Deep Neck Abscess Research Articles

Deep Neck Abscesses in Children and Adolescents: 10 Year Experience in Two General Hospitals

Purpose : The purpose of this study was to review our recent experiences with deep neck abscesses in children and adolescents and to provide helpful information in treatment and diagnosis by comparing them with those in other available literatures. Methods : Medical records of 36 children and adolescents admitted for deep neck abscess at two hospitals from January 2000 to October 2010 were reviewed retrospectively. Results : Male to female ratio was 1.4 : 1 and the mean age was 6.5 years. Painful neck swelling and fever were the most frequent symptoms in patients under thirteen years of age whereas trismus and headache were frequent symptoms in patients over fourteen years of age. Submandibular space was the most common site of deep neck abscess in patients under thirteen years of age, whereas peritonsillar space was the most common site in patients over fourteen years of age. The results of bacterial cultures were positive in 61.5% of drained cases. Staphylococcus aureus was the most commonly identified bacteria in 6 patients (37.5%) and 5 of them were under 2 years of age. Twenty six patients received surgical drainage while the others were treated with antibiotics only. There were no statistically significant differences in the durations of admission, fever after admission, and antibiotic treatment between surgical and medical treatment groups. Conclusion : The common sites of deep neck abscess, associated symptoms, and causative organisms were different between children and adolescents. As there were no differences in durations of admission, fever, or antibiotics treatments between surgical and medical treatment groups, surgical drainage may be avoided by early recognition and suspicion. However, if there is no improvement of symptoms or size of abscesses within 48-72 hours of antibiotic treatment, surgical drainage should be considered.

Otogenic Anterior Chest Wall Abscess: A Rare and Unique Presentation of Bezold's Abscess

ABSTRACTIn the era of antibiotics, deep neck abscess is a rare complication of acute mastoiditis. Bezold's abscess, the most common cause of the otogenic deep neck abscess in preantibiotic era, is a rare complication of mastoiditis nowadays and it should be considered in the differential diagnosis of neck abscesses as well as unexplained intracranial/extracranial or upper thoracic abscesses. We report a case of 20-year old female with an abscess over anterior chest wall as a sequele of bezold's abscess which was a complication of cholesteatoma with mastoiditis.

Deep Neck Abscess in Children: Three Cases Treated with Surgical Drainage

Deep Neck Abscess in Children: Three Cases Treated with Surgical Drainage

Diagnosis and treatment of congenital fourth branchial anomaly

To discuss the anatomic features, clinical presentations, diagnosis, differentiations and treatments of congenital fourth branchial anomaly(CFBA). The clinical data of 8 patients with CFBA were retrospectively analyzed. Of the 8 patients aging from 27 to 300 months (median age: 114 months), 4 male and 4 female; 3 untreated previously and 5 recurrent. All lesions, including 1 cyst, 3 sinus (with internal opening) and 4 fistula, located in the left necks. Three patients presented acute suppurative thyroiditis, 4 deep neck abscesses, and 1 neck lump. Preoperative examinations included barium esophagogram, direct laryngoscopy, ultrasonography, CT, MRI, and so on. The principles of managements were adequate drainage, infection control during acute period and radical surgery during quiescent period. Classic surgical approach consisted of complete excision of branchial lesions, dissection of recurrent laryngeal nerve and partial thyroidectomy. Selective neck dissection was applied in recurrent cases to extirpate branchial lesions, scarrings and inflammatory granuloma. Postoperatively, 1 case was with local incision infection which healed by wound care; 1 case was with temporary vocal cord paralysis which completely recovered 1 month after operation. No recurrence was found in all of 8 cases with follow-up of 13 to 42 months (median: 21 months). CFBA relates closely anatomically with recurrent laryngeal nerve and thyroid grand. The barium esophagogram and direct laryngoscopy are the most useful diagnostic tools. CT and MRI are all beneficial to the diagnosis of CFBA. The treatment key to CFBA is the complete excision of lesion during a quiescent period after inflammatory control, together with the dissection of recurrent laryngeal nerve, partial thyroidectomy and partial resection of lamina of thyroid cartilage (if necessary), which all can decrease the risk of complications and recurrence. For recurrent cases, selective neck dissection is a safe and effective surgical procedure.

