Swallowing the Unexpected: A Case Report on an Unusual Presentation of Esophageal Malignancy.

Head and neck malignancies presenting with a neck abscess as the primary symptom are uncommon and may result in a misdiagnosis or delay in diagnosis and appropriate treatment. Here we report on a rare case where a young adult presented with signs and symptoms of a retropharyngeal abscess, which was later identified as an esophageal malignancy.

Ingested Australasian Snapper (Chrysophrys auratus) Bone Migration to C5 Vertebral Body.

Fishbone ingestion has been reported multiple times previously as a cause of oesophageal perforation. This is a surgical emergency that needs to be identified early to ensure immediate medical attention. This report presents the case of a 70-year-old patient with laryngeal perforation and the migration of a Chrysophrys auratus (Australasian snapper) fishbone to the C5 vertebral body. It is hypothesized that the fishbone migrated from the larynx to the visceral fascia and prevertebral fascia before lodging in between the intramuscular substance of the longus coli muscle. Multiple imaging modalities were used to identify and locate the foreign body, including flexible nasopharyngoscopy, esophagogastroduodenoscopy, and a computed tomography (CT) scan of the neck. The exploration of the neck was done by the ENT team and the orthopaedic spine team via the left anterior cervical approach at the level of the C5 and C6 vertebral bodies. The foreign body was identified (15 mm fishbone) at the left lateral of the C5 body, lodged between the intramuscular substance of the longus coli muscle, and was successfully removed.

Pediatric Lemierre's Syndrome: A Comprehensive Literature Review.

BACKGROUND: Lemierre syndrome is a rare, potentially fatal complication of oropharyngeal infections characterized by septic thrombophlebitis of the internal jugular vein. It primarily affects healthy adolescents and young adults. Its incidence declined after the antibiotic era, but it may have resurged in recent decades, likely due to judicious antibiotic use and increasing bacterial resistance. Prompt diagnosis and treatment are imperative to prevent significant morbidity and mortality. METHODS: Lemierre syndrome has been called "the forgotten disease," with a reported incidence of around 3.6 cases per million. The mean age at presentation is around 20 years old, though it can occur at any age. Lemierre Syndrome follows an oropharyngeal infection, most commonly pharyngitis, leading to septic thrombophlebitis of the internal jugular vein. F. necrophorum is the classic pathogen, though other organisms are being increasingly isolated. Metastatic infections, especially pulmonary, are common complications. Contrast-enhanced CT of the neck confirming internal jugular vein thrombosis is the gold standard for diagnosis. Long-course broad-spectrum IV antibiotics covering anaerobes are the mainstays of the disease's treatment. Anticoagulation may also be considered. Mortality rates are high without treatment, but most patients recover fully with appropriate therapy. CONCLUSIONS: Lemierre syndrome should be suspected in patients with prolonged pharyngitis followed by unilateral neck swelling and fevers. Early diagnosis and prompt antibiotic therapy are key, given the potential for disastrous outcomes if untreated. An increased awareness of Lemierre syndrome facilitates its timely management.

Prognostic value of systemic immune-inflammation index and serological biomarkers for deep neck infections / Valor pronóstico del índice de inmunoinflamación sistémica y biomarcadores serológicos para infecciones profundas del cuello

Background: Inflammatory biomarkers, including C-reactive protein, erythrocyte sedimentation rate, neutrophil tolymphocyte ratio, platelet to lymphocyte ratio, and the systemic immune-inflammation index, have been proposedas prognostic factors diverse pathologies. However, their application for deep neck infections has yet to be clarified.Material and Methods: We performed a retrospective study of 163 adult patients with diagnosis of deep neck infec-tions with the aim to evaluate the association between serological biomarkers with complications and outcomes ofpatients with DNI. Studied variables included demographic data, complications of DNI, outcomes, complicationsand death of the included subjects. The evaluated serological biomarkers were hemoglobin, leukocytes, neutrophils,lymphocytes, platelets, glucose, creatinine, albumin, CRP, and ESR. NLR, PLR, and SIII index were estimated.Results: The patients’ mean age was 40.6 ± 15.3 years. Complications of DNI were observed in 19.6% (n=32) patients, being the need for tracheostomy due to airway obstruction (11%, n=18) and mediastinitis (8.6%, n= 14) themost common. Evaluated subjects had an increased value of serological biomarkers (SII index 2639.9 ± 2062.9,NLR 11.3 ± 8.5, PLR 184.1 ± 108.5, CRP 12.6 ± 8.9 mg/dL, ESR 20.7 ± 9.1 mm/h). Patients with complicationshad a significantly higher value of all inflammatory parameters (p < 0.05). A SII index cut-off value of 2975 wasselected from a ROC curve analysis. A sensitivity of 93.8%, specificity of 86.3%, a positive predictive value of62.5%, and a negative predictive value of 98.3% are reported. The SII index was found to have an increased positive predictive value compared to NLR, PLR, and CRP for DNI complications.Conclusions: Our analysis concluded that the SII index, NLR, and PLR are valuable biomarkers to assess the risk value of 2975.(AU)

Microbiological analysis and antibiotic selection strategy in neck abscesses among patients with diabetes mellitus.

