Neck Abscesses In Children Research Articles

Surgical management of lateral neck abscesses in children: a retrospective analysis of 100 cases

Cervical abscesses are relatively common infections in pediatric patients. There is an ongoing debate about the necessity and time point of surgical drainage. The identification of a focus of infection might play an important role in facilitating a therapeutic decision. In a retrospective study, 100 pediatric patients aged 1–18 years who underwent incision and drainage of a lateral cervical abscess at our institution were analyzed. Patients were divided into two groups based on whether a focus of infection could be identified or not. Data collection included patient characteristics, microbiological results, antibiotic regimen, and clinical course. A focus of infection was found in 29% (29/100) of the patients, most frequently in the tonsils. A causative microorganism was found in 75% (75/100) of all patients, with Staphylococcus aureus and Streptococcus pyogenes being the most common pathogens. All patients received an empiric antibiotic therapy in addition to surgery. Antibiotic medication was changed in 31% in both groups (9/29 with a focus of infection and 22/71 without a focus of infection) during therapy. Children without an identified focus of infection generally were younger and had more comorbidities reducing immune response while also showing differences in the pathogens involved. There were no complications associated to surgery or antibiotic therapy in any of the patients involved.Conclusion: Children with an identified focus of infection show several differences compared to those with isolated lateral abscesses, especially regarding the microorganisms involved. But the focus of infection seems not to have an impact on patient’s outcome.What is Known:• Neck abscesses are a relatively common disease in the pediatric population and may cause serious complications.• Therapy in general consists of intravenous antibiotics with or without surgery.What is New:• The focus identification has no impact on patient’s outcome.• Children with an identified focus of infection show several differences compared to those with isolated lateral abscesses, especially regarding their medical history, age, and the microorganisms involved.

The changing microbiology of neck abscesses in children: implications for antibiotic therapy.

To provide an update on the microbiology, sensitivity rates and antibiotic prescribing patterns for superficial neck lymph node abscesses at Scotland's largest paediatric tertiary centre. Findings were compared to historical data from our institution. A retrospective case series was conducted of paediatric patients undergoing incision and drainage of a superficial neck lymph node abscess at the Royal Hospital for Children in Glasgow, from 2018 to 2021. Thirty-nine abscesses were identified. Methicillin-susceptible Staphylococcus aureus was the commonest micro-organism (28 per cent), followed by Streptococcus pyogenes (13 per cent). Eighty-two per cent of patients were administered a drug regimen containing co-amoxiclav. Only three children required a change in their antibiotics. There was a significant change in causative micro-organisms, including a decrease in S aureus and an increase in the Streptococcus anginosus group. Empirical use of co-amoxiclav is recommended. In abscesses showing no clinical improvement, second-line options such as clindamycin, cefotaxime and vancomycin should be considered.

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.

Deep Neck Abscesses in Children: An Italian Retrospective Study.

Retropharyngeal and parapharyngeal abscesses (RPAs, PPAs) usually affect young children. Surgical drainage and/or antibiotic therapy are treatment of choice, but no specific guidelines exist. In order to reduce the risk of severe complications, appropriate diagnosis and therapy are necessary. The aims of the study were to review diagnosis and management of children with RPAs/PPAs and to compare surgical versus medical approach. This is a multicenter retrospective study including all patients younger than 15 years admitted at 4 Italian pediatric hospitals of Florence, Padua, Rome, and Treviso, with International Classification of Diseases, Ninth Revision discharge diagnosis code of RPAs and PPAs, from January 1, 2008, to December 31, 2016. One hundred fifty-three children were included. The median age was 4.4 years, with overall male predominance. Heterogeneous signs and symptoms (fever, neck cervical, lymphadenopathy, pain, and stiff neck most frequently) and a large mixture of bacteria from pus cultures were detected. Computer tomography (66.7%) and magnetic resonance imaging (27.5%) were performed to confirm the presence of abscess. Fifty-one percent of abscesses were greater than 3 cm. Eighty-seven patients (56.9%) underwent surgery, and 66 (43.1%) were treated with antibiotics alone (mostly ceftriaxone, metronidazole, amikacin, and clindamycin) with median days of therapy of 26.5 days and length of therapy of 16.0 days of median. Median length of stay was 11 days. None had severe complications. Multivariate analysis indicated as independent predictive factors of surgery abscess of 3 cm or greater, high white blood cell count, and-most of all-the hospital of admission. Deep neck abscesses mostly affect patients in early childhood, with a combination of nonspecific signs and symptoms, and it still emerges as a heterogeneous approach in diagnosis and management of these infections. Thus, common shared protocols represent an essential tool in order to standardize care and improve patients' outcomes.

