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Presentation, Diagnosis, and Management of Deep-Neck Abscesses in Infants
Ryan C. Cmejrek, MD;
James M. Coticchia, MD;
James E. Arnold, MD
Arch Otolaryngol Head Neck Surg. 2002;128:1361-1364.
Objective To clarify the presenting signs and symptoms, clinical course, pathogenic organisms, and management of deep-neck-space abscesses in infants.
Design Retrospective chart review.
Setting Tertiary care academic children's hospital.
Patients Records of 25 patients 9 months or younger with deep-neck-space abscesses from July 1989 through May 1999 were reviewed.
Main Outcome Measure Resolution of abscess.
Results Presenting symptoms included neck mass, 92% (n = 23); fever, 60% (n = 15); and dysphagia and/or poor intake by mouth, 36% (n = 9). Overall, patients were symptomatic for a mean duration of 3.8 days before presenting to the hospital; 21 of 22 evaluated patients had elevated white blood cell counts. Imaging included 68% computed tomographic scan (n = 17) and 44% plain radiographs (n = 11). On the basis of radiology and operative findings, locations of the abscesses were as follows: anterior triangle, 8; parapharyngeal, 5; posterior triangle, retropharyngeal, and undefined, 3 each; submandibular, 2; and parotid, 1. Of 17 scanned patients, 13 had some degree of airway compromise evident on computed tomography. All were treated with incision and drainage, 3 of 25 intraorally and 22 of 25 externally. Pus was identified in all 25; 20 of these grew Staphylococcus aureus, 1 grew group A Streptococcus, and 4 grew no organism. All patients received intravenous antibiotics for a mean of 4.8 days and oral antibiotics for a mean of 11 days. Only 1 patient required a second procedure.
Conclusions Deep-neck-space abscesses in infants are rapidly progressive, often cause airway compromise, and usually present with fever and neck mass. The most common pathogen is S aureus. Patients are effectively treated with incision and drainage coupled with intravenous followed by oral antibiotics.
From the University Hospitals of Cleveland, Cleveland, Ohio.
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