Pediatric Deep Neck Abscess: Treatment Strategy According to the Abscess Site

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  • 小児深頸部膿瘍の治療 : 感染部位に応じた治療選択
  • ショウニシンケイブ ノウヨウ ノ チリョウ : カンセン ブイ ニ オウジタ チリョウ センタク

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<p> Deep neck abscess is a serious and potentially life-threatening infection that spreads along the spaces surrounded by the cervical fascia. Because pediatric deep neck abscesses are relatively rare, the clinical characteristics are not yet clearly understood. Surgical treatment remained the first-step approach in most cases of deep neck abscesses in children until recent years. However, numerous recent studies have reported the success of needle aspiration or conservative medical treatment alone.</p><p></p><p> Pediatric deep neck abscesses tend to be contained within lymph nodes long before they spread to the fascial planes of the neck; therefore, they are more commonly contained and less extensive than in adults. Many cases of lymphatic abscesses in children can be successfully managed by conservative treatment, without the need for surgery. However, in the case of a peritonsillar abscess or parotid space abscess, surgical treatment may be required because of the different routes of infection. Herein, we report our treatment strategy for pediatric deep neck abscesses according to the site of the abscess.</p><p></p><p> We retrospectively examined the data of 11 children with deep neck abscesses seen between September 2016 and March 2019 at our hospital. The most common sites of the abscesses were the retropharyngeal space (n=4), peritonsillar space (n=3), and parotid space (n=2). Of the 11 cases, 7 were managed by conservative treatment alone and 4 were treated surgically. According to the abscess site, all patients with retropharyngeal infection were managed by conservative treatment. Four patients (peritonsillar space: 1, parotid space: 2, posterior cervical space: 1) were treated by needle aspiration as the primary treatment. One of patients with parotid space abscess who failed to improve with antibiotic treatment and needle aspiration was subsequently treated by surgical drainage. No significant complications were observed in any of the patients. According to the abscess site, needle aspiration is an effective alternative procedure to surgical drainage in pediatric cases of deep neck infections.</p>

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