Cervical Abscess Research Articles

Benin Goitre in the General Surgery Department at Teaching Hospital Gabriel Tour&#233

Introduction: Goitre is an increase in the volume of the thyroid gland. Goiters may be congenital or acquired, diffuse or nodular, functional or non-functional, benign or malignant. Purpose: The objectives of this work were to study and determine the frequency of benign goitre in the general surgery department of CHU Gabriel Touré, and to study epidemiological, clinical and therapeutic aspects. Patients and Method: This was a retrospective and prospective study conducted in the general surgery department of CHU Gabriel Touré, from January 1999 to December 2019. Included in the study were all patients with benign goiter confirmed in histology, hospitalized and treated in the service. Patients with thyroid malignant tumours, strumite, thyroid tract cyst, cervical abscess and neck trauma were not retained. Socio-demographic, clinical, para-clinical, therapeutic and post-operative aspects were the study parameters. Word processing and tables were done with Microsoft Word and Excel 2016 software. Data analysis was performed with Epi info7 software, the statistical test used was the Khi2 test and a value of P 0.05 was considered statistically significant. Results: A total of 253 patient files were collected. Thyroidectomy represented 5.02% (253/5036) of surgical procedures. The average age was 42.5 years with a standard deviation of 15.6 and extremes of 13.9 and 76 years. The sex ratio was 8.7 in favour of the female sex. Anterior cervical swelling was the most common reason for consultation with 90.0% (230/253). There were 118/253 cases of euthyroid goiter (46.6%), 132/253 cases of hyperthyroid goiter (52.2%) and 3/253 cases of Basedow’s disease (1.2%). Histology revealed (178/253) cases of micro and macro follicular colloid adenoma (70.3%), (27/253) cases of micro and macro follicular vesicular adenoma (10.7%) and (48/253) cases of micro and macro vesicular hyperplasia. The most performed surgical techniques were subtotal thyroidectomy with a rate of 138/253 (54.5%) isthmo-lobectomy with a rate of 102/253 (40.3%), lobectomy with a rate of 11/253 (4.3%) and isthmectomy 1/253 (0.4%). One-month follow-up was marked by 4 cases of surgical site infection (1.6%), 2 cases of transient hypocalcemia (0.8%). One-year follow-up was simple in 98.4% of cases, we noted 4 cases of keloid. The average length of hospitalization was 3.31 ± 0.1 days. Conclusion: Goiter surgery is relatively common in the general surgery department of CHU Gabriel Touré. Good preparation and better post-operative monitoring could help minimize post-operative complications.

A preliminary study on low temperature plasma obliteration for pyriform sinus fistula by visual laryngoscope

Objective:To investigate the effect of low-temperature plasma obliteration for pyriform sinus fistula by visual laryngoscope. Methods:The clinical data of 29 cases with congenital pyriform sinus fistula receiving low temperature plasma obliteration by visual laryngoscope during March 2019 to August 2021 was retrospectively analyzed in department of Otolaryngology Head and Neck Surgery of Children's Hospital of Nanjing Medical University. Nineteen cases accepted the pyriform sinus fistula probing + fistula obliteration, 6 cases accepted the pyriform sinus fistula probing + fistula obliteration + neck abscess incision and drainage, and 4 cases with cervical abscess accepted the pyriform sinus fistula probing + fistula obliteration. Results:All cases had no obvious complications. Two cases had vocal cord impairment after operations and recovered after one month. There was no recurrence in 2 to 30 months follow up, with mean 16 months follow up. Conclusion:Low-temperature plasma obliteration of pyriform sinus fistula by visual laryngoscope is a safe and effective surgical method with little trauma and short hospital stay. It could be the first choice for the treatment of pyriform sinus fistula. Incision and drainage of neck abscess and pyriform sinus fistula obliteration could be performed concurrently.

