ABSTRACT
Abstract Introduction The role of surgical drainage versus conservative therapy in treating patients with parapharyngeal abscesses is still a theme of debate. Objectives This study aimed to investigate the characteristics associated with good outcomes in pediatric patients with parapharyngeal abscesses treated with conservative therapy. Methods This retrospective chart review was performed on children aged 0.3-14 years with the diagnosis of parapharyngeal abscesses confirmed by computed tomography from January 2013 to March 2018. Patients with a severe upper airway obstruction required early intervention, while those in a stable condition initially received conservative therapy with antibiotics. If the patients appeared unlikely to recover, additional surgical drainage was provided. Multivariate logistic regression models were constructed to investigate the clinical characteristics associated with a good response to conservative therapy. A receiver operating characteristic curve was used to identify the age and abscess size cutoff for predicting a successful response. Results A total of 48 children were included in the study. Patient age, antecedent illness, and abscess size were significantly associated with a response to therapy (Odds Ratio = 1.326, 2.314 and 1.235, respectively). The age cutoff associated with the conservative therapy was 4.2 years (76.9% sensitivity, 68.2% specificity), and the abscess size cutoff associated with the conservative therapy was 23 mm (84.6% sensitivity, 77.3% specificity). Conclusion The findings suggested that younger age, smaller abscess size, and less frequent antecedent illnesses, such as upper respiratory tract infection and lymphadenitis, could predict a successful response to conservative therapy in pediatric patients with parapharyngeal abscesses.
Resumo Introdução O papel da drenagem cirúrgica versus tratamento conservador na abordagem de pacientes com abscessos parafaríngeos ainda é uma questão controversa. Objetivo Investigar as características associadas a um bom desfecho em pacientes pediátricos com abscessos parafaríngeos tratados com terapia conservadora. Método Revisão retrospectiva de prontuários feita em crianças de 14 anos com diagnóstico de abscesso parafaríngeo confirmado por tomografia computadorizada de janeiro de 2013 a março de 2018. Pacientes com obstrução grave das vias aéreas superiores necessitaram de intervenção precoce, enquanto aqueles em estado inicialmente estável receberam tratamento conservador com antibióticos. Se a recuperação dos pacientes parecesse improvável, drenagem cirúrgica adicional era feita. Modelos de regressão logística multivariada foram construídos para investigar as características clínicas associadas a uma boa resposta a terapia conservadora. Uma curva ROC, ou seja, característica de operação do receptor, foi usada para identificar a idade e o tamanho do abscesso com o intuito de prever uma resposta bem-sucedida. Resultados Foram incluídas no estudo 48 crianças. Idade do paciente, doenças respiratórias prévias e comorbidades e tamanho do abscesso foram significantemente associados à resposta terapêutica. (odds ratio = 1.326, 2.314 e 1.235, respectivamente). O ponto de corte da idade associado à terapia conservadora foi de 4,2 anos (sensibilidade de 76,9%, especificidade de 68,2%) e o ponto de corte do tamanho do abscesso associado à terapia conservadora foi de 23 mm (sensibilidade de 84,6%, especificidade de 77,3%). Conclusão Os achados sugerem que idade mais jovem, menor tamanho de abscesso e menor frequência de doença comuns, como infecção do trato respiratório superior e linfadenite, podem prever uma resposta bem-sucedida à terapia conservadora em pacientes pediátricos com abscessos parafaríngeos.
Subject(s)
Humans , Child, Preschool , Child , Pharyngeal Diseases , Abscess/therapy , Abscess/diagnostic imaging , Drainage , Retrospective Studies , Conservative TreatmentABSTRACT
Subdural empyema is fulminating purulent infection that develops between the dura and the arachnoid membranes. It is rare but one of the most immediate of neurosurgical emergencies, hence the importance of proper diagnosis and early intervention. Most subdural empyema complicated in the ENT field originate from sinonasal or otologic infections rather than dental infections. In our case of 64-years-old male, who was admitted with headache and fever, the diagnosed subdural empyema originated from odontogenic parapharyngeal abscess. We report that the case was successfully managed after urgent surgical drainage by endoscopic transethmoidal approach with long term intravenous antibiotics.
Subject(s)
Humans , Male , Abscess , Anti-Bacterial Agents , Arachnoid , Diagnosis , Drainage , Early Intervention, Educational , Emergencies , Empyema, Subdural , Fever , Headache , MembranesABSTRACT
Parapharyngeal abscess is relatively common but it can cause life-threatening complications like internal jugular vein thrombophlebitis, septic shock, airway obstruction, and mediastinitis. The diagnosis is dependent on physical examination, endoscopic view, and CT and MR imaging. The treatment is antibiotics but sometimes incision and drainage are necessary. Pseudoaneurysm in deep neck space is very rare and mainly caused by trauma, postoperative state of head and neck surgery and radiation therapy. We herein report a case of massive oropharyngeal bleeding from pseudoaneurysm of the superior thyroid artery associated with parapharyngeal abscess with a review of related literature.
