A clinical analysis of cases with deep neck abscesses requiring surgical drainage multiple times

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  • Mizuno Keisuke
    Ako City Hospital, Department of Otolaryngology Kobe City Medical Center General Hospital, Department of Otolaryngology, Head and Neck Surgery
  • Shinohara Shogo
    Kobe City Medical Center General Hospital, Department of Otolaryngology, Head and Neck Surgery
  • Hamaguchi Kiyomi
    Kobe City Medical Center General Hospital, Department of Otolaryngology, Head and Neck Surgery
  • Takebayashi Shinji
    Kobe City Medical Center General Hospital, Department of Otolaryngology, Head and Neck Surgery

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  • 深頸部膿瘍に対し複数回の排膿手術が必要になるリスク因子の検討

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Deep neck abscess is a serious and life-threatening disease, sometimes requiring surgical drainage multiple times. The aim of this study was to analyze the indications for repeated surgical drainage in patients with deep neck abscesses.<br>A retrospective review was conducted of 45 patients who were diagnosed as having deep neck abscesses and underwent surgical drainage in the Department of Otolaryngology at Kobe City Medical Center General Hospital from 2012 to 2019. The 45 patients were divided into two groups: the group which underwent re-operation （re-operation group, n＝11） and the group which underwent surgery just once and were cured （good response group, n＝34）.<br>Their age, sex, results of blood test, bacteriology, site of abscess, radiology and treatment contents were evaluated, and were compared between the two groups.<br>The re-operation group had a significantly higher serum CRP （26.29 vs 12.57, p＝0.001）, free air in the deep neck space on computed tomography more often （45％ vs 11％, p＝0.028）, mediastinitis more often （63％ vs 14％, p＝0.003） and a higher detection rate of Streptococcus milleri group bacteria （63％ vs 26％, p＝0.035） compared to the good response group. In the re-operation group, the following factors tended to occur more frequently: polymicrobial infections （63％ vs 35％, p＝0.091）, abscess in visceral space （64％ vs 32％, p＝0.069） or retropharyngeal space （55％ vs 24％, p＝0.062）, and initial antibiotic treatment by meropenem and vancomycin （36％ vs 9％, p＝0.09）.<br>We concluded that more sufficient and aggressive drainage, such as prophylactic opening of spaces which lead to the mediastinum （visceral space, retropharyngeal space, vascular space） in addition to the space where abscesses exist, may be necessary in treating deep neck abscesses with the factors previously listed.

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