Ultrasound-guided Drainage vs Surgical Drainage of Deep Neck Space Abscesses: A Randomized Controlled Trial

IntroductionThe most common cause of deep neck infections is dental infection. They are diagnosed with physical examination, imaging studies, ultrasound, or computed tomography. Surgical drainage of collections should always be performed early in a classical or percutaneous way, depending on the case. The aim of the study was to compare ultrasound-guided percutaneous drainage techniques vs. surgical drainage in deep cervical abscesses of odontogenic origin in a controlled and randomized trial. MethodsA randomized controlled clinical trial was performed from January 2015 to December 2019. Hospital stay was evaluated as an efficiency variable. Epidemiological and secondary variable data (tumour, trismus, fever, pain), leukocytosis, cosmetic result comparing both techniques were analysed. Statistical analysis was carried out with STATA v 14.0. Results128 patients were analysed, 51 women and 77 men. Average age 27.3 (SD = 10.13). The percutaneous group had a mean hospital stay of 3.03 (SD = 2.86) days and the surgical group 5.46 (SD = 2.96). The P-value was <.001. Cosmetic results showed differences favouring the percutaneous drainage group. None of the other variables showed statistically significant results. DiscussionSurgical treatment (cervicotomy and debridement) should be undertaken early with evidence of extensive collection in deep spaces. Minimally invasive image-guided procedures are an alternative. These can be performed in well-located, unilocular collections, without compromising of the patient’s airway. Percutaneous drainage and suction techniques if necessary, serially, or drainage placement may be performed. ConclusionsUltrasound-guided and serially guided percutaneous drainage is the best therapeutic option in patients with mild and/or moderate dental infections.

A Case of Deep Cervical Abscess After Upper Gastrointestinal Endoscopy

Patients with a deep cervical abscess sometimes show a serious course and require immediate surgical intervention. The main underlying causes if a deep cervical abscess are peritonsillar abscess, upper respiratory tract infection with acute tonsillitis, and dental infections; on the other hand, it can also, rarely, occur as a complication of medical procedures such as upper gastrointestinal endoscopic examination.

Examination of Dental Cervical Abscess Cases

Examination of Dental Cervical Abscess Cases

A rare case\xa0as different cause of retropharyngeal and spinal epidural abscess: spondylodiscitis

BackgroundRetropharyngeal abscess (RPA) is a life-threatening, dangerous condition and uncommon in adults. The coexistence of RPA, cervical spinal epidural abscess (CSEA), and spondylodiscitis is extremely rare.Case presentationWe present a case with a retropharyngeal and epidural abscess caused by spondylodiscitis. A 61-year-old man was referred to our clinic with the complaints of sore throat, limitation in neck range of motion, numbness, and weakness in the left arm and the left ear for one month. The airway was not obstructed. Neurological deficits were detected in his left arm. Cervical computed tomography revealed a 50 × 30 × 15 mm retropharyngeal abscess. Cervical magnetic resonance imaging showed abscess, C5–6 spondylodiscitis and epidural abscess, and myelopathic signal changes in the C3–7 spinal cord. The abscess was drained, and C5–6 discectomy was performed. The patient was discharged with cervical collar and antibiotics.ConclusionsMultidisciplinary approach that consists of otolaryngologist, neurosurgeon, and infectious disease specialist is needed to avoid complications and any delay.

Deep neck abscesses-a diagnostic and therapeutic challenge

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Deep neck space infections pose a diagnostic challenge, as they traverse complex anatomy, these patients develop devastating complications if the diagnosis is not made early.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a case series over a period of one year, reporting unusual presentation of deep neck abscesses. Patients were subjected to detailed history and clinical examination. Routine investigations, were done. After taking high risk consent, intra oral drainage of abscesses was done.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; In the present study of 30 cases age group affected was 10 to 30 years with male predominance. Peritonsillar abscesses were seen in the adolescent age groups whereas retropharyngeal space infections were seen more in the adult population. Tuberculosis was the most common predisposing factor followed by diabetes. Dysphagia was the most common presenting symptom, followed by neck swelling. Intraoral drainage was done in 23 patients, intraoral drainage and ultrasound guided aspiration was done in 6 patients and 3 patient required emergency tracheostomy for securing of the airway.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Deep cervical abscesses still occur in the antibiotic era and may cause life-threatening complications.&lt;/p&gt;

Novel alphaherpesvirus in a wild South American sea lion (Otaria byronia) with pulmonary tuberculosis.

