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Sequential parapharyngeal abscesses
C M Haben1, P Campisi, R Sweet
1Montreal Children's Hospital/McGill University Health Center, Department of Otolaryngology, 5551 Chemin Queen Mary, ste. 3, Quebec, H3X 1W1, Montreal, Canada. mhaben@po-box.mcgill.ca
Insights
Sequential deep neck infections, specifically parapharyngeal abscesses, can occur in healthy children. Even with appropriate antibiotics, these infections may require further investigation beyond standard CT scans and initial treatments.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Head and Neck Surgery
Background:
- Deep neck infections are common in pediatric and adult populations, often presenting as multiple or recurrent abscesses, particularly in immunocompromised individuals.
- Parapharyngeal abscesses are a specific type of deep neck infection requiring prompt diagnosis and management.
Observation:
- A rare case of sequential, bilateral parapharyngeal abscesses occurred in an otherwise healthy 3-year-old patient.
- The patient received culture-directed, intravenous antibiotics, yet experienced recurrent infections.
- Computed tomography (CT) scanning may underestimate the full extent of deep neck infections.
Findings:
- Sequential parapharyngeal abscesses in healthy pediatric patients without identifiable etiology are exceptionally rare.
- Intravenous clindamycin, a common first-line therapy, may be insufficient for large phlegmonous infections.
- The possibility of underestimation of infection extent by CT imaging is highlighted.
Implications:
- This case underscores the need for vigilant monitoring and potentially advanced imaging or alternative therapeutic strategies in pediatric deep neck infections.
- Clinicians should consider limitations of initial CT assessments and the potential inadequacy of standard antibiotic regimens for extensive phlegmonous deep neck infections.
- Further research into optimal diagnostic and therapeutic approaches for complex pediatric deep neck infections is warranted.
Abstract:
Deep neck infections are not unusual in either the pediatric or adult populations. Multiple, and recurrent abscesses are found not infrequently, especially in immunocompromised and debilitated persons. It is very rare to find sequential parapharyngeal abscesses without identifiable etiology in an otherwise healthy pediatric patient while receiving appropriate, culture-directed, intravenous antibiotics. This could be due to underestimation of the extent of the infection by CT scanning. The use of intravenous clindamycin as a first-line therapy may not be sufficient if a large phlegmon exists. We describe a case of sequential, bilateral parapharyngeal abscesses in a 3-year-old patient.