Çocukluk Yaş Grubunda Derin Boyun Enfeksiyonlarının Değerlendirilmesi

Öz

Giriş ve Amaç: Derin boyun enfeksiyonları derin servikal fasya yaprakları arasındaki potansiyel boşluklarda enfeksiyon gelişmesi ile karakterize bir durumdur. Antibiyotik kullanımının artması ile görülme sıklığı azalmasına rağmen halen ciddi hastalık ve ölüm riski taşımaktadır.Gereç ve Yöntemler: Derin boyun enfeksiyonlarına tanı ve tedavi yaklaşımının değerlendirilmesi amacıyla yapılan bu çalışmaya 2005-2008 yılları arasında Ankara Eğitim ve Araştırma Hastanesi Çocuk Kliniği’nde izlenen 86 hasta ileriye dönük olarak alındı. Hastalara öykü ve fizik muayene bulgularına göre derin boyun enfeksiyonu tanısı konuldu. Tüm hastalara tam kan, C-Reaktif Protein, eritrosit sedimentasyon hızı, viral göstergeler, Brucella ve Salmonella aglutinasyon testleri yapıldı; akciğer grafileri çekildi ve boyun ultrasonografisi yapıldı.Bulgular: Çalışmaya alınan hastaların 37’si (% 43) kızdı. Hastaların yaş ortalaması 3.1±2.5 yıldı. En sık başvuru şikayetleri boyunda şişlik (%100) ve ateşti (%74.4). Ortalama hastanede yatış süresi 6.6±3.9 gün olarak bulundu.Boyun ultrasonografi bulgularına göre en sık submandibular bölgenin (%45.3) tutulduğu görüldü. Etiyolojide en sık tonsillofarenjit (%45.3) saptandı. Odontojenik nedenler (%5.8), doğumsal nedenler (%2.3) ve suçiçeği (%1.2) tespit edilen diğer etiyolojik faktörlerdi.Bütün hastalara ampirik olarak parenteral antibiyotik tedavisi başlandı. En sık verilen antibiyotik sulbaktam ampisilin ve sulbaktam ampisilinin-metronidazol kombinasyonudu. Hastalardan 67’sinde (%77.9) tek başına medikal tedavi ile iyileşme sağlanırken 19 (%22.1) hastaya cerrahi drenaj uygulandı. Bu hastalardan 8’inin (%9.3) drenaj materyalinde Staphylococcus aureus üredi.Komplikasyon olarak 1 (%1.2) hastada bakteriyemi gelişti. Çalışmamızda ölen hasta olmadı.Sonuç: Ciddi hastalık ve ölüm nedeni olabilen derin boyun enfeksiyonları erken tanı ve etkin antibiyotiklerin kullanımıyla yüksek oranda tedavi edilebilir. Ancak gereken hastalarda da gecikmeden cerrahi drenaj uygulanmalıdır.

Anahtar Kelimeler

• Derin boyun enfeksiyonu, çocuklar, tedavi

EVALUTION OF DEEP NECK INFECTIONS IN PEDIATRIC PATIENTS

Öz

Introduction and Aim: Deep neck infections are characterized by the infections in the potential spaces of the fascial planes of the neck. Although the incidence of these infections decreased with the widespread use of antibiotics, they still lead to serious morbidity and mortality. In this study; we aimed to assess the diagnosis, management, and treatment of deep neck infections.Material and Methods: Eighty-six patients with deep neck infections admitted to the Pediatrics Clinics of Ankara Training and Research Hospital, between 2005 and 2008 were included in this study. All patients diagnosed as deep neck infections with complaints and physical examinations. Complete blood count, CReactive Protein, erythrocyte sedimentation rate, viral markers, Brucella and Salmonella agglutination tests, chest radiography, and cervical ultrasonography were performed for all patients.Results: All patients included in this study, 37(43%) were girls. The mean age was 3.1±2.5 years. The most common symptoms at presentation were neck swelling (100%) and fever (74.4%). The mean duration of hospital stay was 6.6±3.9 days.Cervical ultrasonography findings showed that the submandibular space was the most affected region. The most common etiology was tonsillopharangitis (45.3%). The other common etiological factors were odontogenic infections (5.8%), congenital disorders (2.3%), and varicella infection (1.2%). All patients were initially received parenteral empirical antibiotics. Sulbactam-ampicillin alone or in combination with metronidazole was the most common used antibiotics. Sixty-seven (77.9%) patients recovered with only medical treatment. Surgical drainage was performed in 19 (22.1%) cases. Staphylococcus aureus was isolated from 8 (9.3%) patients’ drainage samples.Bacteriemia was developed only in one patient (1.2%) as a complication. No mortality was observed in our study.Conclusion: Deep neck infections which have serious morbidity and mortality can be treated with early diagnosis and effective antibiotics. However; surgical drainage must be performed immediately if it is necessary