In 2017, an adult male South American sea lion (Otaria byronia), presenting emaciation and a cervical abscess, stranded alive in Florianópolis, southern Brazil. The animal was directed to a rehabilitation center, dying a few days later. On necropsy, the main gross findings were necrotizing lymphadenitis of the right prescapular lymph node and nodular bronchopneumonia. A novel alphaherpesvirus, tentatively named Otariid alphaherpesvirus 1, was amplified in several tissue samples. No histopathologic findings associated with viral infection were observed. Additionally, pulmonary tuberculosis by Mycobacterium pinnipedii was diagnosed by histopathological, immunohistochemical, and molecular techniques. Several bacteria were cultured from antemortem and postmortem samples, including Proteus mirabilis from the cervical abscess and cardiac blood, and Escherichia coli from the cervical abscess and pericardial effusion. Flavivirus, morbillivirus, and Apicomplexa were not detected by molecular techniques. Herein, we report a novel alphaherpesvirus in a pinniped species of the family Otariidae. Although previously described in Southern Hemisphere pinniped species, including South American sea lions, there is limited information regarding M. pinnipedii impact over this group. Further research is required to determine the associated pathogenesis of this novel herpesvirus, and prevalence of Otariid alphaherpesvirus 1 and M. pinnipedii in the reproductive colonies.

Anterior cervical abscess

Anterior cervical abscess

8. Factors contributing to cost in management of spinal epidural abscesses

<h3>BACKGROUND CONTEXT</h3> Spinal epidural abscesses (SEA) are increasing in incidence and may be associated with high rates of morbidity and mortality. While management classically consisted of urgent surgical decompression, advances in diagnostic imaging and antibiotic therapies have made possible earlier diagnosis and nonoperative management. Previous work examining the cost of surgically managed SEA demonstrates that this clinical entity is both expensive and associated with high mortality rates. <h3>PURPOSE</h3> To compare costs between operatively and nonoperatively managed spinal epidural abscesses. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study at 2 tertiary academic centers. <h3>PATIENT SAMPLE</h3> Adult patients receiving treatment for spinal epidural abscesses (2016-2017). <h3>OUTCOME MEASURES</h3> Cumulative charges at index hospital discharge, and at 90-days and one-year following discharge. <h3>METHODS</h3> Medical records, laboratory results and hospital billing data were reviewed for data abstraction. Demographic factors including age, sex, region of abscess, intravenous drug use, and comorbidities were abstracted, along with clinical factors such as symptoms and ambulatory function at presentation, spinal instability, ICU admission and complications. The primary outcome was total charges of initial admission, with charges for admission and care delivered in the first 90 days, and total 1-year charges (with only related charges recorded between 90-days and 1-year) considered secondarily. All covariates abstracted were included in this exploratory analysis using negative binomial regression that accounted for confounders and the nonparametric nature of cost data. Results are presented as an incidence rate ratio (IRR) with 95% confidence intervals (CI). <h3>RESULTS</h3> Sixty-six patients were included with mean age 56.6 (SD 16.2). The majority of patients (57.2%) were male and White (77.8%). Thirty-three (52.4%) patients had axial pain on presentation without other symptoms, 10 (15.8%) radicular pain, and 20 (31.7%) paresis or paralysis. Mean charges for initial admission were $202,404 (range: 16,237-927,379); total 90-day charges $250,622 (range 29,698-948,020); and 1-year charges $286,731 (range 32,384-1,232,551). Significant predictors of initial admission charges included surgical management (IRR 1.54, 95% CI 1.23-1.90, p<0.001), ambulatory status on admission (nonambulatory vs independent, IRR 1.62, 95% 1.12-2.33, p = 0.009), radicular vs axial symptoms (IRR 1.60, 95% CI 1.21-2.12, p = 0.001), thoracic vs cervical abscess (IRR 1.51, 95% CI 1.11-2.04, p=0.008) and length of stay (IRR 1.04, 95% CI 1.04-1.06, p<0.001). Factors associated with 1-year total charges included nonambulatory status at initial presentation (IRR 2.05, 95% CI 1.28-3.29, p=0.003), paresis/paralysis on presentation (IRR 1.37, 95% CI 1.02-1.83, p=0.034), spinal mechanical instability (IRR 1.89, 95% 1.23-2.93, p=0.004) and length of stay (IRR 1.05, 95% CI 1.03-1.07, p<0.001). Surgical management was not a significant predictor of charges beyond the initial admission. <h3>CONCLUSIONS</h3> Surgical management of spinal epidural abscess patients is associated with increased health care expenditures during the index hospital admission, but not with total costs 1 year after the initial episode. Length of stay, paresis or paralysis on initial presentation and spinal mechanical instability contributed more to increased charges over the first year following management. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Needle aspiration of lateral neck abscess in children: A simple and effective treatment

