Epidemiologic, Imaging, and Clinical Issues in Bezold's Abscess: A Systematic Review

Area of Science:

• Otolaryngology
• Infectious Diseases
• Radiology

Background:

• Bezold's abscess is a deep neck abscess associated with otomastoiditis.
• Its insidious presentation often delays diagnosis and treatment, increasing the risk of life-threatening complications.
• Existing literature offers a fragmented view, with limited case series.

Purpose of the Study:

• To review the epidemiology, pathogenesis, clinical presentation, imaging findings, and treatment of Bezold's abscess.
• To consolidate findings from a single institution's experience and a PRISMA-based literature review of 97 patients.
• To highlight diagnostic challenges and effective management strategies.

Main Methods:

• Systematic literature review adhering to PRISMA criteria.
• Retrospective analysis of patient data from a single institution.
• Consolidation of findings on 97 identified cases of Bezold's abscess.

Main Results:

• Bezold's abscess affects all age groups, with a male predominance in adults.
• Otomastoiditis and cholesteatoma are significant risk factors; 43% report a history of otitis.
• CT imaging reveals mastoid tip erosion (53%) and concurrent cholesteatoma (40%). Intracranial complications occur in 24% (vascular) and 9% (infectious).

Conclusions:

• Accurate diagnosis of Bezold's abscess is achievable with proper CT imaging.
• MRI is valuable for suspected intracranial complications or coexisting cholesteatoma.
• Prompt antibiotic therapy and surgical intervention are essential for effective treatment.