Diagnosis and treatment of deep neck abscess due to congenital piriform sinus fistula in children

IntroductionCongenital piriform sinus fistula is a relatively rare type of disease in clinical practice, most occurring during childhood, but doctors have insufficient knowledge regarding this disease, easily misdiagnosing it. ObjectivesThis study aimed to identify the characteristics of deep neck abscess due to congenital piriform sinus fistula in children. MethodsWe performed a retrospective study of 21 cases from January 2016 to August 2018 in our hospital. The onset age, clinical characteristics, auxiliary examination and clinical treatment of the patients was summarized to analyze the diagnosis, treatment characteristics and prognosis. ResultsChildren from 11 days to 12 years-old were enrolled, with an average age of 3.5 years. Twenty patients had left congenital piriform sinus fistula and 1 had right congenital piriform sinus fistula. Cervical enhanced computed tomography imaging showed gas-liquid equilibrium or air-shadow in the abscesses in 18 cases, and neck ultrasound demonstrated gas echo in the thyroid region in 10 cases. All patients underwent low temperature plasma to seal the internal fistula and returned to the hospital for electronic laryngoscope and neck ultrasound examination at 3 months, 6 months and 1year after the surgery. No recurrence occurred in any patient. ConclusionCongenital piriform sinus fistula is an important cause of deep neck abscess in children. The presence of purulent gas-liquid equilibrium or air shadow in cervical-enhanced computed tomography or ultrasound suggests a high possibility of the presence of an internal fistula, and endoscopic low temperature ablation can be done at the same time as the diagnostic endoscopy.

Presentation, diagnosis and management of neck abscesses in children.

The aim of the study was to analyze the presenting signs and symptoms, diagnostic procedures, clinical course, pathogenic organisms and management of neck abscesses in children. This retrospective medical records review comprised of 51 pediatric cases referred because of neck abscess from 2001 to 2014. Medical records of the patients were reviewed for demographic data, clinical presentation, treatment before referral, localization of the abscess, imaging evaluation, medical and surgical treatment, bacteriological data and complications. Average age of the patients was 4.9 years. 18 (35%) of the children were below one year of age. The submandibular was the most common area involved (41,2%). Contrast-enhanced computed tomography (CECT) was performed in 45% of patients mainly with deep neck abscesses. All CECT scans showed the fluid collections. In all but one of the patients treated surgically and diagnosed with ultrasound and/or CECT surgical intervention revealed presence of pus. The most common pathogen was Staphylococcus aureus- SA (78% of all isolates) of which 24% were methicillin resistant Staphylococcus aureus - MRSA. Clindamycin resistance was detected in 28% of all SA isolates and in 67% (4/6) of all MRSA isolates. All MRSA isolates were sensitive to vancomycin. CECT is reliable imaging technique for diagnosing deep neck abscesses in children. Infants with neck abscesses are at higher risk of having MRSA as offending pathogen which should be taken into consideration when considering empiric treatment. Vancomycin is recommended as empiric antibiotic therapy in newborns with neck abscess.

Benefits of ultrasound vs. computed tomography in the diagnosis of pediatric lateral neck abscesses

ObjectiveThere are no studies comparing the accuracy of ultrasound and computed tomography in the same population of pediatric patients with lateral neck abscesses. This case series assesses the accuracy of the two imaging techniques. MethodsOne hundred and forty imaging studies (ultrasound n=39 or CT n=101) that were performed from 2005 to 2011 prior to incision and drainage of a lateral neck mass at a tertiary care academic institution were retrospectively reviewed. All children 0–18 years of age with lateral neck abscesses who underwent CT or ultrasound imaging prior to drainage were included. Sensitivity, specificity, and positive and negative predictive values of ultrasound and CT were determined as compared to the gold standard, incision and drainage of the suspected abscess. ResultsIn children undergoing incision and drainage, the prevalence of an abscess was 89%. Ultrasound has a high specificity (100%) but a low sensitivity (53%). The positive predictive value (96%) is high while the negative predictive value is low (16%), assuming a positive abscess prevalence of 0.9. In contrast, CT has low specificity (18%) but slightly higher sensitivity (68%) compared to ultrasound. Similar to ultrasound, CT had low negative (6%) and high positive (88%) predictive values. ConclusionsThis study demonstrates that ultrasound may be an equivalently sensitive and more specific diagnostic tool when compared to CT in the work-up of lateral neck abscesses in children. It is safe and effective in diagnosis when there is an undetermined probability of an abscess.

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.

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

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

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.