BackgroundCervical abscesses frequently occurred in pediatric patients. Surgical drainage is currently recommended in the cases not responding to medical therapy. Needle aspiration may represent a simple, effective and minimally invasive treatment for acute neck suppuration in selected cases. ObjectiveTo evaluate the effectiveness of needle aspiration in the treatment of cervical abscesses in pediatric age as an alternative to surgical drainage. MethodsFrom November 2013 to November 2019, at the ENT Department of the “Bambino Gesù" Pediatric Hospital, Rome, we treated 47 children with cervical abscess by performing aspiration with a 19 G needle in wakefulness after applying local anesthetic. Parenteral antibiotic treatment was associated with all patients both before and after treatment. ResultsComplete regression of the abscess occurred in 46 children with no evidence of recurrence in the follow-up period. Surgical drainage was required in only one patient due to the lack of resolution of the abscess episode. No complications such as hematomas or hypertrophic scars were found in any patient. ConclusionsOur results confirm the effectiveness of needle aspiration in the treatment of cervical abscesses in children as an alternative to surgical drainage.

Drenaje percutáneo ecoguiado vs. drenaje quirúrgico en abscesos cervicales profundos de origen odontógeno. Ensayo clínico controlado y aleatorizado

IntroductionThe most common cause of deep neck infections is dental infection. They are diagnosed with physical examination, imaging studies, ultrasound, or computed tomography. Surgical drainage of collections should always be performed early in a classical or percutaneous way, depending on the case. The aim of the study was to compare ultrasound-guided percutaneous drainage techniques vs. surgical drainage in deep cervical abscesses of odontogenic origin in a controlled and randomized trial. MethodsA randomized controlled clinical trial was performed from January 2015 to December 2019. Hospital stay was evaluated as an efficiency variable. Epidemiological and secondary variable data (tumour, trismus, fever, pain), leukocytosis, cosmetic result comparing both techniques were analysed. Statistical analysis was carried out with STATA v 14.0. Results128 patients were analysed, 51 women and 77 men. Average age 27.3 (SD = 10.13). The percutaneous group had a mean hospital stay of 3.03 (SD = 2.86) days and the surgical group 5.46 (SD = 2.96). The p-value was <.001. Cosmetic results showed differences favouring the percutaneous drainage group. None of the other variables showed statistically significant results. DiscussionSurgical treatment (cervicotomy and debridement) should be undertaken early with evidence of extensive collection in deep spaces. Minimally invasive image-guided procedures are an alternative. These can be performed in well-located, unilocular collections, without compromising of the patient's airway. Percutaneous drainage and suction techniques if necessary, serially, or drainage placement may be performed. ConclusionsUltrasound-guided and serially guided percutaneous drainage is the best therapeutic option in patients with mild and/or moderate dental infections.

COVID-19 Infection and Cervical Abscess in a Three-Month-Old Infant

A three-month-old infant was referred to the emergency department with fever and a right cervical abscess. Nasopharyngeal swab was positive for SARSCoV- 2 infection. Main causes of infectious abscess and immunodeficiency disorders were ruled out. After a surgical drainage and an antibiotic therapy, clinical conditions of the infant improved, and Staphylococcus Aureus was found in the wound drainage culture. This is a possible, not yet described in infant patients, concurrent clinical manifestation of SARS-CoV-2 infection.

