ObjectivesConservative management for retropharyngeal abscesses <2 cm is now a first line option. It is unclear if conservative management can be used to manage larger abscesses without increased morbidity and mortality.Study designA prospective case series was performed from 2012 to 2015 by the Otolaryngology department of the San Fernando General Hospital involving pediatric patients who presented with retropharyngeal abscesses. All patients were initially treated with antibiotics alone.MethodsPatients with clinical features and CT scan confirmation of a retropharyngeal abscess were included in the study. Those who improved clinically and biochemically within 48 h continued to be treated conservatively and those who deteriorated had surgical intervention.ResultsSixteen patients fulfilled the inclusion criteria. Most patients were Afro Trinidadian males between the ages of two and five who were also found to be iron deficient. Drooling was a sensitive predictor for the presence of an abscess but did not indicate the need for drainage. Hoarseness was the clinical feature that prompted surgical intervention. Sixty three percent of patients had an abscess >2 cm of which 90% improved within 48 h. One patient required surgical drainage with no increase in morbidity or mortality.ConclusionConservative management of retropharyngeal abscesses >2 cm can be offered to patients during the first 48 h. If the patient demonstrates clinical and biochemical improvement, antibiotics alone can be continued. If the patient deteriorates, surgical drainage can be subsequently performed with no increase in morbidity and mortality.
Aim: The thyroglossal duct cyst is the most common congenital cystic lesion in the neck. Seven percent of the population has persistence of this duct. It usually occurs in midline and is asymptomatic. The aim of this study is to see the epidemiology of this disease in an eastern Caribbean nation.Design and methods: An 11 year's retrospective study was performed at the San Fernando General Hospital from 1st January 2004 to 31st December 2014. All of patients who had a thyroglossal duct cyst excision from the surgical departments were reviewed. 17 patients were identified. Data on gender, ethnicity, age, reason for seeking medical attention and location of the cyst were extracted.Results: M:F was 7:10, Ethnic distribution: East Indians 65% and Africans 35%, age range birth 51 years, symptomatic patients 65% (unique description of an infected right lateral thyroglossal duct cyst with suprahyoid, anterior hyoid and infrahyoid components), location: midline 71% and right lateral 29% with no left lateral cases. Conclusions:Thyroglossal duct cysts at the San Fernando General Hospital have a mild female preponderance, range from birth to 51 years, is clinically evident soon after head and neck infection and have a higher occurrence of right lateral cysts at the suprahyoid level. An increased number of symptomatic and right lateral thyroglossal cysts were also noted in our population.
Cerebrospinal fluid leaks are rare but remain an important differential diagnosis for patients presenting with persistent, unilateral rhinorrhoea. This case describes a middle-aged female with persistent left sided rhinorrhea. She was minimally responsive to treatment for chronic sinusitis. On re-evaluation, a cerebrospinal fluid leak secondary to a meningoencephalocele was identified. This was subsequently repaired with a pedicled, vascularized graft using an endoscopic endonasal approach. The discussion which follows reviews the management of CSF rhinorrhoea with an emphasis on the available surgical options as well as the materials used for repair.
Pott’s puffy tumor is a non-neoplastic, Otolaryngological emergency. It is regarded as a rare clinical condition in the post-antibiotic era and a high index of suspicion is required for its diagnosis. The aetiology is multifactorial and includes sinusitis, infections, trauma, surgery, malignancy, substance abuse as well as contiguous spread along neurovascular bundles. These result in osteomyelitis and subperiosteal abscess formation within the frontal bone. Intracranial involvement can also occur and lead to serious complications. This is the case report of a 12-year old female who developed intermittent forehead swelling, headaches and pyrexia over a 2-week period. Radiological imaging identified changes consistent with a Pott’s puffy tumor complicated by an intracranial abscess. A combined open and endoscopic endonasal approach was used to drain the purulent collections and the patient was placed on antibiotics for a total of six weeks. The management of Pott’s puffy tumor will then be discussed.
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