[Adult parapharyngeal and retropharyngeal abscesses:clinical features and their implications for treatment strategy].

Objective:To identify the clinical risk factors related to the increased likelihood of surgical drainage and medical therapy failure in parapharyngeal and retropharyngeal abscess. Method:The charts of 93 consecutive patients from January 2006 to April 2017 with parapharyngeal and retropharyngeal abscess were reviewed retrospectively. Logistic regression analysis was used to study the clinical risk factors.Result:A total of 97 adult patients, there were 34 cases in the immediate surgical drainage group and 32 cases in the delayed surgical drainage group and 31 cases treated with medical therapy alone. The rate of operation therapy was 68%,and the success rate of the medical therapy alone was 32%. All patients had successful resolution of their abscesses by medical therapy and(or) surgical drainage. The average length of stay(17.26d) in the surgical drainage group was longer than the medical therapy group(10.26 d), and the difference was statistically significant(P<0.001).The maximum dimension of abscess＞2.37cm is not only the risk factor of increasing likelihood of surgical drainage, but also that of medical therapy failure(P<0.001, P<=0.002).The factors affecting the hospitalization day were whether or not the operation was performed. There was no significant difference in operative rate between diabetic group and nondiabetic group(χ2=0.523,P>0.05).There were no correlation between diabetes mellitus and the multiple space abscesses(r=-0.032,P<=0.760).Conclusion:Although a majority of adult parapharyngeal and retropharyngeal abscesses were treated with surgical drainage and sufficient effective intravenous antibiotics,but not all patients need surgical treatment. The diameter of the abscess is a risk factor affecting the operation or not.For those with larger abscesses,the preoperative preparation should be actively prepared and the operation should be intervened as early as possible;for those with smaller abscess,the treatment can be cured alone, and the surgical incision and drainage should be avoided in order to reduce the complications and shorten the hospital days.

[The diagnosis and treatment strategy for patients with severemultispace abscesses in neck].

Objective:To analyze the clinical characteristics of patients with severe deep neck abscess,etiology,imaging,appropriate treatment selection in those patients,to improve the judgement and understanding of the disease.Method:Thirty cases of severe deep neck abscess treated from March 2010 to June 2015 were retrospectively reviewed,including the clinical characteristics,diagnosis and treatment strategy.Result:The sore throat,odynophagia,dysphagia,fever and difficulty breathing were the most common symptoms of severe deep neck abscess.The causes of deep neck abscess were tooth diseases(5 cases),foreign bodies in pharynx or esophagus(4 cases),the second branchial crack cyst with multiply abscess,uncertain cause(20 cases).Six of the above cases complicated with mediastinal abscess.Radiologic evaluation was performed on all of the patients to identify the most probable location of the abscess:parapharyngeal space,retropharyngeal space,masticator space,carotid space,etc.Twenty-five cases were treated by drainage via incising lateral neck and 4 patientsreceived abscess puncture aspiration.Life-threatening complications were developed in all cases,29 cases were cured but one case dead.Conclusion:The treatment of severe deep neck multispace abscesses should be mindful.Once deep neck abscesses are diagnosed,we should timely undertake surgical drainage via incising lateral neck.Emergency tracheostomy should be perform in some case like severe dyspnea,airway obstrucion.Antibiotics should be appropriately applied,and basic diseases and complications should be carefully controlled.