Deep Neck Abscess Research Articles

多彩な頭頸部病変を呈した <i>Peptostreptococcus micros</i> による敗血症性肺塞栓症の 1 例

A 46-year-old man with no underlying diseases visited our hospital with otorrhea, ocular motility disorder of the left eye, dizziness and loss of appetite which had lasted for two months. Chest radiography and computed tomography (CT) showed bilateral multiple pulmonary nodules and cavities. Furthermore, CT of the head and neck revealed bilateral mastoiditis, a left orbital abscess and a deep neck abscess. Peptostreptococcus micros was cultured from blood and otorrhea specimens. In addition, P. micros DNA was detected with the polymerase chain reaction (PCR) method in the specimens from the site of culture-negative lesions (i.e. sputum, bronchoalveolar lavage, neck abscess). Thus, we diagnosed the lung lesions as septic pulmonary embolisms (SPEs). The clinical findings of the head and neck had improved following antibiotics treatment for five weeks, and follow-up chest radiography and CT showed that all lesions almost disappeared. Since some SPE patients demonstrate a slow progression, SPE should be included in the differential diagnosis of multiple pulmonary nodules such as Wegener's glanulomatosis or neoplasm.

A Case of Internal Jugular Vein Thrombosis and Deep Neck Abscess Caused by Long-term Placement of a Central Venous Catheter

A Case of Internal Jugular Vein Thrombosis and Deep Neck Abscess Caused by Long-term Placement of a Central Venous Catheter

Pediatric deep neck abscess: Significant points in children

Pediatric deep neck abscess: Significant points in children

Clinical features of deep neck abscesses in elderly patients

Clinical features of deep neck abscesses in elderly patients

Three cases of pediatric deep neck abscess

Three cases of pediatric deep neck abscess

To drain or not to drain – Management of pediatric deep neck abscesses: A case–control study

Optimal management of deep neck abscesses has been the subject of debate for more than a century: surgical drainage has been the mainstay of treatment, but recently many centres have reported successful non-operative management in selected cases. ObjectivesOur objective was to review the management of deep neck abscesses in our institution and to identify characteristics that would predict successful non-operative management. MethodsA retrospective chart review from January 2001 to August 2010 was performed. Children up to age fifteen years with a CT-confirmed diagnosis of retropharyngeal or parapharyngeal abscess were included. A case–control study of small deep space neck abscesses (≤25mm maximal diameter) was performed, comparing antibiotic treatment alone with antibiotics plus abscess drainage. Results54 children met the inclusion criteria, of whom half had abscesses ≤25mm diameter. Younger children within the group with smaller abscesses were more likely to need surgical drainage (p<0.05). Of 13 children requiring operative management, ten underwent a period of antibiotic treatment and observation prior to surgery, eight (80%) had fever beyond 48h compared with three (23%) in the non-surgical group (p<0.01).27 children had an abscess >25mm diameter on CT scan, four (15%) of whom responded quickly to antibiotics and were managed non-operatively, while the rest underwent surgery. There were no significant differences between the surgical and non-surgical group characteristics with larger abscesses. ConclusionHigh dose intravenous antibiotics are an effective treatment for deep space neck abscesses and may obviate the need for surgical drainage, particularly in smaller abscesses. Children who do not respond quickly to antibiotics are more likely to require surgery to achieve resolution. Children with larger abscesses may respond to antibiotic therapy alone but should be closely observed. A trial of high dose intravenous antibiotics in stable children with close observation is warranted as first line treatment, especially for small deep space neck abscesses.

