TORTİKOLLİS İLE BAŞVURAN İKİ PARAFARENGEAL ABSE VAKASI. CERRAHİ TEDAVİ Mİ? MEDİKAL TEDAVİ Mİ?

Year 2010, Volume: 73 Issue: 1, 23 - 26, 10.11.2011

Ahmet Özen Hülya Ercan Sarıçoban Mustafa Berber Hande Özgün Karatepe Filiz Bakar Reha Cengizlier Ayça Vitrinlier

Abstract

Bu yazıda tortikollis ile başvuran iki parafarengeal abse olgusu sunuyoruz. Çocuklarda parafarengeal abselere yönelik tedavi seçeneklerini tartışacağız.

VAKA 1: Yirmibeş aylık erkek çocuk, boynunu hareket ettirmek istememe şikayetiyle getirildi. Laboratuar incelemesinde WBC:20400 / mm3 ve CRP:76,8 mg/L bulundu. Boyun BT incelemelerinde parafarengeal abse ile uyumlu görünüm saptandı. intravenöz ampisilin-sulbaktam ve metronidazol tedavileri başlandı. Tedavi altındayken abse boyutunda büyüme ve enflamasyon göstergelerinde yükselme saptandı. Abse drene edildi ve kültüre gönderildi. Kültürde MRSA üremesi oldu. intravenöz vankomisin ve rifampisin tedavisi başlandı. Tedavinin birinci haftası bittiğinde kontrol BT incelemesinde absenin kaybolduğu gözlendi.

VAKA 2: Sekiz yaşında erkek hasta, boyunda şişlik ve eğrilik şikayetiyle getirildi. Anterior servikal lenf nodu palpe edilmekteydi. Enflamasyon göstergelerinde yükselme saptandı. Boyun BT incelemesinde parafarengeal abse ile uyumlu görünüm saptandı. Hastaya intravenöz ampisilin-sulbaktam ve metronidazol kombinasyonu baĢlandı. Medikal tedavi ile hasta komplikasyonsuz iyileşti.

Sonuç olarak, parafarengeal abselerde tedavi şekli hastaların klinik bulgularına göre seçilmeli ve klinik izlemdeki bulgulara göre yönlendirilmelidir.

Anahtar kelimeler: Parafarengeal abse; derin boyun enfeksiyonu; tortikollis; çocuk; tedavi

