Age-, Site-, and Time-Specific Differences in Pediatric Deep Neck Abscesses

Abstract

To clarify presentations, organisms, and locations of deep neck abscesses in children.Design: Retrospective review.Setting: Tertiary children's hospital. The study population comprised 169 patients younger than 19 years who were surgically treated for deep neck abscesses between 1989 and 1999.Main Outcome Measure: Resolution of abscess.Results: Neck mass (91%), fever (86%), cervical adenopathy (83%), poor oral intake (66%), and neck stiffness (59%) were common in all ages. Patients younger than 4 years, compared with patients 4 years or older, presented with agitation (50% vs 14%), cough (35% vs 14%), drooling (27% vs 12%), lethargy (46% vs 33%), oropharyngeal abnormalities (45% vs 60%), respiratory distress (5% vs 2%), retractions (5% vs 2%), rhinorrhea (53% vs 15%), stridor (4% vs 2%), and trismus (14% vs 53%). Children younger than 1 year were infected with Staphylococcus aureus (79%) vs group A streptococcus (6%). Children 1 year or older were infected with group A streptococcus (29%) vs S aureus (16%). Retropharyngeal or parapharyngeal regions were involved in children 1 year or older (49%) vs younger than 1 year (21%). Anterior or posterior triangles and submandibular or submental regions were involved in 39% and 36%, respectively, of children younger than 1 year vs 30% and 23%, respectively, of children 1 year or older. Retropharyngeal and parapharyngeal abscesses yielded group A streptococcus (34%) vs S aureus (11%). Anterior and posterior triangle abscesses yielded S aureus (35%) vs group A streptococcus (19%), as did submandibular and submental abscesses (42% vs 19%).Conclusions: Abscesses in children younger than 1 year affected anterior or posterior triangles and submandibular or submental regions, yielding S aureus. Abscesses in children 1 year or older affected retropharyngeal or parapharyngeal regions, yielding group A streptococcus.

Pediatric Deep Neck Space Abscesses: A Prospective Observational Study

“…Multiple space involvement was seen in 11% of our patients. Submental space involvement was most common in our study seen in 25% of cases followed by paraphyrangeal (18%), submandibular (16%) which is in contrast to a study reported by Coticchia et al [10], where the most commonly encountered sites of abscesses in the head and neck region of paediatric patients were retropharyngeal or parapharyngeal spaces followed by anterior or posterior triangle and submandibular or submental regions, respectively. Parotid space abscesses was seen in our study in 12% of patients while one study [10] reported it only in 1% of patients.…”

“…Submental space involvement was most common in our study seen in 25% of cases followed by paraphyrangeal (18%), submandibular (16%) which is in contrast to a study reported by Coticchia et al [10], where the most commonly encountered sites of abscesses in the head and neck region of paediatric patients were retropharyngeal or parapharyngeal spaces followed by anterior or posterior triangle and submandibular or submental regions, respectively. Parotid space abscesses was seen in our study in 12% of patients while one study [10] reported it only in 1% of patients. Ryan C. Cmejrek et al [17] in a study on 25 paediatric patients found that the more superficial anterior and posterior triangle abscesses (11/25) tend to be more common than those in the parapharyngeal (5/25) or retropharyngeal (3/25) spaces.…”

“…The most common signs and symptoms are a neck mass or swelling, fever, poor oral intake, and prior symptoms of an upper respiratory infection such as rhinorrhoea or cough. Other symptoms include neck pain, irritability, decreased neck mobility, sore throat, upper airway obstructive symptoms and febrile seizures [8,10].…”

Forma atípica de tireoidite supurativa aguda em paciente pediátrico: relato de caso

“…O abscesso retrofaríngeo pode ser diagnosticado apenas pela tomografia computadorizada (1). Na população pediátrica, as infecções de vias aéreas superiores e as tonsilites são as causas mais comuns de abscesso cervical, sendo os espaços retrofaríngeo e parafaríngeo os mais acometidos, principalmente em crianças acima de 1 ano (15).…”

“…Os agentes etiológicos mais comuns dos abscessos cervicais são os estreptococos e os estafilococos, assim como na TA, porém a média de idade do acometimento é um pouco inferior (4,1 anos) à da TA (6 anos), e 75% dos casos ocorrem antes do 5 anos de idade (6,7,15,16). Isso provavelmente é por causa da atrofia dos nódulos linfáticos após o terceiro e quarto ano de idade, uma vez que a formação do abscesso cervical dá-se pela propagação de infecções da nasofaringe, dos seios paranasais e do ouvido médio para o espaço profundo do pescoço, diretamente por continuidade, ou por drenagem linfática para os nódulos linfáticos deste espaço (16).…”