Immobilization Hypercalcemia (IH) in an Adult After Spinal Cord Injury

Background: Immobilization hypercalcemia (IH) is an uncommon diagnosis and little has been published about management of this condition. We present a case of IH and discuss clinical aspects of this unique bone metabolism state. Case: 32-year-old female with history significant for IV drug use, presented to the hospital with features of septic shock, Work up showed MRSA bacteremia associated with tricuspid endocarditis and septic pulmonary emboli. MRI of the spine done for progressive weakness of extremities revealed a cervical epidural abscess leading to spinal cord compression and myelomalacia. She underwent spinal abscess drainage and corpectomy, remained quadriplegic. 8 weeks later we were consulted to see her at inpatient rehabilitation facility for hypercalcemia. Labs showed Creat(0.6 mg/dl), hypercalcemia with corrected Calcium of 12.9 mg/dl f. Further workup showed suppressed PTH (< 6), V D-25 at (< 10 mg/dl). Phosphate (normal). ACE levels, PTHrp, Vit. D 1,25, SPEP, UPEP,and TSH were all normal. 24 hours urine calcium showed hypercalciuria, 400 mg/ml. Fasting Bone markers were elevated with serum N-telopeptide > 40 nM BCE, ref range (6.2–19.0) and C-Telopeptide is 2060 pg/ml ref range (60–650), which indicates increase bone turnover. IH was diagnosed and hydration attempted for few weeks. Serum calcium remained at 13 mg/dl, so she received a single slow infusion of pamidronate 30 mg. 4 days after infusion, calcium levels decreased to normal value of 10.2 mg/dl without any side effects. She remained normocalcemic 5 weeks post infusion. Discussion: IH is an uncommon condition but early recognition and intervention will minimize secondary long-term complications such as kidney stones, Osteoporosis or low bone mass, renal failure and acute pancreatitis. Albert, Fuller described IH in 1941(1). Most cases of IH had been reported in children and adolescents with high bone turn over following recent spinal cord injury(2–3). Very few reports have been published in young adults such as our patient,IH is attributed to prolonged immobilization from paralysis due to spinal cord injury,and other etiology (2–4), Proposed mechanism includes decreased mechanical stress on the bone which leads to increase bone resorption and remodeling and demineralization. To establish the diagnoses of IH, an exhaustive evaluation is warranted to rule out other causes of PTH dependent and independent hypercalcemia(5). Multiple treatment approaches have been used over the past few decades including early mobilization, hydration., saline diuresis, subcutaneous Calcitonin, glucocorticoids (6), IV sodium sulphate and phosphate (7). Bisphosphonates are the preferred pharmacological treatment of IH. Nonnitrogen containing bisphosphonates including clodronate and etidronate (8–9),. are not preferred due to concern for bone demineralization and osteomalacia. (10). Pamidronate has been used to treat IH due to its efficacy, safely and cost (11). Caution to be exercised in those patients with kidney disease.

A Rare Case of Cervical Intramedullary Abscess Following Cervical Osteomyelitis (5000)

A Rare Case of Cervical Intramedullary Abscess Following Cervical Osteomyelitis (5000)

A Rare Case of Cervical Epidural Abscess Post Posterior Cervical Laminotomy with Isolation of Neisseria Meningitides Bacteria

Spinal epidural abscess is a rare condition, although it requires an urgent surgery to decrease the pressure onthe epidural sac in addition to the other structures of the spinal cannel cord and nerve roots.A 29 years old female entered the clinic with large neck swelling. She also had a history of headache withneck pain, both arm paresthesia with mild fever. Her MRI showed an epidural collection at level of cervical5 to cervical 7 compressing the dural sac narrowing the spinal cannel and extending to the paraspinalintramuscular area in the neck.She had undergone a surgery with a 2cm mid line incision above the swelling mass in order to suck out thepus. In addition, the intermittent Valsalva maneuver was performed to enhance the epidural pus gat out.The culture and sensitivity test to pus indicated a Neisseria meningitides bacterial growth. Penicillin G andcefotaxime as antibiotics were prescribed. Improvement occurred within 2 weeks.Although rare, the isolated Neisseria meningitides spinal epidural abscess requires an urgent treatmentthrough evacuating and decompressing. Spondylodiscitis or collapse may occur, therefore, a surgery forspine correction may be needed, fellow up is recommended in all forms of epidural abscesses.

