performed for pre-diagnosis of cases with serious DNI and surgical drainage should be performed in cases with abscess formation. DNIs threatening airway patency may cause severe morbidity and mortality, so early diagnosis, appropriate antibiotic therapy with or without surgical drainage may improve prognosis.