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Relative Incidence and Alternative Approaches for Surgical Drainage of Different Types of Deep Neck Abscesses in Children

Relative Incidence and Alternative Approaches for Surgical Drainage of Different Types of Deep... Abstract Objectives: To determine the relative frequency of retropharyngeal abscesses (RPAs) vs lateral pharyngeal abscesses (LPAs) and to analyze alternative approaches for surgical drainage. Design: Retrospective chart review. Setting: Tertiary care children's hospital. Patients: Seventy pediatric patients who were evaluated, admitted, and treated for presumed deep neck abscesses (RPAs and LPAs) between January 1, 1986, and December 31, 1996. Intervention: Intravenous antibiotic therapy and surgical drainage. Main Outcome Measure: Clinical resolution of the abscess. Results: Fifty-eight patients were evaluated with computed tomographic scan. Thirteen of these patients did not have surgical intervention. Of 12 patients diagnosed as having an isolated RPA, all had intraoral surgical drainage and 9 had evidence of pus at surgery. Twenty-one patients had an isolated LPA. Sixteen of these underwent intraoral drainage and 5 underwent external drainage. Purulence was found at surgery in 14 and 2 patients, respectively. The remaining 12 patients had a combination of RPA and LPA. Eight patients underwent intraoral drainage, and 4 patients required both intraoral and external approaches. Purulence was found at surgery in 5 and 4 patients, respectively. Of the 12 patients who were not evaluated with computed tomographic scan, two thirds were treated prior to 1987. Six of these 12 patients underwent surgical drainage via an intraoral approach, and 4 of the 6 patients had pus. The remaining 6 improved without surgery. Conclusions: Most deep neck abscesses in children are located in the retropharyngeal or in the lateral pharyngeal space medial to the great vessels. Therefore, most can be managed successfully with intraoral rather than external drainage. External approaches are better reserved for those abscesses that are lateral to the great vessels or that involve multiple spaces. In this patient population, LPAs were more commonly seen than RPAs.Arch Otolaryngol Head Neck Surg. 1997;123:1271-1275 References 1. Blomquist IK, Bayer AS. Life-threatening deep facial space infections of the head and neck . Infect Dis Clin North Am . 1988;2:237-264. 2. Gaglani MJ, Edwards MS. Clinical indicators of childhood retropharyngeal abscess . Am J Emerg Med . 1995;13:333-336.Crossref 3. Gidley PW, Ghorayeb BY, Stiernberg CM. Contemporary management of deep neck space infections . Otolaryngol Head Neck Surg . 1997;116:16-22.Crossref 4. Johnson JT. Abscesses and deep space infections of the head and neck . Infect Dis Clin North Am . 1992;6:705-717. 5. Levitt GW. The surgical treatment of deep neck infections . Laryngoscope . 