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。

Treatment of piriform fossa sinuses with monopolar diathermy

Embryological remnants of third or fourth branchial pouches are a rare but important cause of recurrent neck abscesses in children. They are characterised by an internal opening in the piriform fossa. Traditional management involves surgical excision of the entire tract. We present our experience with the use of monopolar diathermy applied to the internal sinus opening as a treatment modality for this condition. A retrospective, case report review was performed. Four cases of piriform fossa sinus were treated with monopolar diathermy to the sinus opening via an endoscopic approach. The first three cases were treated in this way for recurrence, following external tract excision, while the fourth case had simultaneous excision of the tract and diathermy to the piriform fossa opening. There were no serious complications and no recurrence within a follow-up period ranging from nine to 27 months. Obliteration of the internal opening of these sinuses by endoscopic diathermy is a safe and effective management option for this condition, either as an alternative to or as an adjunct to external surgical excision of the tract.

Increased incidence of head and neck abscesses in children

To describe increasing incidence and changing microbiology of head and neck abscesses in children admitted to the hospital during the first quarters of 2000 through 2003. Retrospective data warehouse review identified 89 children less than 19 years of age admitted to a tertiary care pediatric hospital during the first quarters of 2000 through 2003 for suspicion of head and neck abscess involving the neck, face, and peritonsillar, retropharyngeal, and parapharyngeal spaces; and for orbital and intracranial complications of acute sinusitis. Outcome measures included the incidence of infection admissions and description of infection location and microbiology, calculated by chi2 technique. The incidence of infections increased in 2003. The greatest increase was in neck abscesses and complications of acute sinusitis. The increase in group A strep infections may be related to its biologic properties. Group A strep remains a significant cause of head and neck infections in children.

Clinical characteristics of deep neck abscess in children; 15 year experience in a university hospital

Purpose : The objective of this study was to clarify the presentation, associated preceding illness, pathologic organisms, treatment and outcome of deep neck abscess in children according to age and location. Methods : We retrospectively reviewed the in-patient charts of children treated at our hospital for deep neck abscess. Thirty-five such patients were identified as having been treated from March 1990 to December 2005. Results : A total of 35 were enrolled in our study: 25 boys and 10 girls. Their ages ranged from 11 months to 15 years. Presenting symptoms included mass, fever, irritability, trismus and dysphagia. The most commonly known associated preceding illness was viral upper respiratory infection (53%). The most common site of infection was the submandibular space (37%). Bacteria was identified in 16 patients. The most common pathogen was Staphylococcus aureus. Thirteen (37%) children recovered from the infection with conservative treatment and twenty-four (68%) children received surgical drainage. The duration of hospitalization was longer in the group who underwent surgery than in the group who were managed with conservative treatment. No complication occurred. Conclusion : Unexplained torticollis, trismus or irritability in children were suggestive of deep neck abscess. Our results demonstrate that deep neck abscesses in children is respond well to conservative treatment if diagnosed early.

A clinical study of deep neck abscess in children

Purpose : It has been reported that deep neck abscesses are recently increasing again. We analyzed pediatric cases with deep neck abscesses during the last several years to contribute to the treatment of the disease. Methods : The clinical data of 30 children under 16 years of age with deep neck abscess from February 2001 to July 2006 were analysed retrospectively. Results : The mean age was 9 years (2-16 years), and the male/female ratio was 19/11. Abscesses in the peritonsillar space were most common (57%), followed by the retropharyngeal (30%) and parapharyngeal (13%) spaces. Upper respiratory infection in 10 cases (33%), dental infection in four case (14%), cervical lymphadenitis in three case (10%) and sinusitis in two case (6%) contributed to the development of deep neck infections. The frequent symptoms were fever in 16 case (53%), sore throat in 15 case (50%), poor oral intake in 10 (33%), odynophagia in eight (27%), and neck pain in eight (27%). Unilateral tonsillar hypertrophy and displacement in 15 case (50%) were most common. Neck mass in 13 patients (43%), neck stiffness in three (10%) and trismus in three (10%) were also found. Bacteria were isolated in 8 among 10 pus cultures; Streptococcus species 7 and Micrococcus luteus 1. All of those bacteria except Micrococcus luteus were sensitive to penicillin G. Surgical intervention was applied to 12 cases (40%), and the remaining 18 patients (60%) were treated with antibiotics only. There were no differences between the two groups in the duration of admission and antibiotic treatment. No complicated cases were observed. Conclusion : Peritonsillar abscesses were most frequent. Upper respiratory infection was the most common predisposing factor, followed by dental infection and sinusitis. Symptoms of respiratory tract obstruction were not found. The most common pathogens were Streptococcus species. Deep neck abscesses in children, if diagnosed at the early stage, possibly can be treated by antibiotics only, without surgical intervention.