Anahtar Kelimeler

• Deep neck infections, children, treatment

Kaynakça

1. Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS. Deep neck infection: analysis of 185 cases. Head Neck 2004;26(10):854- 60.
2. Bottin R, Marioni G, Rinaldi R, Boninsegna M, Salvadori L, Staf- fieri A. Deep neck infection: a present-day complication. A retros- pective review of 83 cases (1998-2001). Eur Arch Otorhinolary- ngol 2003;260(10):576-9.
3. Tan PT, Chang LY, Huang YC, Chiu CH, Wang CR, Lin TY. Deep neck infections in children. J Microbiol Immunol Infect 2001;34(4):287-92.
4. Yang YS, Lee HU, Lee SH, Hong KH. A clinical study of the deep Neck Infections in Children. Korean J Otolaryngol – Head Neck Surg 2004;47(12):1282-8.
5. Ünsal Tuna EE, Özel E, Özbek C, Özdem C. Derin boyun en- feksiyonu: 63 hastanın incelenmesi. Turk Arch Otolaryngol 2008;46(2):73-7.
6. Parhiscar A, Har-El G. Deep neck abscess: A retrospective revi- ew of 210 cases. Ann Otol Rhinol Laryngol 2001;110(11):1051-4.
7. Cengiz AB, Kara A, Kanra G, Seçmeer G, Ceyhan M, Ozen M. Acute neck infections in children. Turk J Pediatr 2004;46(2):153-8.
8. Belet N, Tapısız A, Uçar Y, Çiftçi E, Fitöz S, İnce E, et al. Deep neck infections in children. J Pediatr Inf 2007;1(2):58-62.