Deep neck abscesses: the Singapore experience

This study aims to review our experience with deep neck abscesses, identify key trends, and improve the management of this condition. This is a retrospective chart review of patients diagnosed with deep neck abscesses in the Department of ENT (Otorhinolaryngology) at Tan Tock Seng Hospital, Singapore between 2004 and 2009. Patient demographics, etiology, bacteriology, systemic disease, radiology, treatment, complications, duration of hospitalization, and outcomes were reviewed. 131 patients were included (64.9% male, 35.1% female) with a median age of 51.0 years. 54 (41.2%) patients had diabetes mellitus. The parapharyngeal space (23.7%) was the most commonly involved space. Odontogenic and upper airway infections were the leading causes of deep neck abscesses (28.0% each). Klebsiella pneumoniae (27.1%) was the most commonly cultured organism in this study and among the diabetic patients (50.0%). 108 (82.4%) patients underwent surgical drainage. 42 patients suffered complications. All 19 patients, who had upper airway obstruction, had either a tracheostomy or intubation. Patients with multi-space abscesses, diabetes mellitus, and complications had prolonged hospitalizations. Old age and diabetes are risk factors for developing deep neck abscesses and their sequelae. The empiric choice of antibiotics should recognize that a dental source is likely, and that Klebsiella is most common in diabetics. Surgical drainage and adequate antibiotic coverage remains the cornerstone of treatment of deep neck abscesses. Therapeutic needle aspiration may successfully replace surgical drainage, if the abscesses are small and no complications are imminent. Airway obstruction should be anticipated in multi-space and floor of mouth abscesses.

Emergency Imaging Assessment of Acute, Nontraumatic Conditions of the Head and Neck

Patients often present to the emergency department with a wide variety of nontraumatic infectious, inflammatory, and neoplastic conditions of the head and neck. Because the use of cervical and neck computed tomography (CT) has become routine in the emergency setting, knowledge of the imaging findings of common acute conditions of the head and neck is essential to ensure an accurate diagnosis of these potentially life-threatening conditions, which include oral cavity infections, tonsillitis and peritonsillar abscess, sialadenitis, parotiditis, diskitis, thrombophlebitis, periorbital and orbital cellulitis, infectious cervical lymphadenopathy, and various neoplasms. Less common conditions that require rapid diagnosis and treatment include epiglottitis, invasive fungal sinusitis, angioedema, and deep neck abscess. Familiarity with these conditions enables the radiologist to make a prompt diagnosis, assess the extent of disease, and evaluate for potential complications. CT is the first-line imaging modality in the emergency setting; however, magnetic resonance imaging plays an important secondary role.

Four cases of acute epiglottitis with a peritonsillar abscess

We report four cases of acute epiglottitis with a peritonsillar abscess originating from the inferior pole of the palatine tonsil. All cases were male, and presented with acute onset of sore throat and dysphagia. Flexible laryngoscopy revealed swollen epiglottis and swelling at the base of tongue along the edge of the epiglottis in all cases. Computed tomography (CT) revealed the position and extent of a peritonsillar abscess. Surgical drainage was not performed. Abscesses decreased in size following intravenous antibiotics and corticosteroids. We surmise that inflammatory exudates extending widely in the pre-epiglottic space cause epiglottic swelling from oropharyngeal infection, the latter of which is thought to produce a peritonsillar abscess. We recommend CT examination for patients with a stable airway and swollen epiglottis, even if the swelling is mild. This will allow for exclusion of deep neck abscess and determination of the most effective treatment including intravenous antibiotics against anaerobe, incision and drainage of an abscess.

