Tonsillectomy increases the risk of retropharyngeal and parapharyngeal abscesses in adults, but not in children: A national cohort study

Abstract

ObjectivesThe purpose of this study is to evaluate the risk of retropharyngeal and parapharyngeal abscesses (deep neck infection) after tonsillectomy in Koreans using national cohort data.MethodsUsing the national cohort study from the Korean Health Insurance Review and Assessment Service, participants who had undergone a tonsillectomy (5,299) and control participants (21,196) were selected and matched 1:4 (for age, sex, income, region of residence, and pre-operative upper respiratory infection visits). The Cox-proportional hazard model was used. A crude model and an adjusted model for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia were used in this analysis. For the subgroup analyses, the participants were divided into 2 groups: children (≤ 14 years old) and adolescents and adults (≥ 15 years old).ResultsThe adjusted hazard ratio of deep neck infection after tonsillectomy was 1.43 (95% confidence interval, CI = 1.18–1.72, P < 0.001). In subgroup analysis, this ratio was 1.12 (95% CI = 0.86–1.47, P = 0.390) in children and 1.87 (95% CI = 1.43–2.45, P < 0.001) in adolescents and adults. The crude hazard ratios were almost the same as the adjusted ratios.ConclusionThe risk of deep neck infection was higher in the tonsillectomy group. The subgroup analysis showed a similar finding in the adolescent and adult group but not in the child group.

Bacteria Pattern, Results of Antibiotic Sensitivity Test, and Complications of Deep Neck Abscess Patients in Dr. Soetomo General Hospital

“…The mechanism of extending the pus into the parapharyngeal and retropharyngeal spaces. 9 The most common source of infection in deep neck abscess came from odontogenic infections as many as 85 patients (52.47%), DM 14 patients (8.64%), while those caused by odontogenic, DM, and oropharyngeal infections were 42 patients (26.25%). This result is in line with previous studies that odontogenic and respiratory infections are the most common etiology.…”

“…9 Figure 2. Sagittal section of neck 9 The expansion mechanism of the abscess from the submandibular to the parapharyngeal and retropharyngeal space due to pressure (contraction) of the mouth floor muscles, as if pushing the pus into the parapharynx cavity and retropharynx (Figure 3). 4 Combined abscesses consisting of two or three abscesses occur together, consisting of submandibular abscess, parapharynx, retropharynx, and peritonsil.…”

“…The spread of infection in the danger space area before the preantibiotic era caused mortality by 50%, in the era of antibiotics the mortality rate decreased to 25%. 2,9 Figure 3. The mechanism of extending the pus into the parapharyngeal and retropharyngeal spaces.…”

“…Kim et al, Explained that tonsillectomy increases the risk of retropharyngeal abscess and parapharyngeal abscess in adulthood compared to children. 9 This is because dental infections can affect the pulp and periodontal and then spread through the pulp or apical foramen to the surrounding area. Apical area of molar teeth above the mylohyoid muscle causes the spread of infection to enter the sublingual space first, while the second and third molars are under mylohyoid muscle so that the infection will be spread faster to the submandibular space.…”

“…The risk of deep neck abscess after tonsillectomy in adolescents and adults is 1.43 times bigger compared to children. 9 Most deep neck abscess is caused by a mixture of various bacteria (polymicrobials), both aerobes, anaerobes, and facultative anaerobic bacteria Staphylococcus aureus (12.5%). 8,11 The abscess culture is divided into three groups.…”