Subject(s)
Abscess , Airway Obstruction , Aneurysm, False , Anti-Bacterial Agents , Arteries , Diagnosis , Drainage , Head , Hemorrhage , Jugular Veins , Magnetic Resonance Imaging , Mediastinitis , Neck , Physical Examination , Shock, Septic , Thrombophlebitis , Thyroid GlandABSTRACT
The present study was undertaken to analyse our experience with deep neck space infections and emphasize the importance of patient presentation, radiologic evaluation and early diagnosis and appropriate management. The records of 59 patients treated for deep neck space infections were evaluated. Odontogenic infections (35.59%) were found to be the most common cause of deep neck space infections followed by tonsillar infections (20.33%). Pain, fever, neck swelling and odynophgia were the most common clinical presentations. Radiological investigations were performed in all the patients (100%) while contrast enhanced CT - scan was performed in 35 patients (59.32%). The most commonly involved sites were the submandibular space and the parapharyngeal space, involving 14 patients and 11 patients respectively. All the patients (100%) were on intravenous antibiotics and fluids. Surgical intervention was done in 47 patients (79.66%) whereas 12 patients (20.33%) improved with conservative medical management alone. Despite the wide use of antibiotics, deep neck space infections are commonly seen. Early clinical and radiological diagnosis and appropriate management help to prevent the development of life threatening complications. Surgical drainage forms the mainstay of treatment, conservative medical therapy is also effective in selective cases.
ABSTRACT
Objective To investigate the clinical features and treatment points of diabetes patients compli-cated with parapharyngeal abscess .Methods The clinical data of 12 diabetes mellitus patients complicated with parapharyngeal abscess were analyzed .Results 12 patients were all cured and discharged without concurrent medias-tinal abscess ,intracranial infection and serious complications such as bleeding .Conclusion The development of dia-betes mellitus complicated with parapharyngeal abscess is rapid ,we must confirm the diagnosis ,timely implementation of abscess incision and drainage ,effective drainage of pus ,keep the airway open ,actively control the infection at the same time strictly control the fluctuations in blood sugar ,strengthen supportive therapy ,thus to improve treatment and reduce the incidence of complications .
ABSTRACT
Parapharyngeal abscess is a serious medical condition that may lead to life-threatening complications. Its incidence has dramatically decreased since the advent of antibiotics. We report two cases of parapharyngeal abscesses in immunocompromised patients. We believe that early diagnosis, broad-spectrum antibiotics, surgery and pus drainage can prevent serious complications.
ABSTRACT
Postobstructive pulmonary edema (POPE) is associated with upper airway obstruction and has two different types of mechanism. Type 1 POPE is due to acute airway obstruction and is related to forceful respiratory efforts leading to extremely negative intrathoracic pressure. Type 2 POPE is caused by chronic airway obstruction and occurs after sudden relief of obstruction which drop in airway pressure that can lead to pulmonary edema. We report a case of postobstructive pulmonary edema in a child who has peripharyngeal abscess.
Subject(s)
Child , Humans , Abscess , Airway Obstruction , Pulmonary EdemaABSTRACT
BACKGROUND AND OBJECTIVES: Parapharyngeal infections are rare but they cause life-threatening complications such as mediastinitis, rupture or aneurysm of the internal carotid artery, internal jugular vein thrombophlebitis. So, until now, the recommended treatment of parapharyngeal abscess is early open surgical drainage. The purpose of this study is to review the clinical course and outcome of treatment in parapharyngeal abscess according to method of treatment. MATERIALS AND METHOD: A retrospective study was peformed on 34 cases with parapharyngeal abscess in patients admitted for deep neck infection during a 8-year period from June 1994 to January 2003. All had contrast-enhanced computed tomography (CT) imaging and had confirmation of an abscess in parapharyngeal space. RESULTS: All patients were treated with intravenous antibiotics, 19 cases (conservative group) were treated with antibiotics only or needle aspiration, 15 cases (surgical group) were treated with intraoral or external drainage. The mean period of hospitalization was 8.2 days in conservative group and 11.6 days in surgical group. There was no complication except the mediastinitis in one case of conservative group. Five patients required tracheotomy because of severe dyspnea. CONCLUSION: Neck CT scan is useful diagnostic tool to detect and establish treatment plan of parapharyngeal abscess. Parapharyngeal abscess may, in some cases, respond to antibiotics, become localized to parapharyngeal space and treated conservatively with no need for early open surgical drainage.