Treatment-failure tularemia in children / 소아과

PURPOSE: Tularemia is an infection caused by Francisella tularensis. Its diagnosis and treatment may be difficult in many cases. The aim of this study was to evaluate treatment modalities for pediatric tularemia patients who do not respond to medical treatment. METHODS: A single-center, retrospective study was performed. A total of 19 children with oropharyngeal tularemia were included. RESULTS: Before diagnosis, the duration of symptoms in patients was 32.15±17.8 days. The most common lymph node localization was the cervical chain. All patients received medical treatment (e.g., streptomycin, gentamicin, ciprofloxacin, and doxycycline). Patients who had been given streptomycin, gentamicin, or doxycycline as initial therapy for 10–14 days showed no response to treatment, and recovery was only achieved after administration of oral ciprofloxacin. Response to treatment was delayed in 5 patients who had been given ciprofloxacin as initial therapy. Surgical incision and drainage were performed in 9 patients (47.5%) who were unresponsive to medical treatment and were experiencing abcess formation and suppuration. Five patients (26.3%) underwent total mass excision, and 2 patients (10.5%) underwent fine-needle aspiration to reach a conclusive differential diagnosis and inform treatment. CONCLUSION: The causes of treatment failure in tularemia include delay in effective treatment and the development of suppurating lymph nodes.

Persistent lingual paresthesia caused by a displaced tooth fragment: a case report and literature review

Accidental displacement of the third molar tooth or its fragment into the anatomical spaces is a rare but potentially serious complication. The most common sites of mandibular third molar displacement are the sublingual, submandibular, and pterygomandibular spaces. Removal of a displaced tooth or its fragments from these spaces may be difficult due to poor access and the vital structures involved in these spaces; therefore, removal may result in permanent damage. This article is intended to provide a concise update of the reported cases of submandibular displacement and to present a case of intraoral management of mandibular third molar root fragments that were displaced into the submandibular space.