A prospective study of 113 deep neck infections managed using a clinical practice guideline

Saluja, Saurabh; Brietzke, Scott E.; Egan, Kristin K.; Klavon, Susan; Robson, Caroline D.; Waltzman, Mark L.; Roberson, David W.

doi:10.1002/lary.24168

Cited by 34 publications

(28 citation statements)

References 14 publications

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“…With airway compromise, immediate I&D is recommended 10. The management of a small abscess (cross-sectional area of <2 to 3 cm 2 ) without airway compromise is a topic of debate currently with some authors offering a conservative approach of intravenous antibiotics,10 with others offering immediate surgery 11…”

Section: Discussionmentioning

confidence: 99%

Kicked to touch: Hoodwinked by torticollis

Donald¹,

Goldrick²,

Fhoghlu

et al. 2017

BMJ Case Reports

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A 2-year-old girl presented to the emergency department with a 3-day history of a painful stiff neck after getting a kick to her head from her older brother. Her general practitioner had recently started her on oral antibiotics for otitis media. Plain film imaging of her cervical spine on admission revealed anterior subluxation of C2 on C3 suggestive of bifacetal dislocation. Subsequent CT imaging confirmed malalignment of the upper cervical spine. The patient was admitted and worked up with MRI of the cervical spine which unexpectedly revealed a large 4×2 cm retropharyngeal abscess extending from C1 to C4. No associated structural abnormality of the spine was detected. This case report highlights the life-threatening causes of torticollis (retropharyngeal abscess and cervical spine injury), and summarises the anatomy and normal variants that one should expect on interpretation of cervical spine imagery.

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Section: Discussionmentioning

confidence: 99%

Kicked to touch: Hoodwinked by torticollis

Donald¹,

Goldrick²,

Fhoghlu

et al. 2017

BMJ Case Reports

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“…Albeit the general consideration that children are less likely to experience DNI than adults and are better candidates for conservative and medical treatments, a recent literature against this preconception prompted us to review our experience (4,8,9). Yang et al (9) discussed 130 patients in their study that included both adult and child patients.…”

Section: Discussionmentioning

confidence: 99%

“…As clearly understood from the views of the authors mentioned above, one of the criteria for making the decision for or against the medical care originated from radiological, particularly neck CT, outcomes. Regarding this topic, Saluja et al (8) explained the indicators of abscess, cellulitis, and lymphadenitis in detail. According to the authors, absence of clear central hypodensity and ring enhancement referred to cellulitis whereas the opposite should be considered as an abscess.…”

Section: Discussionmentioning

confidence: 99%

A New Trend in the Management of Pediatric Deep Neck Abscess: Achievement of the Medical Treatment Alone

Çetin

Olgun

Özses

et al. 2017

Turk Arch Otorhinolaryngol

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Objective: Albeit the traditional opinion that advocates a routine surgical drainage for the treatment of an abscess, the case series presenting high success rates of the medical therapy alone is increasing in deep neck abscesses of childhood. This research focuses on children whose deep neck abscess fully disappeared after only medical treatment. Methods:In a retrospective study, we evaluated medical records of 12 pediatric (<18 years old) cases diagnosed with deep neck abscess or abscess containing suppurative lymphadenitis and treated with only medical therapy between 2010 and 2015 for age, gender, treatment modality, parameters related to antimicrobial agents, location of the infection, etiology, symptoms, duration of hospital stay, characteristics of the radiological and biochemical examination findings, and complications. Results:The mean age of 10 male and two female children was 5.9 years (range, 1-17 years). Baseline and the last control's mean values of white blood cell (WBC), C-reactive protein, and erythrocyte sedimentation rate were 18,050/ μL, 99.8 mg/L, 73.1 mm/h, and 8,166/μL, 34.1 mg/L, 35.3 mm/h, respectively. Contrast-enhanced neck computed tomography demonstrated an abscess in seven cases and an abscess containing suppurative lymphadenitis in five cases. The largest diameter of the abscess was 41 mm. All cases were given broad-spectrum empirical antibiotherapy (penicillin+metronidazole, ceftriaxone+metronidazole, or clindamycin). No medical treatment failure was experienced. Conclusion:Independent of age and abscess size, if the baseline WBC is ≤25.200/μL, if only two or less than two cervical compartments are involved, if there are no complications in the admission, and if the etiological reason is not a previous history of trauma, surgery, foreign body, and malignancy, pediatric deep neck abscess can be treated successfully with parenteral empirical wide-spectrum antibiotherapy.

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“…Fever, torticollis, neck mass, odynophagia, and decreased oral intake are the most common presenting symptoms for DNSIs as a whole. 2,12 This can vary with the age of the child, with children younger than 4 years of age more likely to present with agitation, drooling, rhinorrhea, stridor, and even respiratory distress. Localizing signs/symptoms are more likely in those >4 years, especially trismus.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Presence of a distinct hypodensity with ring enhancement and scalloping of the fluid collection wall was most indicative of abscess. 12 Overall, the reported accuracy of CT in identifying a true abscess when taken for surgical drainage ranges from 68 to 100%. 19,21,22 All authors agree that CT identifies the overall extent of infectious involvement and relationship of infection to the great vessels.…”

Section: Imagingmentioning

confidence: 99%

Pediatric Deep Neck Space Infections: A Medical and Surgical Perspective

Mohandas

Gregory

Chun

et al. 2018

J Pediatr Infect Dis

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Pediatric deep neck space infections (DNSI) are common in children. If unrecognized, DNSIs can rapidly progress with the potential for developing serious complications. Children fair better than their adult counterparts in the face of complications such as mediastinitis, but early recognition and aggressive management is key to prevent mortality and limit morbidity. Knowledge of the anatomy related to the deep neck spaces helps in anticipating and managing the potential complications. In this article, we review the clinical presentation, complications, and management in pediatric DNSI from the point of view of the pediatric infectious disease physician and the otolaryngologist. We discuss the best management based on current available evidence and the experience of the authors.

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A prospective study of 113 deep neck infections managed using a clinical practice guideline

Cited by 34 publications

References 14 publications

Kicked to touch: Hoodwinked by torticollis

Kicked to touch: Hoodwinked by torticollis

A New Trend in the Management of Pediatric Deep Neck Abscess: Achievement of the Medical Treatment Alone

Pediatric Deep Neck Space Infections: A Medical and Surgical Perspective

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