Is surgical airway necessary for airway management in deep neck infections and Ludwig angina?

Background Deep neck infections are potentially life-threatening conditions because of airway compromise. Management requires early recognition, antibiotics, surgical drainage, and effective airway control. The Surgical Education and Self-Assessment Program 12 states that awake tracheostomy is the treatment of choice for these patients. Hypothesis With advanced airway control techniques such as retrograde intubation, GlideScope, and fiberoptic intubation, surgical airway is not required. Design A retrospective analysis of all deep neck abscesses treated from December1999 to July 2006 was performed. Methods All patients who underwent urgent or emergent surgery for Ludwig angina and submental, submandibular, sublingual, and parapharyngeal abscesses (Current Procedural Terminology codes 41015, 41016, 41017, 42320, and 42725) were included in our review. Charts were studied for age, presence of true Ludwig angina, presence of airway compromise, airway management, morbidity/mortality, and the requirement for surgical airway. Results Of 29 patients, 6 (20%) had symptoms consistent with true Ludwig angina. Nineteen (65.5%) had evidence of airway compromise. Eight (42%) of these 19 patients required advanced airway control techniques. No patient required a surgical airway, and no mortality resulted from airway compromise. Advance airway control techniques were required more often in patients with airway compromise ( P < .05). Conclusion Treatment of Ludwig angina and deep neck abscesses requires good clinical judgment. Patients with deep neck infections and symptoms of airway compromise may be safely managed with advanced airway control techniques.

Recurrent neck abscess due to a bronchogenic cyst in an adult

Neck abscesses can originate from congenital cervical cysts. Cervical cysts of bronchogenic origin are rare and often asymptomatic. Common symptoms of bronchogenic cysts are stridor, dyspnoea and dysphagia. The reported patient represents the second published case of a bronchogenic cyst causing a neck abscess in an adult. We report a case of a cervical bronchogenic cyst presenting as a recurrent supraclavicular abscess in a middle-aged woman. During extirpation, a fistula was demonstrated to the right upper lobe of the lung, suspected because the cyst inflated synchronously with respiration. The symptoms of bronchogenic cysts are due to the effects of compression or fistulas. In the majority of these cysts, a thorough investigation involving history, examination and radiological imaging does not clearly demonstrate a fistula. Therefore, extirpation is both diagnostic and therapeutic. A bronchogenic cyst is a very rare cause of a recurrent deep neck abscess. Total extirpation is the treatment of choice.

後腹膜膿瘍を併発した深頸部膿瘍例

Deep neck infection, which is serious and potentially life-threatening, has not decreased in frequency despite advances in antibiotics treatment. An 84-year-old woman with poorly controlled diabetes admitted April 25th 2008, for sore throat and a high fever was found in neck computed tomography (CT) to have a deep neck abscess. Despite good postoperative progress, her fever continued. Further careful examinations, in pelvic CT showed a retroperitoneal abscess, which was then treated and controlled with an intravenous antibiotics drip. We suspect that the deep neck infection had spread hematogeneously. Such deep infections in a compromised host must therefore be treated and controlled carefully.

Two Cases of Descending Necrotizing Mediastinitis Secondary to a Deep Neck Abscess

Descending necrotizing mediastinitis (DNM) can be occasionally caused by cervical deep infection and has a high mortality rate. Therefore, strategies for treating DNM have reported the need for surgical management as well as full antibiotics administration. We experienced two cases of DNM with deep neck abscesses. Neck and chest computed tomographic (CT) imaging of our cases revealed typical signs of neck abscesses and gas formation in mediastinum. In case 1, a 57 year-old-male patient could be rescued by both transcervical mediastinal drainage and mediastinal drainage with thoracotomy. Case 2 (a 59 year-old-male) was managed with transcervical mediastinal drainage without thoracotomy due to poor pulmonary function. The patient died on the 37th postoperative day. From our own cases and other reports, we suggest that early diagnosis with chest CT, and aggressive mediastinal drainage with the addition of a thoracotomy would be essential to improve DNM.