Antibiotic therapy for pediatric deep neck abscesses: A systematic review

ObjectiveTo evaluate the current evidence regarding the safety and efficacy of medical management for deep neck abscesses in children. Data sourcesPubmed and Embase databases accessed 3/27/2012. Review methodsAn a priori protocol defining inclusion and exclusion criteria was developed to identify all articles addressing medical therapy of pediatric deep neck abscesses where details regarding diagnostic criteria, specifics of medical therapy and definitions of failure were presented. The search included electronic databases to identify candidate articles as well as a manual crosscheck of references. The level of evidence was assessed and data extracted by three authors independently. Data were pooled using a random effects model due to significant study heterogeneity. ResultsEight articles met inclusion criteria. The overall level of evidence was grade C. There was significant heterogeneity among the studies (I2=98.8%; p<.001). However, each article uniformly presented cases suggesting that medical therapy may be a viable alternative to surgical drainage in some patients. The pooled success rate of medical therapy in avoiding surgical drainage in children with deep neck infections was 0.517 (95%CI: 0.335, 0.700). When patients taken immediately to surgery were excluded and patients were placed on author defined medical protocols, the success rate increased to 0.951 (95%CI: 0.851, 1.051). Subgroup analysis by duration of intravenous antibiotic trial greater than 48h demonstrated a pooled success rate of 0.740 (95%CI: 0.527, 0.953). ConclusionThe current literature suggests medical management may be a safe alternative to surgical drainage of deep neck abscesses in children. However, the level of evidence lacks strength and further investigation is warranted.

Backyard hazard: a case series of ingested grill brush bristles and a novel approach to extraction

ObjectivesTo report a small case series of an unusual ingested foreign body and a new method for removal of tongue base foreign bodies. MethodsThree patients were identified with wire bristle foreign bodies between 2009 and 2011 at our academic tertiary medical center. Their medical records were reviewed and are described in this report. ResultsEach patient presented to our medical center with progressive pain after ingestion of barbecued food. For 2 patients, the metallic bristle foreign body was imbedded within the lingual tonsil. In these 2 cases, radiofrequency plasma ablation (coblation) assisted partial lingual tonsillectomy was performed to identify the foreign body. In a third case, the foreign body presented as a complex deep space neck abscess and an open trans-cervical approach was required. ConclusionWhile oropharyngeal and esophageal foreign bodies are common, there are only a few case reports describing this particular foreign body. The presentation of an imbedded wire grill brush bristle can be insidious. Persistent pain and foreign body sensation should be taken seriously in patients with a history of barbecue food ingestion. Intraoperatively, wire bristles can be difficult to localize and extract. Radiofrequency plasma assisted lingual tonsillectomy may be helpful for identifying and removing foreign bodies that are imbedded in the tongue base. Grill brushes should undergo stringent safety regulation, as ingested wire bristles are difficult to localize and remove and may cause significant morbidity.

当科で経験した小児深頸部膿瘍の 2 例

当科で経験した小児深頸部膿瘍の 2 例

English

This study aimed to investigate and compare the frequency of toothbrushing and dental health status between Deep neck space infection (DNSI)&nbsp;patients with dental origin and healthy population. 64 participants were included in this study&nbsp;in the form of&nbsp;two groups. The first group consisted of&nbsp;34 DNSI patients with dental onset, and&nbsp;the second group consisted of&nbsp;30 participants (control&nbsp;group).&nbsp;Study was carried out in two separate categories:&nbsp;the frequency of toothbrushing and assessment of dental health status. Toothbrushing frequency was evaluated with a questionnaire. Dental health status was assessed for periodontal and dental disease&nbsp;by&nbsp;periodontist according to the some widely used indicators; DMFT scores, Plaque Index score, Gingival Index score and Sulcus Bleeding Index score. Present study showed that the majority had brushed their teeth occasionally. In DNSI group, the percentage of never toothbrushing was very high andregular&nbsp;toothbrushing&nbsp;rate&nbsp;was so low. DNI group has higher scores than the control group and this indicates poor oral hygiene. Our results showed that,&nbsp;oral health was impaired and regular toothbrushing&nbsp;seems to&nbsp;have been neglected&nbsp;in DNSI group. In our opinion, this negligence is a very important contributory factor towards the more occurrence of deep neck abscess. &nbsp; Key words:&nbsp;Deep neck infection, toothbrushing, dental caries, dental health,&nbsp;DMFT.

