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James M. Coticchia, MD; Geoffrey S. Getnick, MD; Romy D. Yun, BS; James E. Arnold, MD

Arch Otolaryngol Head Neck Surg. 2004;130:201-207.

Objective  To clarify presentations, organisms, and locations of deep neck abscesses in children.

Design  Retrospective review.

Setting  Tertiary children's hospital. The study population comprised 169 patients younger than 19 years who were surgically treated for deep neck abscesses between 1989 and 1999.

Main Outcome Measure  Resolution of abscess.

Results  Neck mass (91%), fever (86%), cervical adenopathy (83%), poor oral intake (66%), and neck stiffness (59%) were common in all ages. Patients younger than 4 years, compared with patients 4 years or older, presented with agitation (50% vs 14%), cough (35% vs 14%), drooling (27% vs 12%), lethargy (46% vs 33%), oropharyngeal abnormalities (45% vs 60%), respiratory distress (5% vs 2%), retractions (5% vs 2%), rhinorrhea (53% vs 15%), stridor (4% vs 2%), and trismus (14% vs 53%). Children younger than 1 year were infected with Staphylococcus aureus (79%) vs group A streptococcus (6%). Children 1 year or older were infected with group A streptococcus (29%) vs S aureus (16%). Retropharyngeal or parapharyngeal regions were involved in children 1 year or older (49%) vs younger than 1 year (21%). Anterior or posterior triangles and submandibular or submental regions were involved in 39% and 36%, respectively, of children younger than 1 year vs 30% and 23%, respectively, of children 1 year or older. Retropharyngeal and parapharyngeal abscesses yielded group A streptococcus (34%) vs S aureus (11%). Anterior and posterior triangle abscesses yielded S aureus (35%) vs group A streptococcus (19%), as did submandibular and submental abscesses (42% vs 19%).

Conclusions  Abscesses in children younger than 1 year affected anterior or posterior triangles and submandibular or submental regions, yielding S aureus. Abscesses in children 1 year or older affected retropharyngeal or parapharyngeal regions, yielding group A streptococcus.

From the Departments of Otolaryngology, Wayne State University, Detroit, Mich (Dr Coticchia), Feinberg School of Medicine, Northwestern University, Chicago, Ill (Dr Getnick), and University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio (Ms Yun and Dr Arnold). The authors have no relevant financial interest in this article.

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