Deep Neck Abscess Research Articles

The COVID-19 period influence on pediatric deep neck abscess: Occurrences and clinical presentation

ObjectiveThe purpose of the study was to investigate the influence of the COVID-19 pandemic on the incidence of deep neck infections (DNIs) in pediatric patients. In addition, it describes the clinical, laboratory, and microbiology presentation as well as the clinical outcomes. Study designRetrospective cohort study. SettingsA single tertiary medical center. MethodsAll patients ≤18 years with a diagnosis of DNI, between the years 2010–2022, were included in the study and the yearly incidence of DNI was calculated. Patients were divided according to their diagnosis of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs), and according to age; Group 1 (aged 0 to ≤4 years) and Group 2 (aged>4 to ≤18 years). ResultsA total of 46 cases of DNIs; 24 were RPAs and 22 were PPAs, age group 1 had 20 patients, and age group 2 had 26 patients. The overall DNI incidence during 2010 was 0.81 and declined in 2020 (COVID-19 pandemic period) to 0.33, followed by a surge in the incidence of 4.85 in 2022 (post-COVID-19 period).In age group 1 RPAs were more dominant (70 %) while PPAs were dominant (61.5 %) in group 2. (p = 0.034). A higher prevalence of positive cultures was seen in the RPA group compared to the PPA group (75 % vs 33 %, p = 0.025, respectively), and in age group 1 compared to age group 2 (77 % vs 30 %, p = 0.001, respectively). ConclusionIn conclusion, our study provides valuable insights about the disease and vulnerable communities. In addition, we showed a decrease during the COVID-19 pandemic followed by an increase in DNI incidence post-COVID-19 pandemic era. A larger comprehensive prospective study is warranted to gain a deeper understanding of these trends and their underlying causes.

Otomastoiditis Complicated by a Bezold Abscess and Extradural Empyema, Case Report

Bezold's abscess is a rare deep neck abscess and is an intratemporal complication of mastoiditis, the infection erodes through the mastoid cortex to the attachment of the sternocleidomastoid (SCM) muscle. Once the infection has reached this space, it can progress into the infratemporal fossa and trip deep to the investing subcaste of the deep cervical fascia [1]. The spread of infection in this subcaste can lead to a progressive cellulitis/ abscess, but can also do toward the carotid jacket, and thrombosis of the internal jugular tone can do. It was first described by Friedrich Bezold in 1881[5]. Since antibiotics were introduced, the number of reported cases of Bezold's abscesses have significantly dropped. According to some authors, since 1967 there have been less than 100 reported cases in the English literature, only four cases in children under the age of five [1].

The Radiographic Characteristics of Mandibular Wisdom Teeth That Can Cause Severe Deep Neck Infection.

Mandibular wisdom teeth can occasionally cause infections, which can progress to severe deep neck infections (DNIs) including deep neck abscesses or necrotizing soft tissue infections, which are fatal. This study aimed to identify the radiographic characteristics of mandibular wisdom teeth that developed severe DNIs. This study included patients who were admitted for the treatment of severe mandibular wisdom tooth infection between July 2012 and June 2024 at a single center. Patient characteristics, clinical data, and radiographic findings were analyzed and compared between the severe DNI group and mild DNI group including patients with cellulitis or superficial abscess. P < 0.05 was considered significant. Nineteen of 42 patients (45.2%) were included in the severe DNI group. The multivariate analysis showed that the highest odds ratio (OR) was for the presence of a radicular cyst (OR=17.7), followed by the presence of a dentigerous cyst (OR =14.5). The most common mandibular wisdom tooth with a dentigerous cyst in patients with severe DNIs was inverted according to Winter's classification and type IIIC in the Pell and Gregory classification. Radiographic characteristics associated with severe DNIs included the presence of radicular and dentigerous cysts in the mandibular wisdom teeth. Especially in dentigerous cysts, deeply impacted teeth should be taken attention.

