[Neck abscess as primary manifestation of head and neck carcinoma: implications for diagnostic management]

Neck abscesses and deep neck infections are common diseases in the field of otorhinolaryngology. However, malignant lymph node metastases presenting as abscesses are uncommon and have rarely been described up to now.

A retrospective review between March 1997 and August 1999 was conducted of 40 patients with deep neck abscesses.

In five patients (12.5%) the histological diagnostics revealed a malignancy. From these, in 3 cases the cervical abscess was the primary clinical symptom of an oropharyngeal as well as a hypopharyngeal carcinoma. With further 2 patients, the neck-abscess was located as first clinical sign of a metachronous lymph node metastases after oropharyngeal carcinoma. Aerobic bacteria were recovered in 18 patients, anaerobes alone in 3 and mixed aerobic and anaerobic bacteria in 6 patients. Bartonella henselae was recovered in 7, Mycobacterium tuberculosis in 3 and Actinomyces israelii in 1 patient.

A biopsy of the abscess wall is recommended in establishing the diagnosis. The indication for a simultaneous panendoscopy--especially in patients with typical risk for malignancies--to exclude a primary tumor in the aerodigestive tract should be regarded generously. Neck abscesses should be considered in the differential diagnosis of head and neck carcinoma.