The Role of Surgery in the Treatment of Cervical Lymph Node Tuberculosis

Cervical lymph node tuberculosis is a public health problem in Morocco and the rest of the world. Its paucibacillary nature makes diagnosis and treatment difficult. This is a descriptive-analytical retrospective study presenting 104 cases of patients with manifestations of cervical lymph node tuberculosis confirmed by pathological examination (100%), associated in some cases with positive bacteriology (40.6%), treated and followed up in the otolaryngology (ENT) department of the Cheikh Khalifa International University Hospital (HUICK) over a period of 5 years and 9 months (from January 01, 2017, to September 30, 2022). In our study, 14 patients (i.e., 13.5%) had a history of tuberculosis (all locations); only four (i.e., 3.8%) of them had confirmed cervical lymph node tuberculosis, of which three were still under treatment: two of them presented for treatment failure (i.e., 1.9%) and one patient for a paradoxical reaction (i.e., 1%). Three pulmonary locations (i.e., 2.9%) and one mediastinal location (i.e., 1%) were found. Surgery associated with histological study was the key to the diagnosis of tuberculosis in our study. Its procedures were: excisional biopsy for 26 patients (i.e., 25%), adenectomy for 54 patients (i.e., 51.9%), lymph node dissection for 15 patients (i.e., 14.4%), and lymphadenectomy for nine patients (i.e., 8.7%). In some cases, drainage (+/- curettage) was recommended in addition to the surgical procedure in 14 patients (i.e., 13.5%). All our patients benefited from post-surgical anti-bacillary treatment. Lymphorrhea was the only operative complication and it affected two patients (i.e., 1.9%). Meanwhile, the relapse rate was 10.6% (i.e., 11 patients), the treatment failure rate was 3.8% (i.e., four patients), and the paradoxical reaction affected 2.9% (i.e., three patients). The latter had all benefited from a simple biopsy. This indicates that a more extensive surgical procedure gives better results with a better healing rate. In conclusion, anti-bacillary treatment remains the reference treatment for lymph node tuberculosis. However, surgery holds great promise as the first-line treatment in case of fistula or abscess or in the event of failure or if complications occur.