A multicentre observational study of paediatric head and neck abscesses

IntroductionIn winter of 2022/3 paediatric ENT surgeons across the UK observed that the incidence of severe abscesses in the head and neck and associated complications was higher than seen in previous years. We aimed to collate and evaluate data from across the UK to establish if this was a true rise in cases, and to describe the factors associated. MethodsA multicentre retrospective data collection was undertaken from 13 units across the UK. Patients admitted between September 2022–February 2023 with a head and neck abscess including sinogenic, otogenic, deep and superficial neck abscesses were included. Demographic, disease specific, management and outcome data were collected. Hospital episode statistic data were also requested and analysed to allow for comparison with previous 10 years of head and neck abscesses. Results262 patients with abscesses of the head and neck were admitted during the study period, 100 between September and November and 163 between December and February. Mastoid abscesses were the most common abscess across both groups. The rate of group A streptococcus + culture results rose significantly from 12 % in autumn group to 30 % in winter (p = 0.02). The rate of intracranial complications rose from 10 % to 18 % (p = 0.11) and the rate of venous thrombosis rose over the same timeframe from 3 % to 14 % (p = 0.01). DiscussionThis study demonstrated a statistically significant rise in the rate of group A streptococcus associated abscesses when comparing Autumn and Winter 2022/2023. Over the same timeframe a statistically significant rise in the proportion of patients with venous thromboses associated with H&N abscesses was noted. Interestingly, despite perceived national consensus regarding a spike in abscess incidence, the number of abscesses seen in winter 2022/2023 was in keeping with expected rates of paediatric H&N abscesses, based on pre covid year-on-year rise in incidence.

Association of the Moore sign with the presence of deep neck abscess of retropharyngeal space

Association of the Moore sign with the presence of deep neck abscess of retropharyngeal space

Parapharyngeal and retropharyngeal infections in children: Kawasaki disease needs vigilance

ObjectiveKawasaki Disease (KD) may mimic Parapharyngeal (PPI) and Retropharyngeal Infections (RPI), leading to misdiagnosis as Deep Neck Infections (DNIs). The treatment plans for the two diseases are different, and delayed treatment can lead to serious complications. Therefore, prompt diagnosis and management are necessary. This study was performed to evaluate the clinical features of KD mimicking DNIs and explore the treatment options. MethodsChildren with cellulitis or abscess in parapharyngeal or retropharyngeal space in neck CT were included in this study. The medical records of enrolled children were retrospectively reviewed. ResultsIn total, 56 children were diagnosed with PPI or/and RPI. Twenty-two (39.3%) participants were eventually diagnosed with KD, and 34 (60.7%) were diagnosed with DNIs. Compared with the DNIs group, the KD group had a higher body temperature (p=0.007), and higher levels of AST (p=0.040), ALT (p=0.027), and ESR (p=0.030). Deep cervical cellulitis (p=0.005) were more common in the KD group. However, deep neck abscess often occurred in the DNIs group (p=0.002), with parapharyngeal abscess being the most common type of abscess (p=0.004). The KD mimicking DNIs cases did not respond to antibiotic treatment, but symptoms significantly improved after the use of Immunoglobulin (IVIG) and aspirin. ConclusionChildren with KD may exhibit retropharyngeal or parapharyngeal inflammation in the early stages. KD should be considered a differential diagnosis for children with DNIs, high fever, and no response to antibiotic therapy. Surgery in KD mimicking deep neck abscess requires caution. Level of EvidenceI.

Factors associated with complications and mortality of deep neck abscesses in adults

Abstract OBJECTIVE. Our objective was to evaluate the factors associated with complications and death in patients with abscesses of the deep spaces of the neck. MATERIAL AND METHODS. An observational, cross-sectional, analytical, retrospective study was conducted from 2017 to 2022. Demographic variables, comorbidities, affected spaces, management, need for tracheostomy, ICU care, presence and type of complications and death were collected. Descriptive statistics were applied as measures of central tenure and measures of dispersion, for inferential analysis; Pearson'’s Chi-square or Fisher'’s exact tests, odds ratio for risk analysis, binary logistic regression test to evaluate the predictor variables were used. RESULTS. We included 46 cases; mean age 44.41 ±13.84 years; 60.87% male patients. As comorbidities, we found diabetes alone and diabetes with hypertension as the most frequent. Three affected neck spaces were in 44% of patients. 46% needed a tracheostomy, this parameter being significantly associated with complications (p=0.037) and mortality (p=0.037). The need for intensive care and complications revealed a p=0.000 and with a p=0.005 for mortality; days of hospitalization ≥ 11 days was significantly associated with complications (p=0.005) and death (p=0.013). Hospital stay ≥11 days were risk factors for complications (OR=1.357, 95%CI 1.037-1.776) and death (OR=1.267, 95%CI 1.004-1.598); the need for ICU and complications had an OR=78.00 (95%CI 5.726 -1062.546), ICU and death had an OR=39.000 (95%CI 3.046-499.323). The variables ICU admission, tracheotomies and hospital stay ≥11 days were predictors of complications and death. CONCLUSION. The need for tracheostomy, ICU admission, hospitalizations ≥11 days are associated with complications and death in patients with deep neck abscesses. The same variables were risk factors and predictors of mortality and complications.