Vacuum‐assisted closure for managing neck abscesses involving the mediastinum

A 57-year-old immunocompetent male patient with a deep neck abscess involving the mediastinum was referred to us following unsuccessful treatment at his local hospital with medical therapy and ultrasound-guided aspiration. After initial evaluation and resuscitation, a contrast-enhanced computed tomography (CT) scan was performed, and the patient was transferred for surgical drainage. A vacuum-assisted closure (VAC) device was used as a surgical drain to help prevent reaccumulation of the purulent collections. A repeat CT scan on day 3 confirmed the absence of residual pus in the mediastinum and in the neck spaces, and the VAC device was removed. Perfect healing of the deep tissues with successful mediastinal toilette was observed. The patient resumed oral meals on postoperative day 10, and 2 days later he was discharged. A 1-month follow-up CT again demonstrated the complete healing and absence of the neck abscess. This case illustrates the possibility of avoiding more extensive and life-threatening procedures, such as open thoracotomy, in the treatment of neck abscesses extending into the mediastinum, and highlights the utility of VAC in the management of deep neck abscesses.

A Comparative Study of Deep Neck Abscess with Regards to Anatomical Location and Age Groups Using CT and Clinical Data

Copyrights © 2012 The Korean Society of Radiology Purpose: To evaluate differences anatomical location and age groups on CT and clinical data in deep neck abscess. Materials and Methods: This study included 200 patients who underwent CT and were diagnosed with a deep neck abscess, from December 2005 to July 2010. Patients were divided into four groups by age (children, adolescent, adult, elderly). Next, the anatomic location, location multiplicity and clinical data regarding the deep neck abscesses were analyzed restrospectively. The deep neck abscesses observed were defined as superficial or deep and partitioned into sub-groups, with further analysis of their clinical data. Results: The incidence of the parapharyngeal abscess was more frequent in children and elderly groups (p < 0.05). The masticator abscess was only observed among patients in the elderly group (p < 0.05). Multiple locations were observed with increased frequecy in children and elderly groups (p < 0.05). Swelling in the neck was more frequently observed in children and elderly groups (p < 0.05), cervical lymphadenitis was frequently seen in children and adolescent groups (p < 0.05), and the incidence of symptoms including sore throat were significantly increased in adolescent and adult groups (p < 0.05). Location multiplicity was significantly higher in parapharyngeal, retropharyngeal, submandibular, danger, visceral and masticator spaces than other spaces (p < 0.05). With regards to anatomic location, neck swelling was more frequent in superficial group and sorethroat was more frequent in deep group (p < 0.05). Conclusion: Deep neck abscess would show significant differences with regards to the abscess location, location multiplicity, and clinical symptoms according to age. The clinical symptoms observed are dependent on the anatomic location as defined by a superficial or deep abscess. A Comparative Study of Deep Neck Abscess with Regards to Anatomical Location and Age Groups Using CT and Clinical Data 해부학적 위치와 연령에 따른 심경부농양의 전산화단층촬영 소견과 임상적 특징의 비교 연구

Pediatric deep neck abscess: A retrospective review of 10 cases

Pediatric deep neck abscess: A retrospective review of 10 cases

当院における深頸部膿瘍11症例の検討

当院における深頸部膿瘍11症例の検討

Clinical Study of Deep Neck Abscesses

Clinical Study of Deep Neck Abscesses

MRSA deep neck abscesses: treatment implications

Purpose: Methicillin-resistant Staphylococcus aureus is an unusual finding in abscesses of deep fascial planes of the neck. This case report highlights MRSA found in the deep neck spaces in an otherwise healthy adult individual. The patient in question was treated with multiple incision and drainage procedures, tracheotomy, and culture-guided antibiotic therapy with concomitant infectious disease support. A review of literature to evaluate the incidence of such cases as well as the indicated surgical treatment is discussed.

Craniocervical necrotizing fasciitis: Radiologic findings in comparison to deep neck abscess

Objectives: Craniocervical necrotizing fasciitis (CCNF) is a rare life threatening soft tissue infection that results primarily in necrosis of fascial planes. The early stage of disease, clinically is similar to those of deep neck infections, which occur much more frequent. Radiologic findings are used to distinguish these two entities and early diagnose a CCNF.