Increased incidence of head and neck abscesses in children

Objectives: Describe the changing incidence, microbiology and management of head and neck abscesses in children admitted during the first quarters of 2000–2003. Methods: Retrospective chart and data warehouse review in a tertiary care pediatric hospital. A broad range of ICD-9 codes were used to identify 965 potentially appropriate patient encounters in children <19 years admitted during the first quarters of 2000–2003 with possible head and neck abscesses, excluding mastoiditis. Data review confirmed 89 relevant infections. Outcome measures included incidence of infections relative to total hospital admissions evaluated by chi-square technique and evaluation of abscess location, management, and microbiology. Results: Forty-two of 2310 hospital admissions (1.8%) during the first quarter of 2003 were compared to 13 of 1791 (0.7%), 18 of 2141 (0.8%), and 16 of 2192 admissions (0.7%) in 2000, 2001, and 2002, respectively ( P < 0.004). 38 peritonsillar, retropharyngeal or parapharyngeal infections; 26 neck infections; 13 orbital or intracranial complications of acute sinusitis; and 12 facial infections were identified. Sixty-six (74%) were managed surgically, 2 additional ones were drained by needle aspiration. Various streptococcal species were identified in 28 cultures, staphylococcus in 6, atypical mycobacterium in 3, and other organisms in 20; cultures from some patients revealed multiple organisms. Conclusions: The incidence and proportion of head and neck infections in children admitted to the study hospital increased significantly during the first quarter of 2003. The most common organism identified was group A streptococcus. This is in agreement with reports from other institutions of an increasing incidence of streptococcal infections.

Microbiology and antibiotic treatment of head and neck abscesses in children.

The clinical data, microbiological results and antibiotic treatment of 65 children who have required incision and drainage of suppurative head and neck abscesses was retrospectively investigated with the aim of developing a more effective clinical protocol of treatment, improving speed of resolution and rationalizing the need for surgical intervention. A positive culture grew in 78% of children and of these 45% were Staphylococcus aureus, 9% Streptococcus pyogenes, and 8% atypical mycobacteria. Only 3% of the samples grew anaerobes. All isolates of S. aureus were sensitive to Flucloxacillin and all isolates of S. pyogenes were sensitive to penicillin. All anaerobes were Metronidazole sensitive. In 40% of the children there were no localizing symptoms which could guide the treatment, therefore we recommend Flucloxacillin and Metronidazole as the antibiotic regimen of choice in acute suppurative lymphadenitis. The increasing incidence of atypical mycobacterial lymphadenitis is noteworthy.

Relative incidence and alternative approaches for surgical drainage of different types of deep neck abscesses in children.

To determine the relative frequency of retropharyngeal abscesses (RPAs) vs lateral pharyngeal abscesses (LPAs) and to analyze alternative approaches for surgical drainage. Retrospective chart review. Tertiary care children's hospital. Seventy pediatric patients who were evaluated, admitted, and treated for presumed deep neck abscesses (RPAs and LPAs) between January 1, 1986, and December 31, 1996. Intravenous antibiotic therapy and surgical drainage. Clinical resolution of the abscess. Fifty-eight patients were evaluated with computed tomographic scan. Thirteen of these patients did not have surgical intervention. Of 12 patients diagnosed as having an isolated RPA, all had intraoral surgical drainage and 9 had evidence of pus at surgery. Twenty-one patients had an isolated LPA. Sixteen of these underwent intraoral drainage and 5 underwent external drainage. Purulence was found at surgery in 14 and 2 patients, respectively. The remaining 12 patients had a combination of RPA and LPA. Eight patients underwent intraoral drainage, and 4 patients required both intraoral and external approaches. Purulence was found at surgery in 5 and 4 patients, respectively. Of the 12 patients who were not evaluated with computed tomographic scan, two thirds were treated prior to 1987. Six of these 12 patients underwent surgical drainage via an intraoral approach, and 4 of the 6 patients had pus. The remaining 6 improved without surgery. Most deep neck abscesses in children are located in the retropharyngeal or in the lateral pharyngeal space medial to the great vessels. Therefore, most can be managed successfully with intraoral rather than external drainage. External approaches are better reserved for those abscesses that are lateral to the great vessels or that involve multiple spaces. In this patient population, LPAs were more commonly seen than RPAs.

Ultrasonography in the evaluation of neck abscesses in children.

A prospective study evaluating the benefits of preoperative ultrasonography of paediatric neck abscesses is presented. Twenty-three consecutive children who presented with suspected neck abscesses to the Accident and Emergency Department at the Temple Street Children's Hospital between 1990 and 1992 have been evaluated prospectively. On admission, ultrasonography showed a collection of pus in 11 children and these underwent incision and drainage. The other 12 had intravenous antibiotics. Six of these remained pyrexial and had a repeat ultrasound after 72 h revealing pus which was drained. The remaining were managed successfully with medical treatment. In this study there were no negative surgical interventions and we recommend ultrasonography for preoperative evaluation of children with suspected inflammatory neck abscesses.

小児深頚部膿ようの２症例

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