Deep Neck Infection: A Case Series

Background: Deep neck abscess is a collection of pus (pus) in the potential space between the fascia of the deep neck due to spread from various sources of infection, such as teeth, mouth, throat, paranasal sinuses, ears and neck. Various spaces can be a place for deep neck abscesses including the submandibular, peritonsillar, parapharyngeal, retropharyngeal, submental, parotid, anterior visceral, carotid, and masseter spaces. Inflammation or damage to chronic problem teeth can lead to complications of deep neck abscesses. The main complaint that causes sufferers to come to the hospital is dysphagia, which is difficulty swallowing due to the pain felt by the patient. These complaints can also be accompanied by trismus, stridor caused by tracheal compression, to airway obstruction. Purpose: To determine the progressivity of deep neck abscess so that it can provide medical management until operative incision and drainage. Case report: We report 5 cases of deep neck abscess with management according to the progress of each case. Conclusion: The most common cause or etiology that can lead to deep neck abscess is toothache. Management of deep neck abscess, starting with the administration of empirical antibiotics which is the first step to reduce the infection of bacteria that produce beta lactamase. In deep neck abscess, medical therapy can be given in the form of an antibiotic combination of ceftriaxone with metronidazole, or meropenem with metronidazole as well as surgery in the form of incision and drainage. Treatment can be chosen based on the presence or absence of warning signs and signs of complications. Incision and drainage is performed when complaints do not improve after administration of antibiotics, multiple abscesses and airway obstruction that threatens the patient's life.

A Case of Excessive Dynamic Airway Collapse Caused by Deep Neck Abscess and Tracheostomy

A Case of Excessive Dynamic Airway Collapse Caused by Deep Neck Abscess and Tracheostomy

Parapharyngeal Abscess: A Model of Continuity and Contiguity Deep-Neck Space Infections: A Diagnostic Dilemma!

The aims of the present case report were to review, computed tomography (CT) scans, clinical signs, treatment, and outcome of parapharyngeal space infections. These infections remain an important health problem with significant risks of morbidity and mortality. The term parapharyngeal abscess or infection is composed of two different disorders: infection located in the posterior part of the PPS with no invasion into the parapharyngeal fat and the second disorder is when the infection involving the parapharyngeal fat may be termed parapharyngeal abscess or deep neck abscess. Diffusion into the mediastinum and other severe complications are frequent. A 59 year old male, presented with three days history of intermittent high grade fever and left neck swelling which was rapidly increasing in size and associated with stridor, odynophagia and neck pain. The infection and accumulation of purulent discharge extend into the pharyngomaxillary space and inferiorly is located at the greater cornu of the hyoid bone. Temporary tracheostomy for respiratory assistance was performed. The frequent co-existence of parapharyngeal abscess and peritonsillar abscess favours careful consideration of addition of tracheotomy to lateral cervicotomy. Parapharyngeal abscess are deep neck abscesses that are common and thorough knowledge of their complex anatomy and aetiologies is essential in their treatment. Urgent surgical drainage is therefore mandatory.

A case of deep neck abscess caused by blunt injury

A case of deep neck abscess caused by blunt injury

Utility of a clinical risk scale to predict the requirement of advanced airway management in patients with a diagnosis of deep neck abscess

ObjectivesTo analyze the clinical utility of a clinical risk scale to predict the need for advanced airway management in patients with deep neck abscess. MethodsObservational, analytical, cross-sectional study. Patients over 18 years old, both genders, with surgical management of a deep neck abscess, between January 1st, 2015 to December 31th, 2021, who were applied the clinical risk scale (https://7-414-5-19.shinyapps.io/ClinicalRiskScore/). The sensitivity, specificity, and predictive values of the scale were calculated based on the identified clinical outcomes. A p<0.05 was considered significant. ResultsA sample of 213 patients was obtained, 121 (56.8%) men, of whom 50 (23.5%) required advanced airway management. Dyspnea was the variable with the most statistical weight in our study, (p=0.001) as well as the multiple spaces involvement, (p=0.001) the presence of air corpuscles, (p=0.001) compromise of the retropharyngeal space (p=0.001) and age greater than 55 years (p=0.001). Taking these data into account, were found for the clinical risk scale a sensitivity of 97% and a specificity of 65% (p=0.001, 95% CI 0.856–0.984). ConclusionsThe clinical risk scale developed to predict advanced airway management in patients with a diagnosis of deep neck abscess may be applicable in our environment with high sensitivity and specificity. Level of evidenceIV.