入院加療を行った深頸部膿瘍例の検討

We reviewed 42 cases of deep neck abscess drained surgically or treated conservatively between February 2001 and August 2008, based on age, gender, primary focus, main symptom, abscess location, systemic disease, pathogenic bacteria, hospital treatment, hospitalization length, complications and long-term hospitalization. Of the 42, 26 were men and 16 women aged 14 to 80 (central age: 54.5 years). Abscess was caused most by tonsil inflammation (38.1%). Main symptom were sore throat (54.8%) and neck swelling (35.7%). Abscesses were found in the supra- and infrahyoid region in 30 cases and extended to the mediastinum in 2. Of the 42, 14 (33.3%) had hypertension and 11 (26.2%) diabetes mellitus (DM). Inflammation was due to aerobic bacteria (mainly Streptococcus milleri) in 23 cases (54.8%) and to anaerobic bacteria (mainly Peptostreptococcus) in 11 cases (26.2%). Flexible fiberscopic examination was important in evaluating pharyngeal and laryngeal mucosal disorders and enhanced computed tomography was useful in both diagnosis and postoperative observation. Of the 42, 38 required surgical drainage and 4 were cured using needle aspiration and antibiotics. Of the 38 undergoing surgery-tracheostomy was required in 22. Hospitalization for those with tracheostomy and DM was longer than in those without these factors. Complications included 2 cases each of, mediastinal abscess, sepsis, disseminated intravascular coagulation (DIC), acute renal failure, severe pneumonia, upper digestive tract bleeding and swallowing disorder. Early surgical drainage and intravenous antibiotic administration are thus essential for treating deep neck abscesses.

深頸部感染症２９９例の臨床的検討

Deep-neck infection (DNI) remains potentially fatal. We retrospectively analyzed 299 surgically treated DNI cases between January 1997 and October 2007 by reviewing computed tomography (CT) results and discuss treatment and risk factors. Subjects were divided into two groups by abscess-site; peritonsillar abscess (PTA) (n=251) and deep-neck abscess (DNA) (n = 48). Age, smoking habits, body mass index (BMI) and bacteriological histories were collected from clinical records and compared by group. DNI and PTA severity parameters were C-reactive protein (CRP) titer and hospitalization length. Median subject age in DNI was 51.0 years and peak incidence in the 50s. Median subject age in PTA was 31.0 years and the peak incidence in the 20s. Smoker prevalence was higher in both groups than in normal healthy subjects. The DNI group had higher BMI and diabetes mellitus. Factors potentially most affecting illness were complications such as obesity and diabetes mellitus in DNI and age in PTA.

Deep Neck Abscess due to Urinary Tract Infection

Deep Neck Abscess due to Urinary Tract Infection

Thymic cyst: A fourth branchial cleft anomaly

We report a unique case of a fourth branchial cleft cyst found within the thymus of an adult patient. In the literature to date, there have been no reports of such a finding in the adult population. These anomalies can often cause recurrent acute suppurative thyroiditis or recurrent deep neck abscesses. Delay in recognizing the underlying etiology can lead to significant complications.

Bacteremic methicillin-resistant Staphylococcus aureus deep neck abscess in a newborn—Case report and review of literature

We describe an unusual localization of methicillin-resistant Staphylococcus aureus infection (MRSA) in a very young newborn. A 3-week-old male infant was admitted with fever, irritability, sialorrhea and stiffed left neck. The ENT examination revealed a deep neck mass and an ultrasound examination showed diffuse swelling of the left latero-pharyngeal area. A CT examination confirmed a deep neck abscess with difficult-to-define borders. Blood and nasopharyngeal cultures returned positive for MRSA. Treatment was started with intravenous teicoplanin and continued for 14 days with a marked decrease in abscess's dimensions and improvement in patient's general condition. MRSA should be suspected in the etiology and treatment of neck abscesses in newborns, infants and young children.

