Clinical Outcomes of Transcervical and Transoral Approaches in Parapharyngeal Abscesses

Abstract

Objective: The aim of this study was to identify the microorganisms cultured from abscesses in patients who underwent drainage with transoral and transcervical approaches and to compare the demographic data, anaesthesia duration, and length of hospital stay of patients using both techniques. Material and Methods: We included 96 patients who underwent surgery for parapharyngeal abscesses at the Dicle University, Faculty of Medicine, Ear, Nose, and Throat and Head and Neck Surgery Clinic between 2015 and 2023. Drainage was performed using a transoral approach in 48 patients and using a transcervical approach in 48 patients. We compared both groups based on gender, age, comorbidities, bacteriology, length of hospital stay, and duration of anaesthesia. Results: Upon evaluating the culture results for all patients in both groups, we found that no growth was detected in 50% of the cultures, whereas growth was detected in the other 50%. The average duration of anaesthesia in the transcervical group was 85 min, whereas in the transoral group, it was 52 min, with the duration of anaesthesia in the transoral group being significantly shorter than in the transcervical group. The average length of hospital stay in the transcervical group was 10 days, whereas in the transoral group, it was 8 days, indicating a significantly shorter hospital stay in the transoral group. Conclusion: In our study, we found that patients undergoing transoral drainage had less morbidity, shorter anaesthesia duration and length of hospital stays.

Keywords

• Parapharyngeal abscesses
• transcervical
• transoral
• culture

References

1. 1. Amar YG, Manoukian JJ. Intraoral drainage: recommended as the initial approach for the treatment of parapharyngeal abscesses. Otolaryngol Head Neck Surg 2004;130(6):676-80. google scholar
2. 2. Baldassari CM, Howell R, Amorn M, Budacki R, Choi S, Pena M. Complications in pediatric deep neck space abscesses. Otolaryngol Head Neck Surg 2011;144:592-5 google scholar
3. 3. Page C, Biet A, Zaatar R, Strunski V. Parapharyngeal abscess: diagnosis and treatment. Eur Arch Otorhinolaryngol 2008;265:681-6. google scholar
4. 4. Sichel J-Y, Attal P, Hocwald E, Eliashar R. Redefining parapharyngeal space infections. Ann Otol Rhinol Laryngol 2006;115(2):117-23. google scholar
5. 5. Oh J-H, Kim Y, Kim C-H. Parapharyngeal abscess: comprehensive management protocol. ORL 2006;69(1):37-42. google scholar
6. 6. Schuler PJ, Cohnen M, Greve J, Plettenberg C, Chereath J, Bas M, et al. Surgical management of retropharyngeal abscesses. Acta oto-laryngol 2009;129(11):1274-9. google scholar
7. 7. Esposito S, De Guido C, Pappalardo M, Laudisio S, Meccariello G, Capoferri, G et al. Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses. Children 2022;9(5):618. google scholar
8. 8. Ohori, J, Iuchi H, Nagano H, Umakoshi M, Matsuzaki H, Kurono Y. The usefulness of abscess tonsillectomy followed by intraoral drainage for parapharyngeal abscess concomitant with peritonsillar abscess in the elderly. Auris Nasus Larynx 2020;47(4):697-701. google scholar

9. 9. Betka J, Chovanec M, Klozar J, Taudy M, Plzak J, Kodetova D, et al. Transoral and combined transoral-transcervical approach in the surgery of parapharyngeal tumors. Eur Arch Otorhinolaryngol 2009; 267(5):765-72. google scholar
10. 10. Kirse DJ, Roberson DW. Surgical management of retropharyngeal space infections in children. Laryngoscope 2001;111(8):1413-22. google scholar
11. 11. Lalakea ML, Messner AH. Retropharyngeal abscess management in children: current practices. Otolaryngol Head Neck Surg 1999;121(4):398-405. google scholar
12. 12. Daya H, Lo S, Papsin BC, Zachariasova A, Murray H, Pirie J et al. Retropharyngeal and parapharyngeal infections in children: the Toronto experience. Int J Pediatr Otorhinolaryngol 2005;69(1):81-6. google scholar
13. 13. Hidaka H, Ishida E, Suzuki T, Matsutani S, Kobayashi T, Takahashi S. Unusual parapharyngeal extension of peritonsillar abscess to the masticator space: successfully drained by extraoral and intraoral endoscopic approaches. Ann Otol Rhinol Laryngol 2014;123(5):333-7. google scholar
14. 14. Cable BB, Brenner P, Bauman NM, Mair EA. Image-guided surgical drainage of medial parapharyngeal abscesses in children: a novel adjuvant to a difficult approach. Ann Otol Rhinol Laryngol 2004;113(2):115-20. google scholar
15. 15. Klug TE, Greve T, Andersen C, Hahn P, Danstrup C, Petersen NK, et al. Microbiology of parapharyngeal abscesses in adults: in search of the significant pathogens. Eur J Clin Microbiol Infect Dis 2021;40(7):1461-70. google scholar
16. 16. Maroun CA, Zalzal HG, Mustafa AA, Carr M. Transoral versus transcervical drainage of pharyngeal abscesses in children: post-operative complications. Ann Otol Rhinol Laryngol 2021;130(9):1052-6. google scholar
17. 17. Nagy M, Pizzuto M, Backstrom J, Brodsky L. Deep neck infections in children: a new approach to diagnosis and treatment. Laryngoscope 1997;107(12):1627-34. google scholar