Nasopharyngeal Carcinoma Presenting as Deep Neck Abscess

Objective: Nasopharyngeal carcinoma (NPC) is endemic in South East Asia and is the fifth most common cancer in Singapore. The most common presenting symptom is cervical nodal metastasis. There have been only 2 reports of NPC presenting as deep neck abscesses. We present our experience with 4 patients. Method: Retrospective review of the archives of patients admitted for deep neck abscesses from 2 tertiary hospitals from November 2006 to September 2010 revealed 4 patients with a nasopharynx primary. Results: The 4 patients consist of 3 males and 1 female with a mean age of 50 years (range, 32-63 years). All patients presented with fever and a painful fluctuant neck mass. Incision and drainage was performed in 2 patients who did not improve symptomatically from intravenous antibiotics. Computer tomography (CT) showed deep neck abscess in all patients and a nasopharyngeal primary only in 2 patients. Repeat physical examination showed nasopharyngeal mucosa irregularity in these patients and biopsy performed showed undifferentiated NPC. Three patients were stage 4 NPC while 1 patient was stage 2. Conclusion: The nasopharynx should be carefully examined in patients presenting with deep neck abscess even with normal CT findings, especially in countries where NPC is endemic. Deep neck abscess may be the initial presentation of NPC.

Bacteriology of Deep Neck Abscesses: A Retrospective Review of 96 Cases

ObjectiveReview the microbiology of deep neck abscesses and identify the factors that influence their occurrence.MethodRetrospective chart review of 96 patients diagnosed with deep neck abscesses in the Department of ENT at Tan Tock Seng Hospital, Singapore between 2004 and 2009. Logistic regression was applied to analyze and compare the incidence of common organisms in various conditions (age, gender, etiology, and effect of diabetes).ResultsOf the 96 patients recruited, 18 had polymicrobial cultures. The leading pathogens cultured were Klebsiella pneumoniae (27.1%), Streptococcus milleri group (SMG) bacteria (21.9%), anaerobic bacteria ‐ not otherwise specified (NOS) (20.8%). Klebsiella pneumoniae (50.0%) was over‐represented in the diabetic group. SMG bacteria (68.8%) and anaerobic bacteria ‐ NOS (43.8%) were most commonly isolated in patients with odontogenic infections. Klebsiella pneumoniae was found more commonly among the female patients (39.3%). Klebsiella pneumoniae was the most common organism cultured in parapharyngeal space abscesses, while the submandibular space and parotid space most commonly isolated SMG bacteria and Staphylococcus aureus respectively.ConclusionBroad‐spectrum antibiotics are recommended for treating deep neck abscesses. Empirical antibiotic coverage against Klebsiella pneumoniae infection in diabetic patients and SMG and anaerobic bacteria in patients with an odontogenic infection is advocated. Routine antibiotic coverage against gram‐negative bacteria is not paramount.

Deep neck space infections: a retrospective review of 173 cases

Purpose The purpose of this study is to review our recent experience with deep neck infections and emphasize the importance of radiologic evaluation and appropriate treatment selection in those patients. Materials and Methods The records of 173 patients treated for deep neck infection at the Department of Otolaryngology and Head and Neck Surgery of Dicle University Hospital during the period from 2003 to 2010 were retrospectively reviewed. Their demography, symptoms, etiology, seasonal distribution, bacteriology, radiology, site of deep neck infection, durations of the hospital admission and hospital stay, treatment, complications, and outcomes were evaluated. The findings were compared to those in the available literature. Results Dental infection was the most common cause of deep neck infection (48.6%). Peritonsillar infections (19.7%) and tuberculosis (6.9%) were the other most common cause. Pain, odynophagia, dysphagia, and fever were the most common presenting symptoms. Radiologic evaluation was performed on almost all of the patients (98.3%) to identify the location, extent, and character (cellulitis or abscesses) of the infections. Computed tomography was performed in 85.3% of patients. The most common involved site was the submandibular space (26.1%). In 29.5% of cases, the infection involved more than one space. All the patients were taken to intravenous antibiotic therapy. Surgical intervention was required in 95 patients (59.5%), whereas 78 patients (40.5%) were treated with intravenous antibiotic therapy alone. Life-threatening complications were developed in 13.8% of cases; 170 patients (98.3%) were discharged in stable condition. Conclusion Despite the wide use of antibiotics, deep neck space infections are commonly seen. Today, complications of deep neck infections are often life threatening. Although surgical drainage remains the main method of treating deep neck abscesses, conservative medical treatment are effective in selective cases.