PURPOSE: This study aimed to analyze the clinical characteristics, pathogen distribution, drug sensitivity, and antibiotic treatment strategies of patients with neck abscesses with or without diabetes. METHODS: A retrospective analysis was conducted on 2194 patients who underwent neck abscess surgery at our hospital over the past 13 years. Patients were grouped as NAwithDM (neck abscess with diabetes mellitus) or NAwithoutDM (neck abscess without diabetes mellitus). Clinical features, pathogen distribution, and antibiotic sensitivity were compared between the groups. Venn diagrams were used to illustrate the antibiotics effective against all three predominant pathogens. RESULTS: A total of 2194 patients with neck abscesses were included in this study, with 579 patients (26.43%) in the NAwithDM group and 1612 patients (73.51%) in the NAwithoutDM group. There were no significant differences in sex or age distribution between the two groups (all P > 0.05). However, there were significant differences in BMI, length of hospital stays, occurrence of laryngeal obstruction, hypertension, and hypoalbuminemia between the two groups (all P < 0.05). In the NAwithoutDM group, the top three pathogens were Streptococcus constellatus, Klebsiella pneumoniae, and Staphylococcus aureus. The antibiotics that were simultaneously effective against all three pathogens were ceftriaxone, moxifloxacin, and ampicillin/sulbactam. In the NAwithDM group, the top three pathogens were Streptococcus pyogenes, Streptococcus pneumoniae, and Streptococcus constellatus. The antibiotics that were simultaneously effective against all three pathogens were compound sulfamethoxazole, cefuroxime, levofloxacin, ciprofloxacin, vancomycin, and imipenem. CONCLUSION: Neck abscess patients with diabetes have distinct clinical features. Therefore, it is crucial to pay attention to these clinical features and manage them accordingly during the treatment process. Empirical antibiotic treatment should be tailored to individual patient groups. Sulfamethoxazole-methoxazole is recommended for neck abscess patients with diabetes, while ceftriaxone or moxifloxacin is recommended for those without diabetes.

Lemierre's Syndrome Secondary to Shoulder Hematoma Complicated by COVID-19: A Case Report.

This case report illustrates a unique presentation of Lemierre's syndrome precipitated by Fusobacterium necrophorum. This case report describes a 20-year-old patient who developed Lemierre's syndrome secondary to a shoulder hematoma and neck abscess with multiple systemic complications in the absence of tonsillitis or oropharyngeal infection. Two weeks prior to presentation, the patient sustained a right shoulder injury and contracted COVID-19. Due to his Lemierre's syndrome, he developed right internal jugular vein and subclavian vein thrombosis, septic lung emboli, right sided Horner's syndrome, disseminated intravascular coagulation, pelvic collection, septic arthritis of pubic symphysis and osteomyelitis of the right pubic bone, and proximal left femoral shaft. The patient received non-operative and operative management to manage his Lemierre's syndrome including surgical drainage, antibiotics, and anticoagulation; he was discharged following an extended hospital stay. This case report highlights a rare presentation of Lemierre's syndrome secondary to a shoulder hematoma in a COVID-19 positive patient, and its potential systemic and life-threatening complications. Its importance is highly relevant in the context of the COVID-19 pandemic. Further studies are warranted to explore the effect of preceding COVID-19 infections on the microbiological profile in Lemierre's syndrome.

Effects of Physical Therapy on a Patient With Lemierre's Syndrome Who Had Atelectasis and Limited Range of Motion in the Neck.

Lemierre's syndrome (LS) is a severe infectious disease that can lead to the formation of neck abscesses and thrombosis. LS may be an indication for surgery; however, there are few reports on the physical therapy approaches used in patients with LS. A male patient in his 20s reported atelectasis and limited range of motion in the neck after resection of a deep neck abscess on the left side of the neck caused by LS. Thrombophlebitis was also observed around the neck lesion, indicating the risk of pulmonary embolism. Physical therapy was initiated with low-load, deep breathing exercises. Additional breathing exercises, such as respiratory assistance and positive pressure loading, were initiated after the administration of anticoagulants. Although the therapeutic intervention was delayed due to the unstable wound with partially resected muscle, it was assumed that the impairment of the range of motion in the neck was unlikely to persist as the patient was young. No critical adverse events were observed, and the range of motion was recovered such that the patient was able to resume playing baseball. The presence of a venous thrombus and inflammation may affect physical therapy; however, careful management of the exercise load could aid in the safe and effective treatment of LS without the incidence of complications, even in the early postoperative period.

Infratemporal Fossa Abscess Drainage via a Trans-Oral Image Guided Approach.

Deep neck space infections can cause antibiotic-resistant abscesses that can impinge on vital anatomical structures. Image-guided surgery systems using preoperative computed tomography (CT) imaging can be utilized to characterize pathology and assist surgeons in avoiding iatrogenic injury. This manuscript explores the presentation and unique CT-guided surgical management of an infratemporal fossa abscess in a 48-year-old male who presented with left-sided dental pain and facial swelling that had progressed despite antibiotics and dental extraction. CT-guided imaging can assist in localizing and protecting vital anatomical structures during deep neck abscess drainage and can prevent the potential risks and complications of classic surgical approaches.