Emerging findings for the assessment and treatment of pediatric deep neck abscesses.

The purpose of this review is to summarize new literature regarding the description, diagnosis, and treatment of pediatric deep neck abscesses. Providers should include multi-inflammatory syndrome in children (MIS-C) in a differential diagnosis in children suspected of having a retropharyngeal abscess. MRI may guide the proper management of children with deep neck abscesses by more accurately detecting free fluid compared to computed tomography imaging. Factors that may predict the need for surgical management include elevations in white blood cell counts and abscess size more than 3 cm. However, future investigation is necessary to establish consistent guidelines. Medical management is effective in many children, with a new study indicating success using a combination of cefotaxime and rifampicin. Anatomical and age-related risk factors predispose children to the development of deep neck abscesses. Findings from recent studies may aid providers in making an accurate diagnosis and providing proper medical or surgical management of children with these infections.

Lemierre’s syndrome complicating deep neck abscess: a case report

BackgroundLemierre’s Syndrome is a severe medical condition that can result from oropharyngeal infection, typically caused by Fusobacterium necrophorum, leading to sepsis, internal jugular vein thrombosis, and metastatic septic emboli. However, there is limited literature on this syndrome caused by Streptococcus anginosus, and few previous cases have been reported to have deep neck space infection. We present the first case of Lemierre’s Syndrome caused by Streptococcus anginosus with deep neck abscess.Case presentationA 53-year-old male patient with no significant medical history presented with right neck pain after accidentally swallowing a fish bone one month ago. Laryngoscopy did not reveal any abnormalities. Five days prior to admission, the patient developed high fever. Imaging studies showed internal jugular vein thrombosis and a neck abscess surrounding the carotid artery sheath. Blood culture results were positive for Streptococcus anginosus infection, and the patient was diagnosed with Lemierre’s syndrome. The patient underwent surgical drainage and received antibiotics and anticoagulant therapy, and had satisfactory clinical progress. He was discharged after a 16-day hospitalization.ConclusionsAlthough Lemierre’s syndrome is rare, it needs attention because it can lead to serious complications and requires timely treatment. Deep neck space infections can be life-threatening and doctors must be aware of its potential severity.

Clinical and Microbiological Characteristics of Deep Neck Abscesses in Pediatrics: Analysis of a Case Series from a 3rd Level Pediatric Hospital.

As there is currently no consensus on managing deep neck infections in pediatric populations, we report a case series from a large pediatric hospital. Clinical data of patients discharged from Istituto Gaslini-Children's Hospital from January 2014 to June 2020 with peritonsillar, parapharyngeal, or retropharyngeal abscess diagnoses were collected. A total of 59 patients were identified. Patients underwent surgical drainage in 47% of cases. Streptococcus mitis/oralis was the most isolated pathogen. Surgically treated patients did have larger abscesses compared to others, but there were no differences in the duration of hospitalization. Children who received NSAIDs at home had significant delays in diagnosis (median 4 vs. 1.5 days, p = 0.008). In our experience, clinical presentation of DNIs is often evocative, but evaluation should include imaging with CT/MRI. Surgery is effective in larger abscesses, allowing for etiological diagnosis with consequent antibiotic adjusting. From an anamnestic point of view, home medications such as NSAIDs could delay diagnosis.

Perioperative factors influencing hospitalization duration for pediatric neck abscesses

PurposePediatric neck abscesses are a common pathology seen in an ambulatory setting. Although some pediatric neck abscesses are managed medically with antibiotics, surgical intervention is often required. Given the often non-emergent presentation of many abscesses, a variety of logistical and perioperative factors may delay time to care and subsequently prolong hospital stay. The objective of this study was to examine factors that influence the overall time to surgery (TTS) and hospital length of stay (LOS) in a pediatric population with neck abscesses who ultimately require surgical drainage. Materials and methods161 pediatric patients who underwent incision and drainage of a neck abscess over a ten-year period at a tertiary referral children's center were reviewed. Demographic information, radiographic studies, and surgical information were extracted from patient charts. Descriptive statistics, Mann-Whitney U tests, and multivariate analyses were performed. ResultsThe most common subcategory location was deep neck abscesses (33.1 %). Computed tomography (CT) was the most common pre-operative imaging modality (54.1 %) followed by ultrasound (US) (49.1 %) and magnetic resonance imaging (2.6 %). US and a combination of multiple preoperative imaging modalities were associated with increased LOS and TTS. Repeat surgery was associated with increased LOS. Pre-admission antibiotic use was associated with increased LOS and TTS. Younger patients were more likely to have a longer LOS. ConclusionsA variety of factors can influence TTS, LOS, and time from surgery to discharge including patient age, abscess location, a non-optimized utilization of imaging modalities, the utilization of pre-admission antibiotics, and the need for repeat operations.

