Korean J Pediatr Infect Dis.  2011 Dec;18(2):163-172.

Deep Neck Abscesses in Children and Adolescents: 10 Year Experience in Two General Hospitals

• Kim E
• Jeon JH
• Lee WU
• Kim SY
• Kim ER

Abstract

PURPOSE
The purpose of this study was to review our recent experiences with deep neck abscesses in children and adolescents and to provide helpful information in treatment and diagnosis by comparing them with those in other available literatures.
METHODS
Medical records of 36 children and adolescents admitted for deep neck abscess at two hospitals from January 2000 to October 2010 were reviewed retrospectively.
RESULTS
Male to female ratio was 1.4 : 1 and the mean age was 6.5 years. Painful neck swelling and fever were the most frequent symptoms in patients under thirteen years of age whereas trismus and headache were frequent symptoms in patients over fourteen years of age. Submandibular space was the most common site of deep neck abscess in patients under thirteen years of age, whereas peritonsillar space was the most common site in patients over fourteen years of age. The results of bacterial cultures were positive in 61.5% of drained cases. Staphylococcus aureus was the most commonly identified bacteria in 6 patients (37.5%) and 5 of them were under 2 years of age. Twenty six patients received surgical drainage while the others were treated with antibiotics only. There were no statistically significant differences in the durations of admission, fever after admission, and antibiotic treatment between surgical and medical treatment groups.
CONCLUSION
The common sites of deep neck abscess, associated symptoms, and causative organisms were different between children and adolescents. As there were no differences in durations of admission, fever, or antibiotics treatments between surgical and medical treatment groups, surgical drainage may be avoided by early recognition and suspicion. However, if there is no improvement of symptoms or size of abscesses within 48-72 hours of antibiotic treatment, surgical drainage should be considered.

Keyword

Neck; Abscess; Child; Adolescent

MeSH Terms

Abscess
Adolescent
Anti-Bacterial Agents
Bacteria
Child
Drainage
Female
Fever
Headache
Hospitals, General
Humans
Male
Medical Records
Neck
Staphylococcus aureus
Trismus
Anti-Bacterial Agents

Reference

References

1). Korean Society of Otorhinolaryngology-Head and Neck surgery. Otorhinolaryngology-Head and Neck Surgery.2nd ed. Seoul: Ilchokak Co;2009. p. 1781–99.

2). Lee DW, Lee HS, Lee KY, Park IB, Park CW, Tae K. A clinical study of deep neck infection in children. Korean J Otolaryngol-Head Neck Surg. 2005; 48:1382–7.

3). Lee JK. A clinical study of fourteen cases of deep neck infection with mediastinal involvement. Korean J Otolaryngol-Head Neck Surg. 2005; 48:636–40.

4). Lee DH, Kim SM, Lee JH, Kim JH, Hur JK, Kang JH. Deep neck abscesses in Korean children. Korean J Pediatr Infect Dis. 2004; 11:81–9.

5). Wynne DM, Borg HK, Botma M, MacGregor F. Acute paediatric neck abscess. Scott Med J. 2008; 53:17–20.

6). Goo MJ, Yeom JS, Kim EJ, Park JJ, Seo JH, Park ES, et al. Clinical characteristics of deep neck abscess in children; 15 year experience in a university hospital. Korean J Pediatr. 2007; 50:649–54.

7). Lee SJ, Shin MY, Kim CH, Koh YW. A clinical study of deep neck abscess in children. Korean J Pediatr. 2007; 50:363–8.

8). Nagy M, Pizzuto M, Backstrom J, Brodsky L. Deep neck infections in children: A new approach to diagnosis and treatment. Laryngoscope. 1997; 107:1627–34.

9). Chang L, Chi H, Chiu NC, Huang FY, Lee KS. Deep neck infections in different age groups of children. J Microbiol Immunol Infect. 2010; 43:47–52.

10). 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; 130:201–7.

11). Lee SM, Kwon BC, Choi SY, Sohn MH, Kim KE. Peritonsillar abscess in a 40-day-old infant. Yonsei Med J. 2006; 47:568–70.

12). Yang YS, Lee HU, Lee SH, Hong KH. A clinical study of the the deep neck infections in children. Korean J Otolaryngol-Head Neck Surg. 2004; 47:1282–8.

13). Cmejrek RC, Coticchia JM, Arnold JE. Presentation, diagnosis, and management of deep-neck abscesses in Infants. Arch Otolaryngol Head Neck Surg. 2002; 128:1361–4.

14). Millar KR, Johnson DW, Drummond D, Kellner JD. Suspected peritonsillar abscess in children. Pediatr Emerg Care. 2007; 23:431–8.

15). Porter MJ, van Hasselt CA. Deep neck space infections. Hong Kong Med J. 1992; 44:2–6.

16). Gidley PW, Ghorayeb BY, Stiernberg CM. Contemporary management of deep neck space infections. Otolaryngol Head Neck Surg. 1997; 116:16–22.

17). Steelman R, Milczuk H, Grosz A. Masticator space abscess in a 21-month-old child. Int J Pediatr Otorhinolaryngol Extra. 2006; 1:185–7.

18). Raju R, Digoy GP. Pediatric Otolaryngology for the Clinician. 1st ed.New York: Human Press, Inc;P. 2009. p. 223–9.

19). Nicklaus PJ. Deep neck infections. Curr Infect Dis Rep. 1999; 1:39–46.

20). Vural C, Gungor A, Comerci S. Accuracy of computerized tomography in deep neck infections in the pediatric population. Am J Otolaryngol. 2003; 24:143–8.

21). Sakaguchi M, Sato S, Asawa S, Taguchi K. Computed tomographic findings in peritonsillar abscess and cellulitis. J Laryngol Otol. 1995; 109:449–51.

22). Courtney MJ, Mahadevan M, Miteff A. Management of paediatric retropharyngeal infections: nonsurgical versus surgical. ANZ J Surg. 2007; 77:985–7.

23). Tan PT, Chang LY, Huang YC, Chiu CH, Wang CR, Lin TY. Deep neck infections in children. J Microbiol Immunol Infect. 2001; 34:287–92.

24). Cengiz AB, Kara A, Kanra G, Se meer G, Ceyhan M, ç zen M. Acute neck infections in children. Turk J Pediatr Ö. 2004; 46:153–8.

25). Abshirini H, Alavi SM, Rekabi H, Hosseinnejad F, Gha-zipour A, Yavari M, et al. Predisposing factors for the complications of deep neck infection. Iran J Otorhinolaryngol. 2010; 22:97–102.

26). McKellop JA, Mukherji SK. Emergency head and neck radiology: neck infections. Appl Radiol. 2010; 39:23–9.