Nonsurgical Management of Parapharyngeal Space Infections: A Prospective Study

Sichel, Jean‐Yves; Dano, Itshac; Hocwald, Eitan; Biron, A; Eliashar, Ron

doi:10.1097/00005537-200205000-00023

Cited by 101 publications

(78 citation statements)

References 17 publications

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“…Parapharyngeal infection remains potentially dangerous because of the possibility of severe complications [2] . The treatment options vary between immediate surgical drainage of the abscess to instituting a trial of intravenous antibiotics in every stable case or in selected cases [3,[5][6][7] .…”

Section: Discussionmentioning

confidence: 99%

“…Since De Marie et al [4] reported a nonsurgical approach in treating parapharyngeal space infection using intravenous antibiotics and CT-guided selective aspiration, there has been much argument over the criteria for surgical intervention of this disease. Although Sethi and Stanley [8] reported that early open surgical drainage resulted in rapid recovery and short hospital stay, several reports have described changing trends in deep neck space abscesses over time [2][3][4][5] . Sichel et al [2] performed a prospective study of 12 patients with the diagnosis of parapharyngeal infection.…”

Section: Discussionmentioning

confidence: 99%

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Parapharyngeal Abscess: Comprehensive Management Protocol

Oh¹,

Kim²,

Kim³

2006

ORL

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Parapharyngeal infections are rare, but they cause serious morbidity and mortality. Therefore, until now, the recommended treatment of parapharyngeal abscess has been early open surgical drainage. The purpose of this study is to review the clinical course and outcome of treatment in parapharyngeal abscess according to method of treatment. A prospective study was designed for parapharyngeal abscess in patients admitted for deep neck infection. During an 8-year period, from June 1994 to January 2003, 34 patients were enrolled. All had contrast-enhanced computed tomography (CT) imaging and confirmation of an abscess in the parapharyngeal space. All patients were treated with intravenous antibiotics. We treated 19 cases (conservative group) with antibiotics only or needle aspiration and 15 (surgical group) with intraoral or external drainage. The mean duration of hospitalization was 8.2 days in the conservative group and 11.6 days in the surgical group. There was no complication except mediastinitis in 1 case of the conservative group. Because of severe dyspnea, 5 patients required tracheotomy. Neck CT scan is a useful diagnostic tool to detect and establish the treatment plan of parapharyngeal abscess. Parapharyngeal abscess may, in some cases, respond to antibiotics, become localized to the parapharyngeal space and be treated conservatively with no need for early open surgical drainage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Parapharyngeal Abscess: Comprehensive Management Protocol

Oh¹,

Kim²,

Kim³

2006

ORL

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“…Ekşioğlu et al (14) also highlighted the importance of using neck CT for the management of pediatric deep neck abscess based on its contributions to the ascertainment of complications. Some authors also utilized MRI for complementary diagnostic information (9,15). Despite the fact that CT is responsible for an intense radiation exposure, the long duration and necessity of immobilization during the MRI process and the reductive fine tuning of the radiation dose when performing CT in children in our university limited the preference of MRI in our research.…”

Section: Discussionmentioning

confidence: 99%

“…Vieria et al (16) suggested the use of empirical antibiotics for DNI which have adequate spectrum for both aerobic and anaerobic bacteria such as penicillin alone or combined with beta-lactamase agents, beta-lactamase--resistant drugs such as ceftriaxone, and antibiotics against anaerobic bacteria such as metronidazole and clindamycin. The complete achievement was obtained in a prospective study performed in seven pediatric deep neck abscess cases using amoxicillin and clavulanic acid combination by Sichel et al (15). Lawrence and Bateman (2) determined the recommendation level of the utilization of these antibiotics mentioned above as grade C in their data collection but mostly because of the included reviews' low level of evidence.…”

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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“…Even if some recent reports [1,4,5] have confirmed that intravenous antibiotic therapy alone, associated with strict radiological follow-up, can be successfully used in the management of uncomplicated parapharyngeal abscess, surgical drainage is the treatment of choice in cases where patients are not responsive to first-line antibiotics, with systemic symptoms or with severe complications, such as airway compromise, meningitis, mediastinitis (through retropharyngeal space) and Lemierre's syndrome [6,7]. Following these indications, we decided to promptly perform intraoral drainage in our patient, since he did not respond to the antibiotic therapy, and had episodes of high fever.…”

Section: Discussionmentioning

confidence: 99%