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Nonsurgical management of deep neck infections in children
1Department of Pediatrics, University of Kentucky Medical Center, Lexington 40536-0084.
Insights
Some pediatric deep neck infections, even those appearing as abscesses on CT scans, may resolve with antibiotics alone. This study found 8 of 14 patients improved without surgery, highlighting a less invasive treatment option.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Radiology
Background:
- Deep neck infections (DNIs) in children often require surgical intervention.
- The role of non-surgical management for DNIs, particularly those with imaging evidence of abscess, is less defined.
Purpose of the Study:
- To evaluate the outcomes of pediatric patients with deep neck infections treated with antibiotics alone.
- To determine if imaging findings suggestive of abscess formation preclude successful non-surgical management.
Main Methods:
- Retrospective review of 14 pediatric patients with DNIs from 1981-1990.
- Analysis of treatment (surgical vs. antibiotic therapy) and clinical outcomes.
- Correlation of outcomes with computerized tomography (CT) findings.
Main Results:
- Eight of 14 patients received antibiotic therapy without surgical drainage and achieved resolution.
- CT scans in 7 patients revealed parapharyngeal cystic lesions suggestive of abscess.
- Clinical improvement occurred within 1.6 days of antibiotic initiation, with defervescence within 3.8 days.
Conclusions:
- Antibiotic therapy alone can be effective in managing some pediatric deep neck infections, even with CT-apparent abscess formation.
- Non-operative management should be considered for select pediatric DNIs.
- Further investigation into criteria for non-surgical DNI management is warranted.
Abstract:
Of the 14 pediatric patients with deep neck infections hospitalized at our institution from 1981 through 1990, only 6 were managed surgically. The remaining 8 patients received antibiotic therapy and their infection resolved without the need for surgical drainage. All 8 patients were hospitalized within 4 days (mean, 1.8 days) of onset of illness. Computerized tomography of the neck was performed in 7 and revealed soft tissue swelling and a round or oval cystic lesion in the parapharyngeal region in all 7. Parenteral antibiotic therapy was administered to all patients for 2 to 9 days (mean, 5.5 days) before changing to oral therapy which was continued for 10 to 35 days (mean, 15.1 days). Clinical improvement was evident in all patients 1 to 3 days (mean, 1.6 days) after the onset of antibiotic therapy, with defervescence within 7 days (mean, 3.8 days). Follow-up computerized tomography scans were obtained in 4 patients revealing improvement in 3. It is known that patients with cellulitis of the deep neck tissues may respond well to antibiotic therapy; our experience suggests that some patients with apparent abscess formation as determined by computerized tomography scan may also respond favorably to antibiotic therapy and not require surgical drainage.