ABSES SUBMANDIBULA

The purpose of this literature review is as an additional reference in diagnosing and managing submandibular abscess. The writing of this article was obtained from various sources in the form of books, scientific journals and guidelines for related institutions. Source searches were carried out on various online portals such as Medscape, NCBI Google Scholar and other health websites. Submandibular abscess is an inflammation accompanied by accumulation of pus in the potential space between deep neck fascia which is an anatomically very complex space. Nearly all odontogenic infections that cause abscesses are caused by a mixture of aerobic and anaerobic microbes. Necrosis of the dental pulp as a result of deep caries provides an entry channel for bacteria into the periapical tissues. After periapical inoculation of bacteria, infection develops which will spread in all directions, but more in areas of lowest resistance. The main priority for deep neck abscesses is to maintain airway patency, followed by intravenous antibiotics and then surgical drainage.

Deep Neck Abscess: A Retrospective Study of 52 Cases

Deep Neck Abscess: A Retrospective Study of 52 Cases

Assessment of Bacteriological Pattern and Antimicrobial Susceptibility in Deep Neck Space Abscess

Background: Deep neck abscess is a common clinical entity in developing countries like ours. Despite the widespread use of antibiotics, deep neck infections do not disappear and remain one of the most difficult emergencies encountered in daily clinical practice. The extent and severity of the illness could become life-threatening. Therefore, coping with deep neck abscess remain a challenge to otolaryngologists. This study aimed to analyze the bacteriological pattern and antimicrobial susceptibility in deep neck space abscesses. Material Methods: It was a cross-sectional observational study. 50 patients with deep neck space abscesses fulfilling the inclusion and exclusion criteria admitted to the department of ENT Head Neck Surgery, Rangpur Medical College Hospital, Rangpur, from 1st July 2017 to 30th December 2017 were enrolled in this study. Pus from deep neck space abscess was collected by either aspiration or incision and drainage with proper aseptic measure and sent by sterile test tube to microbiology department immediately. Data were collected by detailed history taking and clinical examination investigations with informed written consent and analyzed by SPSS (version 20). Results: In this study most commonly involved deep neck spaces were Submandibular (38%), Peritonsillar (32%), Retropharyngeal (14%), and parapharyngeal (8%) spaces. Streptococcus viridans was the most prominent organism 14 (28%) followed by Klebsiella pneumonia 9(18%) and Staph. aureus 4 (8%). The most effective antibiotic was Ceftriaxone 34(79%) followed by Cefuroxime 30 (70%) and Erythromycin 23(54%). Aerobic organisms were highly sensitive to Cefuroxime (83%) and Ceftriaxone (83%) followed by Erythromycin (48%). Anaerobic organisms were sensitive to Clindamycin (100%), Metronidazole (100%), and Erythromycin (100%) followed by Ceftriaxone (75%). Conclusion: The most frequently isolated organism in deep neck space abscesses were Streptococcus viridans and Staphylococcus aureus and sensitivity results showed the majority of isolates are susceptible to Ceftriaxone and Cefuroxime.

Management of Deep Neck Abscess Cases Accompanied by Comorbid Renal Failure

Background: Deep neck space abscess is a life-threatening disease due to its complications. Several co-morbid effects on the successful management of deep neck abscesses. Comorbid kidney failure, one of which, causes uremia, resulting in an imbalance of pro and anti-inflammatory factors in patients with deep neck abscesses. Purpose: Knowing how to properly handle cases of deep neck abscesses with comorbid kidney failure. Cases: Reports serial cases of deep neck abscesses accompanied by kidney failure undergoing various therapies with varying results. Result: Three articles were found that met the inclusion and exclusion criteria that were relevant to the reported case series. The management of neck abscess accompanied by kidney failure begins with the management of kidney failure in advance according to Kidney Disease: Improving Global Outcome (KDIGO) in 2012, followed by the management of deep neck abscesses, except in emergencies. Renal diagnostics and management require serial serum creatinine and monitoring the amount of urine. Conclusion: management of deep neck abscesses accompanied by kidney failure is given treatment first, followed by management of deep neck abscesses. Proper management of kidney failure will reduce the morbidity and mortality of deep neck abscesses.