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Volume 50, Number 5, October 2017

Deep neck infections in children 


Chung-Ming Huang, Fang-Liang Huang, Ya-Li Chien, Po-Yen Chen


 

Corresponding author:

Po-Yen Chen, Corresponding author. Division of Infection, Department of Pediatrics, Taichung Veterans General Hospital, Number 1650, Section 4, Taiwan Boulevard, Taichung 407, Taiwan.
 



 

Background and purpose: 

Deep neck infections (DNIs) often have a rapid onset and can progress to life-threatening complications. There are only a few reports on pediatric DNIs' clinical manifestations, diagnostic clues, and etiology in Taiwan. 



 

Methods:

A retrospective chart review of patients (aged ≤ 18 years) diagnosed with DNI from January 2005 to December 2014 was performed. DNIs were classified into retropharyngeal, parapharyngeal, peritonsillar, submandibular, and multispace abscesses. 



 

Results:

A total of 52 patients with DNI were identified. The most common site of DNI was the parapharyngeal space (n = 22, 42.3%). The most commonly associated antecedent illness was preceding upper respiratory tract infection (30.8%). The most common clinical presentation was neck mass or swelling (82.7%) and fever (75%). Pus drainage or needle aspiration was performed to obtain pus samples from the infection site for pus culture (n = 31). The most commonly isolated pathogen was Staphylococcus aureus (n = 7). Amoxicillin–clavulanic acid (56.6%) was the most commonly used antibiotics, followed by penicillin (15.1%). There was no long-term morbidity or mortality. 



 

Conclusion:

When a patient (regardless of age) presents with neck mass or swelling, the DNI should always be included in the differential diagnosis. The low culture rate in Taiwan and previous partial treatment of infections may have affected identification of pathogens in cultures. Performing Gram staining and acid-fast staining of pus, instead of culture alone, as early as possible before initiating the initial antimicrobial therapy are thus crucial. The recurrence of DNI should alert the physician to the possibility of an underlying bronchogenic cyst. Excision surgery is required to cure recurrent infections. 



 

Key words:

deep neck infection, parapharyngeal abscess, peritonsillar abscess, retropharyngeal abscess, submandibular abscess