Pediatric deep neck infections: efficacy of conservative treatment versus immediate surgical intervention

Yıl 2017, Cilt: 7 Sayı: 2, 94 - 98, 30.09.2017

Emel Tahir , Nilda Süslü R. Önder Günaydın Oğuz Kuşçu Onur Ergün Umut Akyol

Öz

Objective: The objective of this study was
to review the management of deep neck space infections in pediatric
patients and to evaluate the efficacy of intravenous antibiotic
treatment alone before surgical drainage, and also to point out the
indications for the drainage.




Methods: We
reviewed sixty pediatric cases who were treated in our clinic because of
deep neck space infections. The details of demographic data, medical
history, initial complaints and physical examination, radiological
examination, microbiology and laboratory results (C-reactive protein
level and leukocyte count), treatment modality and follow-up findings
were collected. The bacteriological results, management, complications,
follow-up data and outcomes were also noted. A basic treatment algorithm
for the management of the pediatric deep neck space infections was
constituted.




Results: In
47 (78.3%) of the children, infection did not require any surgical
intervention or puncture - in other words, needle aspiration - and it
was successfully treated with antibiotic therapy alone. Fifty-six
patients (93%) were initially treated with sulbactam-ampicillin.




Conclusion: We
advise surgical drainage in cases of fluctuating large abscesses and
infections without clinical improvement despite antibiotic treatment,
and in complicated or life-threatening cases such as retropharyngeal
abscess and mediastinitis. An otolaryngologist should be patient before
any surgical intervention.

Anahtar Kelimeler

Deep neck infection, children, antibiotic treatment, surgery, Derin boyun enfeksiyonu, çocuklar, antibiyotik tedavisi, cerrahi

Kaynakça

• 1. Cheng J, Elden L. Children with deep space neck infections: our experience with 178 children. Otolaryngol Head Neck Surg 2013;148:1037–42. 2. Wong DK, Brown C, Mills N, Spielmann P, Neeff M. To drain or not to drain – management of pediatric deep neck abscesses: a case–control study. Int J Pediatric Otorhinolaryngol 2012;76: 1810–3. 3. Carbone PN, Capra GG, Brigger MT. Antibiotic therapy for pediatric deep neck abscesses: a systematic review. Int J Pediatr Otorhinolaryngol 2012;76:1647–53. 4. Songu M, Demiray U, Adibelli ZH, Adibelli H. Bilateral deep neck space infection in the paediatric age group: a case report and review of the literature. Acta Otorhinolaryngol Ital 2010;30:190– 3. 5. Bakir S, Tanriverdi MH, Gün R, et al. Deep neck space infections: a retrospective review of 173 cases. Am J Otolaryngol 2012;33:56– 63. 6. Meyer AC, Kimbrough TG, Finkelstein M, Sidman JD. Symptom duration and CT findings in pediatric deep neck infection. Otolaryngol Head Neck Surg 2009;140:183-6. 7. Eftekharian A, Roozbahany NA, Vaezeafshar R, Narimani N. Deep neck infections: a retrospective review of 112 cases. Eur Arch Otorhinolaryngol 2009;266:273–7. 8. Sauer MW, Sharma S, Hirsh DA, Simon HK, Agha BS, Sturm JJ. Acute neck infections in children: who is likely to undergo surgi- cal drainage? Am J Emerg Med 2013;31:906–9. 9. Flanary VA, Conley SF. Pediatric deep space neck infections: the Medical College of Wisconsin experience. Int J Pediatr Otorhinolaryngol 1997;3:38:263–71. 10. Rozovsky K, Hiller N, Koplewitz BZ, Simanovsky N. Does CT have an additional diagnostic value over ultrasound in the evalua- tion of acute inflammatory neck masses in children? Eur Radiol 2010;20:484–90. 11. Meyer AC, Kimbrough TG, Finkelstein M, Sidman JD. Symptom duration and CT findings in pediatric deep neck infection. Otolaryngol Head Neck Surg 2009;140:183–6. 12. Raffaldi I, Le Serre D, Garazzino S, et al. Diagnosis and manage- ment of deep neck infections in children: the experience of an Italian paediatric centre. J Infect Chemother 2015;21:110–3. 13. Cramer JD, Purkey MR, Smith SS, Schroeder JW Jr. The impact of delayed surgical drainage of deep neck abscesses in adult and pediatric populations. Laryngoscope 2016;126:1753–60. 14. Bolton M, Wang W, Hahn A, Ramilo O, Mejias A, Jaggi P. Predictors for successful treatment of pediatric deep neck infec- tions using antimicrobials alone. Pediatr Infect Dis J 2013;32: 1034–6. 15. Neff L, Newland JG, Sykes KJ, Selvarangan R, Wei JL. Microbiology and antimicrobial treatment of pediatric cervical lymphadenitis requiring surgical intervention. Int J Pediatr Otorhinolaryngol 2013;77:817–20. 16. Baek MY, Park KH, We JH, Park SE. Needle aspiration as ther- apeutic management for suppurative cervical lymphadenitis in children. Korean J Pediatr 2010;53:801–4.