Case Of Deep Neck Abscess Research Articles

ガス産生を伴う深頸部膿瘍の４例

Cases of deep neck abscess have decreased thanks to the use of antibiotics, but remain life-threatening and potentially mortal when gas forms. We report four cases of gas-forming deep neck abscess—one each in the region of submandibular bone, the submandibular space, the parapharyngeal space, and in the thyroid gland. All four had other diseases such as carcinoma or diabetes that weakened their physical conditions. Both aerobic and anaerobic bacteria were detected in all four. We found computed tomography (CT) to be very useful in early diagnosis and treatment. Emergency surgery combined with antibiotic therapy and local irrigation enabled all four to recover. We therefore recommend prompt surgical drainage if CT detects a gas-forming abscess.

Poster 027: A Case of Deep Neck Abscess by Which Ring Enhancement of the External Jugular Vein Became an Indicator of the Diagnosis

It is well known that contrast-enhanced CT is useful for diagnosis of deep neck abscess. The characteristic findings are: (1) single cystic or multiloculated low-density findings; (2) contrast enhancement of the abscess wall; (3) edema surrounding the abscess; (4) anatomical boundaries that fit the fascial spaces; and (5) air and/or fluid at the center of the abscess. However, little is known about the nature of the inflammatory reaction. Herein, we report an abnormal case of deep neck abscess developing from odontogenic infection. In this case, rapid spread of the inflammation was demonstrated and there was a lack of characteristic CT findings to suggest the formation of abscess. The patient was a 46-year-old woman with swelling in the right parotid region complicated by right inferior alveolar neuroparalysis. The patient’s medical history included diabetes (HbA1C 12%). Although the patient reported oppressive pain in the right parotid region at the first medical examination, the range of swelling was ambiguous because the neck was thick and short. It was only the intraoral view that showed slight redness in the right mandibular first-molar region. The right parotid gland showed diffuse swelling on contrast-enhanced CT, but there were no signs of a clear abscess. However, there was ring enhancement of the right external jugular vein extending for about 11cm from the inferior pole of the parotid gland, and circumferential edema was also noted. The WBC was 15100/ul and CRP was 25 mg/dl. She was given a diagnosis of right mandibular osteomyelitis and cervical cellulites caused by an odontogenic infection of the right mandibular first-molar. Although antimicrobial therapy and blood sugar management were started under hospitalization, there was no reduction of inflammation. Based on the range of ring enhancement of the right external jugular vein, the region was incised and pus was drained from the superficial layer of the cervical fascia. This experience suggests that ring enhancement of the vein was an indicator of abscess on contrast-enhanced CT.

小児深頚部膿ようの２症例

Two cases of deep neck abscess in children are reported. Case 1, in a one-year-old female, was caused by acute upper respiratory tract infection. Case 2, in a 9-year-old female, who had been experiencing bone marrow suppression due to chemotherapy for the treatment of acute myelocyticleukemia, was caused by rubella. Both cases were treated by surgical drainage under general anesthesia and the subsequent clinical course was good.Deep neck abscess is rarer in children than in adults. As such, the characteristics of this type of abscess in children are discussed in this paper.