9. Vural C, Gungor A, Comerci S. Accuracy of computerized tomog- raphy in deep neck infections in the pediatric population. Am J Otolaryngol 2003;24(3):143-8.
10. Cmejrek RC, Coticchia JM, Arnold JE. Presentation, diagnosis, and management of deep-neck abscesses in infants. Arch Otolary- ngol Head Neck Surg 2002;128(12):1361-4.
11. da Silva PS, Waisberg DR. Internal carotid artery pseudoaneurysm with life-threatening epistaxis as a complication of deep neck spa- ce infection. Pediatr Emerg Care 2011;27(5):422-4.
12. Baldassari CM, Howell R, Amorn M, Budacki R, Choi S, Pena M. Complications in pediatric deep neck space abscesses. Otolaryngol Head Neck Surg 2011;144(4):592-5.
13. Larawin V, Naipao J, Dubey SP. Head and neck space infections. Otolaryngol Head Neck Surg 2006;135(6):889-3.
14. Boyanova L, Kolarov R, Gergova G, Deliverska E, Madjarov J, Marinov M, et al. Anaerobic bacteria in 118 patients with deep- space head and neck infections from the University Hospital of Maxillofacial Surgery, Sofia, Bulgaria. J Med Microbiol 2006 ;55(pt 9):1285-9.
15. Lee JK, Kim HD, Lim SC. Predisposing factors of complica- ted. deep neck infection: an analysis of 158 cases. Yonsei Med J 2007;48(1):55-62.
16. Çağlı S,Yüce İ, Güney E. Derin Boyun Enfeksiyonları: 50 Vakanın Sonuçları. Erciyes Tıp Dergisi 2006;28(4):211-5.
17. Yen CW, Lin CY, Tsao LY, Yang SC, Chen HN, Chang MY. Children’s deep neck infections in central Taiwan. Acta Paediatr Taiwan 2007;48(1):15-9.
18. Tom MB, Rice DH. Presentation and management of neck abs- cess: a retrospective analysis. Laryngoscope 1988;98(Pt 1):877-80.
19. Gürel SF. Okul çağı çocukları ve beslenme sorunları. Aile Hekim- liği Dergisi 2008; 2(3):16-21
20. Plaza Mayor G, Martinez-San Millan J, Martinez-Vidal A. Is con- servative treatment of deep neck space infections appropriate? Head Neck 2001;23(2):126-33.
21. Ridder GJ, Technau-Ihling K, Sander A, Boedeker CC. Spectrum and management of deep neck space infections: an 8-year experi- ence of 234 cases. Otolaryngol Head Neck Surg 2005;133(5):709- 14.
22. Uskun E, Türkoğlu H, Nayir T, Kişioğlu AN, Öztürk M. Isparta il merkezindeki konutların sağlık standartlarına uygunluk durumu. Kor Hek 2007;6(3):151-60.
23. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, Sağlık Bakanlı- ğı Ana Çocuk Sağlığı ve Aile Planlaması Genel Müdürlüğü, Dev- let Planlama Teşkilatı ve Avrupa Birliği, Ankara, Türkiye. Erişim: http://www.hips.hacettepe.edu.tr/tnsa2008/data/TNSA-2008, Eri- şim tarihi: ağustos 2010.
24. Agarwal AK, Sethi A, Sethi D, Mrig S, Chopra S. Role of socioe- conomic factors in deep neck abscess: A prospective study of 120 patients. Br J Oral Maxillofac Surg 2007;45(7):553-5.
25. Wang LF, Tai CF, Kuo WR, Chien CY. Predisposing factors of complicated deep neck infections: 12-year experience at a sing- le institution. J Otolaryngol Head Neck Surg 2010;39(4):335-41.
26. Miller WD, Furst IM, Sandor GK, Keller MA. A prospective, blin- ded comparison of clinical examination and computed tomography in deep neck infections. Laryngoscope 1999;109(11):1873-9.
27. Rozovsky K, Hiller N, Koplewitz BZ, Simanovsky N. Does CT have an additional diagnostic value over ultrasound in the evalu- ation of acute inflammatory neck masses in children? Eur Radiol 2010;20(2):484-90.
28. Crespo AN, Chone CT, Fonseca AS, Montenegro MC, Pereira R, Milani JA. Clinical versus computed tomography evaluation in the diagnosis and management of deep neck infection. Sao Paulo Med J 2004;122(6):259-63.
29. Coticchia JM, Getnick GS, Yun RD, Arnold JE. Age, site, and time-specific differences in pediatric deep neck abscesses. Arch Otolaryngol Head Neck Surg 2004;130(2):201-7.
30. Gidley PW, Ghorayeb BY, Stiernberg CM. Contemporary manage- ment of deep neck space infections. Otolaryngol Head Neck Surg 1997;116(1):16-22.
31. Brook I. Microbiology and management of peritonsillar, retrop- haryngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg 2004;62(12):1545-50.
32. Brook I, Frazier EH, Thompson DH. Aerobic and anaerobic mic- robiology of peritonsillar abscess. Laryngoscope 1991;101(3):289- 92.
33. Beck AL. The influence of the chemotherapeutic and antibiotic drugs on the incidence and course of deep neck infections. Ann Otol Rhinol Laryngol 1952; 61(2):515-32.
34. Suehara AB, Gonçalves AJ, Alcadipani FA, Kavabata NK, Mene- zes MB. Deep neck infection: analysis of 80 cases. Braz J Otorhi- nolaryngol 2008;74(2):253-9.
35. Baldassari CM, Howell R, Amorn M, Budacki R, Choi S, Pena M. Complications in pediatric deep neck space abscesses. Otolaryngol Head Neck Surg 2011;144(4):592-5.
36. Estrera AS, Landay MJ, Grisham MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet 1983;157(6):545-52.