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Nonsurgical management of parapharyngeal space infections: a prospective study
Jean-Yves Sichel1, Itshac Dano, Eitan Hocwald
1Department of Otolaryngology-Head and Neck Surgery, Hadassah University Hospital, Jerusalem, Israel.
Objective/Hypothesis:
Parapharyngeal infections, which can potentially cause life-threatening complications, may, in certain cases, be treated conservatively with no need for surgical drainage. A review of the literature reveals that the most recommended treatment of parapharyngeal infection is surgical drainage combined with intravenous antibiotic therapy. Several retrospective reports recommend conservative treatment with no surgical drainage.
Study Design:
Prospective, nonrandomized.
Methods:
A prospective study was performed on all patients with an infection limited to the parapharyngeal space.
Results:
Twelve patients presented with clinical and radiological diagnosis of parapharyngeal infection during a 5-year period. Five patients showed obvious presence of pus in other spaces and therefore were excluded. Seven patients with no gross extension into other spaces and with no respiratory distress or septic shock were treated with intravenous amoxicillinclavulanic acid for 9 to 14 days (average period, 11 days). All patients except one were children. All were cured with conservative management, and no surgical drainage was needed. None had any complications.
Conclusion:
Our results confirm the effectiveness of nonsurgical treatment of infections limited to the parapharyngeal space, at least in the pediatric population.
Insights
Conservative management, including intravenous antibiotics, effectively treats parapharyngeal infections in children. This approach avoids surgical drainage and complications for localized infections.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Pediatric Medicine
Background:
- Parapharyngeal infections pose life-threatening risks but may be managed non-surgically.
- Current literature often recommends surgical drainage alongside antibiotics for parapharyngeal infections.
- Some studies suggest conservative treatment without surgical intervention is viable.
Purpose of the Study:
- To evaluate the effectiveness of conservative, non-surgical management for parapharyngeal space infections.
- To determine if intravenous antibiotic therapy alone is sufficient for treating localized parapharyngeal infections.
Main Methods:
- Prospective, non-randomized study design.
- Inclusion criteria: patients with infections confined to the parapharyngeal space.
- Treatment: Intravenous amoxicillin-clavulanic acid for 9-14 days for eligible patients.
Main Results:
- Seven pediatric patients with localized parapharyngeal infections were treated conservatively.
- All patients received intravenous amoxicillin-clavulanic acid for an average of 11 days.
- Complete resolution of infection was achieved in all patients without surgical drainage or complications.
Conclusions:
- Nonsurgical treatment is effective for parapharyngeal infections limited to the parapharyngeal space.
- Conservative management is particularly effective in the pediatric population.
- This study supports avoiding surgical drainage in select cases of pediatric parapharyngeal infections.