1971; 81:403-411.Crossref 6. Levitt GW. Cervical fascia and deep neck infections . Otolaryngol Clin North Am . 1976;9:703-716. 7. Mosher HP. The submaxillary fossa approach to deep pus in the neck . Trans Am Acad Ophthalmol Otolaryngol . 1929;34:19-26. 8. Ungkanont K, Yellon RF, Weissman JL, Casselbrant ML, Gonzalez-Valdepena H, Bluestone CD. Head and neck space infections in infants and children . Otolaryngol Head Neck Surg . 1995;112:375-382.Crossref 9. Beasley DJ, Amedee RG. Deep neck space infections . J La State Med Soc . 1995; 147:181-184. 10. Barratt GE, Koopmann CF, Coulthard SW. Retropharyngeal abscess: ten-year experience . Laryngoscope . 1984;4:455-463.Crossref 11. Broughton RA. Nonsurgical management of deep neck infections in children . Pediatr Infect Dis J . 1992;11:14-18.Crossref 12. Dodds B, Maniglia AJ. Peritonsillar and neck abscesses in the pediatric age group . Laryngoscope . 1988;98:956-959.Crossref 13. Har-El G, Aroesty JH, Shaha, A, Lucente FE. Changing trends in deep neck abscess . Oral Surg Oral Med Oral Pathol . 1994;77:446-450.Crossref 14. Lazor JB, Cunningham MJ, Eavey RD, Weber AL. Comparison of computed tomography and surgical findings in deep neck infections . Otolaryngol Head Neck Surg . 1994;111:746-750.Crossref 15. Sethi DS, Stanley RE. Parapharyngeal abscesses . J Laryngol Otol . 1991;105: 1025-1030.Crossref 16. Tom MB, Rice DH. Presentation and management of neck abscess: a retrospective analysis . Laryngoscope . 1988;98:877-880.Crossref 17. Coulthard M, Isaacs D. Retropharyngeal abscess . Arch Dis Child . 1991;66:1227-1230.Crossref 18. Wholey MH, Bruwer AJ, Baker HL. The lateral roentgenogram of the neck . Radiology . 1958;71:528-536. 19. de Marie S, Tham RT, van der Mey AGL, Meerdink G, van Furth R, van der Meer JWM. Clinical infections and nonsurgical treatment of parapharyngeal space infections complicating throat infection . Rev Infect Dis . 1989;6:975-982.Crossref 20. Matt BH, Lusk RP. Delineation of a deep neck abscess with magnetic resonance imaging . Ann Otol Rhinol Laryngol . 1987;96:615-617. 21. Morrison JE, Pashley NRT. Retropharyngeal abscesses in children: a 10 year review . Pediatr Emerg Care . 1988;4:9-11.Crossref 22. Thompson JW, Cohen SR, Reddix P. Retropharyngeal abscess in children: a retrospective and historical analysis . Laryngoscope . 1988;98:589-592.Crossref 23. Brook I. Microbiology of abscesses of the head and neck in children . Ann Otol Rhinol Laryngol . 1987;96:429-433. 24. Brodsky L, Belles W, Brody A, Squire R, Stanievich J, Volk M. Needle aspiration of neck abscesses in children . Clin Pediatr . 1992;31:71-76.Crossref 25. Guarisco L, Grundfast KM. Method for draining retropharyngeal abscess . Laryngoscope . 1988;98:242-243. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Relative Incidence and Alternative Approaches for Surgical Drainage of Different Types of Deep Neck Abscesses in Children

