Neck Abscess Research Articles

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

Cavernous Sinus Thrombosis Secondary to Streptococcus Constellatus Pharynges

Streptococcus constellatus pharyngis is a gram-positive commensal bacterium commonly found in the oropharynx, gastrointestinal and urogenital tracts. It might be an aggressive opportunistic pathogen causing invasive pyogenic infections in sterile areas, mostly as peritonsillar and orofacial abscesses. We report the case of a 6-year-old girl, who presented multiple head and neck abscesses and bilateral cavernous sinus thrombosis secondary to Streptococcus constellatus pharyngis. Cavernous sinus thrombosis, consequent to this microorganism, has not been reported to date in the literature. Due to the invasive features of this pathogen, a long-term antibiotherapy (up to 9 months) is required. Additionally, a surgical drainage is indicated in case of head and neck, or brain abscesses, larger than 20 or 25 mm respectively. Anticoagulation should be considered in case of venous thrombosis. The interest of this case is not only based on the rarity and severity of the disease, but also on the success of medical and surgical therapy (including long- term antibiotics, anticoagulation and two surgical procedures). This experience may serve as a guide to treat future cases.

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

Swallowing the Unexpected: A Case Report on an Unusual Presentation of Esophageal Malignancy.

Head and neck malignancies presenting with a neck abscess as the primary symptom are uncommon and may result in a misdiagnosis or delay in diagnosis and appropriate treatment. Here we report on a rare case where a young adult presented with signs and symptoms of a retropharyngeal abscess, which was later identified as an esophageal malignancy.

Tuberculosis, neck abscess a case report and literature review

This case report discusses the diagnosis and management of TB in a 35-year-old male patient of Asian origin living in Ireland. The patient presented with neck abscess, fatigue, and low energy levels. Clinical examination revealed a neck lump with a discharging wound. Further investigations, such as imaging, blood tests, and histopathology, led to the diagnosis of tuberculosis (TB). The tests further showed pulmonary nodules and enlarged lymph nodes. The patient's QuantiFERON test was positive, indicating latent TB infection. Various diagnostic tests were conducted to rule out other infections and autoimmune conditions. Treatment involved incision and drainage of the neck abscess and a combination of anti TB drugs such as isoniazid, pyrazinamide, rifampicin, and ethambutol. Providing a significant focus and conducting comprehensive diagnostic evaluations is crucial for effectively treating extrapulmonary TB. It is imperative to quickly identify, manage, and take preventative measures in order to achieve the optimal patient outcome when dealing with TB.

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.

The Etiological Bacterial Spectrum of Neck Abscesses of Lymph Node Origin - Gram-Positive and Gram-Negative Bacteria.

According to our medical practice as maxillofacial and oral surgeons, operated patients with purulent infections of the cervical lymph nodes are not many in number. On the other hand, the presence of a purulent infection requires not only the surgical evacuation of the pusbut also the application of antimicrobial preparations. This necessitatesgood knowledge of the spectrum of the bacterial causative agents of the disease, the determination and analysis of which is the purpose of this original article. The bacteria studied in 181 patients with a mean age of 26.25 years, ranging between 29 days and 82 years, who underwent surgery for suppurating cervical lymph nodes, were retrospectively analyzed over a period of eight years. No bacteria were found in 69 of them. In 83 (74.11%) of the remaining 112 studied patients, the isolated microorganisms were of the gram-positive spectrum - Staphylococcus aureus (n=34), gram-positive resident microflora represented by more than one bacterial species (n=21), Staphylococcus hemolyticus (n=10), Staphylococcus epidermidis (n=9) and beta-hemolytic streptococci (n=9). Gram-negative bacteria were 25.89% (n=29) - Klebsiella pneumoniae (n=8), Bartonella henselae (n=7), Klebsiella oxytoca (n=6), Enterobacter cloacae (n=5) and Flavimonas oryzihabitans (n=3). No anaerobic and fungal microorganisms were isolated. Therefore, antimicrobial therapy in these patients should be directed against both gram-positive and gram-negative bacteria, which in our study were represented in a ratio of approximately three to onein favor of gram-positive microorganisms. Otherwise, we create a prerequisite for the formation of phlegmon on the neck, which hides real chances for the lives of patients.

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.

Perplexing First Branchialcleft Anomalies-A Case Series with Review of Literature.

Incomplete obliteration of the branchial apparatus results in the formation of branchial cleft anomalies. First branchial cleft anomalies may persist anywhere in the first branchial arch, from the external auditory canal at the level of the bony cartilaginous junction to the submandibular triangle. The majority of cases present in childhood as an opening in the skin though they may present as cysts or neck masses, mostly mistaken for neck abscesses which leads to inadequate treatment and complications. Here different cases of first branchial cleft anomalies with variable presentation and treatment are illustrated. The need for proper diagnosis and adequate treatment cannot be overemphasized to avoid mismanagement and complications.

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.

Extraluminal migration of a foreign body: A bolt from the blue

Abstract One of the most frequently encountered emergencies in otolaryngology practice is ingested foreign body. In most cases, patients present within the first 24–48 h of ingestion with complaints of foreign body sensation or difficulty in swallowing. Few of these foreign bodies can perforate the upper digestive tract and an even smaller number of these can migrate extraluminally. The late presentation may result in more life-threatening complications such as neck abscess, mediastinitis or perforation, and injury to the common carotid artery. Here, we report a rare case of fish bone migration to the thyroid gland.

