Lung Abscess and Its Relation to Surgery of the Upper Respiratory Tract

Abstract

THERE are two modes of approach to the statistical study of lung abscess. The internist sees enough of this disease in the course of years to be profoundly impressed, not only by its seriousness but also by the fact that in many instances it follows some surgical procedure in the region of the mouth, nose or throat, and particularly tonsillectomy. The otolaryngologist, on the other hand, sees in this attitude a challenging implication with which he takes issue.The otolaryngologist rarely if ever sees lung abscess as a complication in his operative cases. Furthermore, studies of large series of cases show an average incidence of 1 case of lung abscess in 2000 or 3000 cases of tonsillectomy.1,2 Some writers, especially in England, have even found the incidence greater after general operations than after surgery on the respiratory tract. At this point, however, it should be stressed that the important factor is not the ratio of this complication to a given number of operations, of whatever kind, but the very serious fact that in any substantial group of lung-abscess cases, a large proportion occur after operation on the upper respiratory tract, and particularly after tonsillectomy.The observation of Norris and Landis3 is pertinent to this matter. They say:Although the experience of any one operator, or even that of a large clinic, is limited, the number of cases of abscess following tonsillectomy is in the aggregate quite large. Statements of individual operators that they have never met with this sequel are of doubtful value, and this is especially true of large clinics where the patients are easily lost trace of. It is now known that many of these abscess cases never come to the knowledge of the operator. Some of them are recognized by another physician as abscesses only after months have elapsed.In 1925, Lord4 reported 227 cases of lung abscess observed at the Massachusetts General Hospital between 1909 and 1924. Of these, 96 (42 per cent) followed some operative procedure; 78 (34 per cent) followed some operation on the upper respiratory tract, of which 21 (9 per cent) occurred after the extraction of teeth and 49 (22 per cent) after tonsillectomy, and the remaining 8 followed operation elsewhere. Aspiration of foreign bodies was responsible for 8 cases. There were 28 cases (12 per cent) in this series which were ascribed to From the Thoracic Clinic, Beth Israel Hospital, Boston. *Clinical professor of medicine, Tufts College Medical School; visiting physician, Beth Israel Hospital, Boston. pneumonia. One case followed esophagoscopy, and in the rest the cause was not determined.In 1934, King and Lord5 reported a second series of 210 cases of lung abscess, observed at the Massachusetts General Hospital between 1924 and 1932. While in Lord's earlier series, just mentioned, approximately 1 of every 3 cases could be traced to operations in or near the upper respiratory tract, the proportion in the second series rose to about 1 of every 2 cases (117 cases, or 56 per cent). The operative procedures included the remova...