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References (28)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1997.01900120015002
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Abstract

Abstract Objectives: To determine the relative frequency of retropharyngeal abscesses (RPAs) vs lateral pharyngeal abscesses (LPAs) and to analyze alternative approaches for surgical drainage. Design: Retrospective chart review. Setting: Tertiary care children's hospital. Patients: Seventy pediatric patients who were evaluated, admitted, and treated for presumed deep neck abscesses (RPAs and LPAs) between January 1, 1986, and December 31, 1996. Intervention: Intravenous antibiotic therapy and surgical drainage. Main Outcome Measure: Clinical resolution of the abscess. Results: Fifty-eight patients were evaluated with computed tomographic scan. Thirteen of these patients did not have surgical intervention. Of 12 patients diagnosed as having an isolated RPA, all had intraoral surgical drainage and 9 had evidence of pus at surgery. Twenty-one patients had an isolated LPA. Sixteen of these underwent intraoral drainage and 5 underwent external drainage. Purulence was found at surgery in 14 and 2 patients, respectively. The remaining 12 patients had a combination of RPA and LPA. Eight patients underwent intraoral drainage, and 4 patients required both intraoral and external approaches. Purulence was found at surgery in 5 and 4 patients, respectively. Of the 12 patients who were not evaluated with computed tomographic scan, two thirds were treated prior to 1987. Six of these 12 patients underwent surgical drainage via an intraoral approach, and 4 of the 6 patients had pus. The remaining 6 improved without surgery. Conclusions: Most deep neck abscesses in children are located in the retropharyngeal or in the lateral pharyngeal space medial to the great vessels. Therefore, most can be managed successfully with intraoral rather than external drainage. External approaches are better reserved for those abscesses that are lateral to the great vessels or that involve multiple spaces. In this patient population, LPAs were more commonly seen than RPAs.Arch Otolaryngol Head Neck Surg. 1997;123:1271-1275 References 1. Blomquist IK, Bayer AS. Life-threatening deep facial space infections of the head and neck . Infect Dis Clin North Am . 1988;2:237-264. 2. Gaglani MJ, Edwards MS. Clinical indicators of childhood retropharyngeal abscess . Am J Emerg Med . 1995;13:333-336.Crossref 3. Gidley PW, Ghorayeb BY, Stiernberg CM. Contemporary management of deep neck space infections . Otolaryngol Head Neck Surg . 1997;116:16-22.Crossref 4. Johnson JT. Abscesses and deep space infections of the head and neck . Infect Dis Clin North Am . 1992;6:705-717. 5. Levitt GW. The surgical treatment of deep neck infections . Laryngoscope . 1971; 81:403-411.Crossref 6. Levitt GW. Cervical fascia and deep neck infections . Otolaryngol Clin North Am . 1976;9:703-716. 7. Mosher HP. The submaxillary fossa approach to deep pus in the neck . Trans Am Acad Ophthalmol Otolaryngol . 1929;34:19-26. 8. Ungkanont K, Yellon RF, Weissman JL, Casselbrant ML, Gonzalez-Valdepena H, Bluestone CD. Head and neck space infections in infants and children . Otolaryngol Head Neck Surg . 1995;112:375-382.Crossref 9. Beasley DJ, Amedee RG. Deep neck space infections . J La State Med Soc . 1995; 147:181-184. 10. Barratt GE, Koopmann CF, Coulthard SW. Retropharyngeal abscess: ten-year experience . Laryngoscope . 1984;4:455-463.Crossref 11. Broughton RA. Nonsurgical management of deep neck infections in children . Pediatr Infect Dis J . 1992;11:14-18.Crossref 12. Dodds B, Maniglia AJ. Peritonsillar and neck abscesses in the pediatric age group . Laryngoscope . 1988;98:956-959.Crossref 13. Har-El G, Aroesty JH, Shaha, A, Lucente FE. Changing trends in deep neck abscess . Oral Surg Oral Med Oral Pathol . 1994;77:446-450.Crossref 14. Lazor JB, Cunningham MJ, Eavey RD, Weber AL. Comparison of computed tomography and surgical findings in deep neck infections . Otolaryngol Head Neck Surg . 1994;111:746-750.Crossref 15. Sethi DS, Stanley RE. Parapharyngeal abscesses . J Laryngol Otol . 1991;105: 1025-1030.Crossref 16. Tom MB, Rice DH. Presentation and management of neck abscess: a retrospective analysis . Laryngoscope . 1988;98:877-880.Crossref 17. Coulthard M, Isaacs D. Retropharyngeal abscess . Arch Dis Child . 1991;66:1227-1230.Crossref 18. Wholey MH, Bruwer AJ, Baker HL. The lateral roentgenogram of the neck . Radiology . 1958;71:528-536. 19. de Marie S, Tham RT, van der Mey AGL, Meerdink G, van Furth R, van der Meer JWM. Clinical infections and nonsurgical treatment of parapharyngeal space infections complicating throat infection . Rev Infect Dis . 1989;6:975-982.Crossref 20. Matt BH, Lusk RP. Delineation of a deep neck abscess with magnetic resonance imaging . Ann Otol Rhinol Laryngol . 1987;96:615-617. 21. Morrison JE, Pashley NRT. Retropharyngeal abscesses in children: a 10 year review . Pediatr Emerg Care . 1988;4:9-11.Crossref 22. Thompson JW, Cohen SR, Reddix P. Retropharyngeal abscess in children: a retrospective and historical analysis . Laryngoscope . 1988;98:589-592.Crossref 23. Brook I. Microbiology of abscesses of the head and neck in children . Ann Otol Rhinol Laryngol . 1987;96:429-433. 24. Brodsky L, Belles W, Brody A, Squire R, Stanievich J, Volk M. Needle aspiration of neck abscesses in children . Clin Pediatr . 1992;31:71-76.Crossref 25. Guarisco L, Grundfast KM. Method for draining retropharyngeal abscess . Laryngoscope . 1988;98:242-243.

Journal

Archives of Otolaryngology - Head & Neck Surgery – American Medical Association

Published: Dec 1, 1997

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