Experience with remedies for deep neck abscess in children.

目的探讨小儿颈深部脓肿的有效救治方法。方法对1998年1月至2008年10月收治的31例颈深部脓肿患儿的临床资料进行回顾性分析。根据患儿脓肿的部位分别采用不同径路的脓肿切开引流术，同时广谱抗生素足量联合应用，加强全身支持治疗；对并发的各种基础疾病请相关科室协同处理，重视可能出现的并发症并作相应的处理。结果本组4例患儿曾延误诊治，经CT检查确诊。1例糖尿病患儿在治疗脓肿的同时控制原有疾病，1例并发感染性休克患儿通过及时抢救和抗感染均痊愈。31例患儿治疗4～23d皆痊愈出院，有效治愈率100%。结论及时切开引流，合理应用多联抗生素，加强全身支持治疗，有效控制基础疾病以及重视并发症的处理是颈深部脓肿治疗成功的保证。

A case of brain abscess extended from deep fascial space infection

A case of brain abscess in the temporal lobe caused by direct intracranial extension of deep neck abscess is described. The abscess also spread to the orbital cavity through infraorbital fissure. The possible etiology of this case might be dental surgery. The diagnostic imaging clearly showed the routes of intracranial and -orbital extension of parapharyngeal and masticator space abscesses. From the abscess specimens, oral streptococci, anaerobic streptococci, and anaerobic gram-negative bacilli were isolated. Antimicrobial susceptibility testing of isolates showed that some Prevotella and Fusobacterium strains had decreased susceptibility to penicillin, and these bacteria produced beta-lactamase. The bacteria from the deep neck abscess were consistent with those detected from the brain abscess. Proper diagnosis, aggressive surgical intervention, and antibiotics chemotherapy saved the patient from this life-threatening condition.

Preoperative blood sugar and C‐reactive protein associated with persistent discharge after incision and drainage for patients with deep neck abscesses

The aim of this study was to investigate whether preoperative C-reactive protein (CRP) and blood sugar correlated with persistent discharge after incision and drainage for patients with deep neck abscesses. Retrospective data analysis. Tertiary referral centre. A total of 204 patients who underwent operation for deep neck abscess. Persistent discharge after operation. One hundred seventy patients were included for final analyses. Most of the patients were male (n = 115; 68%) and the average age was 54 years. Using logistic regression analyses, age >55 years [odds ratio (OR): 3.053; P = 0.002], preoperative CRP >15 mg/dL (OR: 2.174; P = 0.027), and preoperative blood sugar >8.3 mmol/L (OR: 3.280; P = 0.001) were independent factors correlated with persistent discharge. Older age, elevated preoperative CRP level and blood sugar had a statistically significant association with persistent discharge after operation in deep neck abscesses patients.

Deep neck abscess due to Acinetobacter baumannii infection

Acinetobacter baumannii strains are isolated in up to 1% of nosocomial infections mostly from intensive care units immunocompromised patients and are associated with high mortality rates. A baumannii infections include pneumonia, urinary tract infection, endocarditis, skin and soft-tissue infections, surgical-site infection, meningitis, osteomyelitis, and septicemia. We report an extremely rare case of deep neck abscess due to multidrug-resistant A baumannii infection. The isolate strain was analyzed by a repetitive sequence-based polymerase chain reaction typing method: the isolate profile was compared with other strains obtained from isolates recovered in the hospital in that period. Our patient underwent 2 neck explorations and antibiotic treatment (tigecycline 50 mg, twice per day). Five weeks after admission, the patient was discharged in good general conditions. Considering the other obtained strains, 4 different profiles were identified, one as prominent (profile A, 18 isolates), the index case (B), and 2 others (C, D) as divergent.