Keywords

Parafarengeal abse, derin boyun enfeksiyonu, tortikollis, çocuk, tedavi

References

• Bach MC, Roediger JH, Rinder HM. Septic anaerobic jugular phlebitis with pulmonary embolism: problems in management. Rev Infect Dis 1988;10:424–427.
• Brodsky L, Belles W, Brody A, Squire R, Stanievich J, Volk M. Needle aspiration of neck abscesses in children, Clin Pediatr 1992;31:71-76.
• Brook I, Microbiology of abscesses of the head and neck in children, Ann. Otol. Rhinol. Laryngol. 1987;96:429-433.
• Broughton RA. Nonsurgical management of deep neck infections in children. Pediatr Infect Dis J. 1992;11:14-18.
• Buchwald C, Nissen F, Thomsen J. View from within: radiology in focus parapharyngeal abscess and torticollis. J Laryngol Otol 1990;104:829–830.
• Buckingham SC, McDougal LK, Cathey LD, Comeaux K, Craig AS, Fridkin SK, Tenover F.C. Emergence of community-associated Staphylococcus aureus at a Memphis, Tennessee Children‟s Hospital, Pediatr Infect Dis J. 2004;23:619- 624.
• methicillin-resistant
• Chen MK, Wen YS, Chang CC, Huang MT, Hsaio HC. Predisposing factors of life-threatening deep neck infection: logistic regression analysis of 214 cases. J Otolaryngol 1998;27:141-144.
• De Marie S, Tham RT, Van der Mey AG, Meerdink G, Van Furth R, Van der Meer JW. Clinical infections and nonsurgical treatment of parapharyngeal space infections complicating throat infections. Rev Infect Dis 1989;11: 975-982.
• Eliachar I, Peleg H, Joachims HZ. Mediastinitis and bilateral parapharyngeal abscess. Head Neck Surg 1981;3:438-442. complicating a
• Feder HM. Methicillin-resistant Staphylococcus aureus infections in 2 pediatric outpatients, Arch Fam Med, 2000; 9:560-562.
• Fernández CA, Tagarro S, Lozano-Arnilla CG, Preciado J, Lacosta JL. Internal carotid pseudoaneurysm within a parapharyngeal infection: An infrequent complication of difficult 2005;132:671-673. Head Neck Surg
• Flanary VA, Conley SF. Pediatric deep space neck infections: The Medical College of Wisconsin experience. Int J Pediatr Otorhinolaryngol 1997;38:263-271.
• Frank AL, Marcinak JF, Mangat PD, Schreckenberger PC. Increase Staphylococcus aureus in children, Clin Infect Dis 1999;29:935-936.
• methicillin-resistant
• Gottlieb RD, Shah MK, Perlman DC, Kimmelman CP. Community-acquired methicillin-resistant Staphylococcus aureus Head Neck Surg 1992; 107:434-437.
• otolaryngology, Otolaryngol.
• Herold BC, Immergluck LC, Maranan MC, Lauderdale DS, Gaskin RE, Boyle-Vavra S, Leitch CD, Daum RS. Community-acquired Staphylococcus aureus in children with no identified predisposing risk, JAMA 1998; 279:593-598.
• Hussain FM, Boyle-Vavra S, Bethel CD, Daum RS. Current trends in community-acquired methicillin- resistant Staphylococcus aureus at a tertiary care pediatric facility, Pediatr Infect Dis J 2000;19:1163- 1166. 17. Johnigan RH, Pereira KD, Poole MD. Communityacquired Staphylococcus aureus in children and adolescents, Arch Otolaryngol Head Neck Surg 2003;129:1049- 1052. methicillin-resistant
• Laugenbrunner DJ, Dajani S. Pharyngomaxillary space abscess with carotid artery erosion. Arch Otolaryngol 1971; 94:447-457.
• Lueg EA, Awerbuck D, Forte V. Ligation of the common carotid artery for the management of a mycotic pseudoaneurysm of an extracranial internal carotid artery: a case report and review of the literature. Int J Pediatr Otorhinolaryngol 1995;33:67-74.
• McClay JE, Murray AD, Booth T. Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Arch Otolaryngol Head Neck Surg 2003; 129:1207-1212.
• Nagy M, Pizzuto M, Backstrom J, Brodsky L. Deep neck infections in children: a new approach to diagnosis and treatment, Laryngoscope 1997;107:1627-1634.
• Naidu SI, Donepudi SK, Stocks RM, Buckingham SC, Thompson JW. Methicillin-resistant Staphylococcus aureus as a pathogen in deep neck abscesses: a pediatric case series. Int J Pediatr Otorhinolaryngol 2005;69:1367- 1371. 23. Purcell K, Fergie JE. Exponential increase in communityacquired methicillin-resistant Staphylococcus aureus infections in South Texas children [Letter], Pediatr Infect Dis J 2002;21:988-989.
• Reisner A, Marshall GS, Bryant K, Postel GC, Eberly SM. Endovascular occlusion of a carotid pseudoaneurysm complicating deep neck space infection in a child. J Neurosurg 1999;91:510–514.
• Sakaguchi M, Sato S, Ishiyama T, Katsuno S, Taguchi K. Characterization and management of deep neck infections. Int J Oral Maxillofac Surg 1997;26:131-134.
• Sethi DS, Stanley RE. Parapharyngeal abscesses. J Laryngol Otol 1991;105:1025-1030.
• Sichel JY, Dano I, Hocwald E, Biron A, Eliashar R. Nonsurgical management of parapharyngeal space infections: 2002;112:906-910. study. Laryngoscope.
• Sichel JY, Gomori JM, Saah D, Elidan J. Parapharyngeal abscess in children: the role of CT for diagnosis and treatment. Int J Pediatr Otorhinolaryngol 1996;35:213-222.
• Singh M, Bandyopadhyay S, Mohindra N, Mishra LS. Survival of a patient with endopharyngeal common carotid blow out due to parapharyngeal abscess as an unusual complication 2005;119:909-912. J Laryngol Otol
• Tom MB, Rice DH. Presentation and management of neck abscess: a retrospective analysis. Laryngoscope 1988;98: 877-880.
• Ungkanont K, Yellon RF, Weissman JL, Casselbrant ML, Gonzalez-Valdepena H, Bluestone CD. Head and neck space infections in infants and children. Otolaryngol Head Neck Surg 1995;112:375-382.
• Wetmore RF, Mahboubi S, Soyupak SK. Computed tomography in the evaluation of pediatric neck infections. Otolaryngol Head Neck Surg 1998;119:624- 627.