Preoperative computed tomography, surgical treatment and long-term outcomes of dogs with abscesses on migrating vegetal foreign bodies and oropharyngeal stick injuries: 39 cases (2010-2021).

This study evaluated success rates of surgical treatment of head and neck abscesses and draining tracts for suspected migrating vegetal foreign body and oropharyngeal penetrating injuries, and compared the outcomes according to whether a vegetal foreign body was identified in preoperative computed tomography (CT) examination. This retrospective study involved 39 dogs that underwent CT and subsequent surgical exploration of abscesses and/or draining tracts in the head and neck, in a single institution between 2010 and 2021. Recorded data included signalment, history, physical examination, CT and surgical findings. The postoperative follow-up period was at least 8 months. Cases were classified according to whether a foreign body was identified on CT or was only suspected because of the presence of cavities and/or draining tracts on CT. A vegetal foreign body was identified on CT in 11 of 39 cases and later confirmed at surgery in 10 cases. In 28 of 39 cases, a vegetal foreign body was not identified on CT, but in seven of these 28 cases it was found at surgery. Resolution of clinical signs was achieved in 11 of 11 cases when a vegetal foreign body was identified on CT and in 26 of 28 cases without a foreign body identified on CT. Two cases of recurrence were observed in animals in which no foreign body was detected. In this population of dogs undergoing surgery after preoperative CT scan, we observed resolution of clinical signs after a single surgical procedure in 95% of the cases. All animals in which a foreign body was identified were cured.

Salivary bypass tube in managing persistent and large pharyngocutaneous and tracheoesophageal fistulas: a series of seven cases

BackgroundA salivary bypass tube (SBT) is a silicone tube that directs oral content from the mouth to the esophagus. We studied a series of seven cases of persistent and large neck fistulas of different aetiologies to assess the beneficial use of SBTs in each case.Case presentationA total of seven patients underwent SBT insertion, six cases were post-total laryngectomy with underlying laryngeal malignancy, and one case was poor wound healing of a neck abscess after extensive drainage. Five cases have pharyngocutaneous fistula (PCF) and two cases have tracheoesophageal fistula (TEF), and all of the cases have failed conservative and multiple surgical management for fistula closure, with some concurrently having neopharynx stenosis. Post-insertion, all patients were able to eat orally after day 2 to 1-week. The duration of tube usage was one month in the three cases of persistent PCF post-operatively, and in two cases, the fistula was healed and the tube was removed without fistula recurrence. The other four cases (three post-radiotherapy fistulas and one stoma recurrence) were planned for lifelong use, with the duration of usage ranging from 4 months to 3 years. The outcome is their fistula is dry, and they tolerate the tube well. There were no intraoperative or immediate postoperative complications, and no complications were observed in the temporary usage cases. Among the patients who had to use the tube for a longer term, one had localised pressure necrosis of regional soft tissue that resolved after tube adjustment, and another had a loose-fitting tube that displaced distally into the oesophagus and resolved with a larger tube.ConclusionsSBT is safe, easy-to-apply, reduces morbidity, improves mental health, reduces inpatient stay, and overall improves the patient's quality of life in the management of persistent and large TEF and PCF for temporary or long-term usage.

HYPORT: Phase 1 Study of 3-Week Hypofractionated Postoperative Radiation Therapy for Head and Neck Squamous Cell Carcinoma

Shortening the overall radiation therapy (RT) treatment time has advantages in cost and treatment burden, but data on hypofractionated RT in head and neck squamous cell carcinoma are limited. This study assessed the safety of moderately hypofractionated RT in the postoperative setting. Patients with completely resected stage I-IVB squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx with intermediate risk factor(s) including T3/4 disease, positive lymph node(s), close margin(s), perineural invasion, and/or lymphovascular invasion were enrolled on a rolling 6-design phase 1 study. Levels 0 and 1 consisted of 46.5 Gy in 15 fractions delivered 5 days a week and 44.4 Gy in 12 fractions delivered 4 days a week, respectively. The primary endpoint was maximum tolerated dose/fractionation of moderately hypofractionated postoperative RT. Twelve patients were enrolled with 6 each on levels 0 and 1. No patient experienced a dose-limiting toxicity or grade 4 to 5 toxicity. Acute grade 3 toxicity occurred in 2 patients on level 0 (weight loss, neck abscess) and 3 patients on level 1 (all oral mucositis). One patient on level 0 experienced late grade 3 toxicity (persistent neck abscess). With a median follow-up of 18.6 months, 2 patients on level 1 had a recurrence: a regional recurrence in the undissected, unirradiated contralateral neck from a well-lateralized tonsil primary and an in-field local recurrence of oral tongue primary. The maximum tolerated dose/fractionation was determined to be 44.4 Gy in 12 fractions, but owing to more favorable tolerability in the setting of equivalent biologically effective dose, 46.5 Gy in 15 fractions was deemed the recommended phase 2 dose/fractionation. Moderately hypofractionated RT delivered over 3 weeks is well tolerated in the short term in this phase 1 cohort of patients with head and neck squamous cell carcinoma following surgical resection. The follow-up phase 2 randomized trial will deliver 46.5 Gy in 15 fractions as the experimental arm.