＜Editors' Choice＞ Treatment strategy for upper cervical epidural abscess: a literature review.

ABSTRACTWe aimed to determine available evidences in the literature regarding surgical approaches and methods, timing of surgical interventions, duration of perioperative antibiotics, and duration of nonsurgical treatments (antibiotics administration) in patients with upper cervical (occiput–C2) epidural abscess (UCEA). We performed a literature review of the articles on surgical interventions and antibiotic therapy to treat UCEA, searching the PubMed database for relevant articles published in the English language (as of March 2020). In total, 53 patients with UCEA were identified. Permanent limb paralysis or death was observed in 1/15 (6.7%) patients who received the transoral approach and 2/15 (13.3%) patients who received the transcervical approach, 1/26 (3.8%) patients who underwent surgery before the onset of paralysis, and 2/4 (50.0%) patients who underwent surgery after the onset of paralysis. In 85%–89% of cases, antibiotic administration was continued for 6–12 weeks, which was determined by the confirmation of reduced inflammatory response and/or abscess disappearance on imaging. Differences in surgical approaches may not be associated with the incidence of permanent limb paralysis or death. Surgical interventions before limb paralysis onset are recommended in UCEA patients. In perioperative and nonoperative treatments, antibiotic administration for 6–12 weeks may be supported based on the confirmation of reduced inflammatory response and/or abscess disappearance on imaging. Further investigations are needed.

A rare case of cervical abscess caused by Parvimonas micra

Cervical abscesses develop in the tissue spaces between the cervical fascia. The rapid expansion of these abscesses can lead to fatal outcomes. We describe a case of a deep cervical abscess caused by Parvimonas micra. He was referred to our department with complaints of sore throat and neck pain. Ultrasonography revealed a hypoechoic area in the cervical interfascicular space. An ultrasound-guided puncture was performed to collect pus for bacteriological examination. Subsequently, a contrast-enhanced computed tomography scan revealed a multi-focal abscess extending from the left mandible to the left side of the neck, without any mediastinal abscess. An emergency drainage and antibacterial therapies were performed, and the patient progressed well. Parvimonas micra, a gram-positive anaerobic bacterium, was detected in the pus collected before incision, and appropriate antibiotics were immediately administered. The collection of pus prior to incision and drainage aids accurate identification of the causative organism and appropriate treatment.

Brucellar cervical epidural abscess - A rare cause of neck pain.

Brucellosis, is a zoonosis infection with a planetary distribution, caused by facultative intracellular bacteria of the genus Brucella, thus has a variable clinical presentation. Spinal epidural abscesses are a rare presentation of the disease, and may carry risk of a neurovascular compromise. Here we report a 22-year-old male with spinal brucellosis complicated by a cervical epidural abscess. The diagnosis was based on presenting symptoms and his occupation, confirmed by laboratory investigations, blood culture and magnetic resonance imaging results. Surgical drainage of abscess was performed, followed by 6 weeks of combination antibiotic therapy. The combination of the therapeutic strategies we used lead to a significant clinical improvement in this rare case.

Subcutaneous and muscular lagochilascariasis in a cat from Rio Grande do Sul, Brazil

ABSTRACT: A domestic cat was submitted to necropsy with a small abscess within the subcutaneous tissue and skeletal muscles dorsal to the left ear. It contained multiple 0.8 to 1.2 cm-long adult nematodes and was drained by two cutaneous fistulae. On histopathology, multiple cavitary areas within the skeletal muscles and subcutaneous tissue contained adult nematodes and were surrounded by thick fibrotic and chronic-active inflammatory reaction. The parasites were externally lined by a smooth cuticle and had two prominent lateral alae. They contained an intestinal tract and a pseudocoelom. A prominent polymyarian-coelomyarian musculature and two large lateral chords were identified, and some sections contained a uterus with multiple non-operculated eggs. Lagochilascariasis should be considered a differential diagnosis for cervical skin abscesses in domestic cats from Southern Brazil. This article brings important contributions to the clinical and anatomopathologic diagnosis of this rare zoonotic disease.