Neck Abscess Due to Pocket Shot: Is It Just the Tip of the Iceberg?

A 45-year-old Caucasian male presented to the emergency department for pain and swelling on the left side of his neck for the past 10 days. His medical history revealed that he was an intravenous (IV) drug abuser. Physical examination demonstrated a 5×5 cm red, swollen bump with a positive fluctuation on the left supraclavicular area concerning for an abscess. Fluid aspiration from the abscess was performed, and three sets of blood cultures were obtained, which later all came back positive for methicillin-resistant Staphylococcus aureus (MRSA). His initial blood tests revealed elevated levels of platelets, leukocytes, and C-reactive protein (CRP) and anemia. The computed tomography (CT) scan showed an enlarged pectoralis major with the presence of air. The retrosternal, infraclavicular, and supraclavicular regions also contained air. The clinical diagnosis was therefore supported by the laboratory results and imaging. Additionally, transthoracic echocardiography showed no vegetations, and transesophageal echocardiography was scheduled. Antibacterial treatment was initiated empirically from the emergency room with meropenem and vancomycin, planned for four weeks. Repeat cultures were obtained for the following three days, which were all negative. However, the patient left the hospital against medical advice and did not complete his antibiotic treatment. The risk of a peripherally inserted central catheter (PICC) line being misused for illegal narcotics was considered too high; hence, it was not recommended for continued IV antibiotic therapy at home. Those with a history of intravenous drug use, after using the most accessible injection sites, oftentimes resort to finding alternative and potentially more dangerous injection sites. The major veins of the neck, such as the jugular, subclavian, or brachiocephalic veins, are commonly used. This technique is referred to as a "pocket shot" by intravenous drug abusers (IVDAs). Apart from the apparent abscess, clinicians should oversee for other complications including underlying pus collections, pneumothorax, mediastinitis, osteomyelitis, and hemothorax.

Changes in operative otolaryngology infections related to the COVID19 pandemic: A retrospective cohort study.

BACKGROUND: Pediatric emergency admissions fell significantly during the COVID-19 pandemic. This study investigated the changes in severe infectious complications managed by otolaryngology between the pre-pandemic period and the first year of the pandemic to determine if COVID-19 or related public health measures influenced the rate or severity of presentations managed in otolaryngology. METHODS: A retrospective chart review was conducted on pediatric patients who presented with severe infectious otolaryngology presentations (acute mastoiditis, deep neck space abscesses, and orbital complications of sinusitis) over the pre-pandemic (March 2018-February 2020) and early pandemic (March 2020-February 2021) periods. Patient characteristics, details of presentation, treatment, and outcomes were extracted from patients' charts. Independent samples t-tests/Mann-Whitney U-tests for continuous variables and Pearson chi-squared tests/Fisher's exact test for categorical variables were conducted to compare the pre vs early pandemic groups. RESULTS: There were 93 pre-pandemic and 28 early pandemic presentations. The monthly case average was significantly lower during the early pandemic period than the 2 years prior [3.58 (2.80) vs 2.00 (2.00), P = .045]. The average monthly frequency of presentations for deep neck space abscess and mastoiditis were significantly higher in the pre-pandemic group when compared to the early pandemic group [1.96 (±0.33) vs 1.33 (±0.48), P = .049; .71 (±0.26) vs 0.17 (±0.41), P = .01, respectively]. The early pandemic group was significantly younger (3.81 vs 6.04 years, P = .005), however there were no differences in gender, length of admission, and days from symptom onset to presentation between the two groups (P > .05). The early pandemic group had significantly elevated inflammatory markers on presentation [CRP, WBC, neutrophils (P = .02, P = .02, P = .04, respectively)] compared to the pre-pandemic group. CONCLUSION: The COVID-19 pandemic has had an effect on severe infectious complications of ENT pathologies, including decreased average monthly cases during the early pandemic, younger age at presentation, and elevated inflammatory markers.

Perioperative factors influencing hospitalization duration for pediatric neck abscesses.

PURPOSE: Pediatric neck abscesses are a common pathology seen in an ambulatory setting. Although some pediatric neck abscesses are managed medically with antibiotics, surgical intervention is often required. Given the often non-emergent presentation of many abscesses, a variety of logistical and perioperative factors may delay time to care and subsequently prolong hospital stay. The objective of this study was to examine factors that influence the overall time to surgery (TTS) and hospital length of stay (LOS) in a pediatric population with neck abscesses who ultimately require surgical drainage. MATERIALS AND METHODS: 161 pediatric patients who underwent incision and drainage of a neck abscess over a ten-year period at a tertiary referral children's center were reviewed. Demographic information, radiographic studies, and surgical information were extracted from patient charts. Descriptive statistics, Mann-Whitney U tests, and multivariate analyses were performed. RESULTS: The most common subcategory location was deep neck abscesses (33.1 %). Computed tomography (CT) was the most common pre-operative imaging modality (54.1 %) followed by ultrasound (US) (49.1 %) and magnetic resonance imaging (2.6 %). US and a combination of multiple preoperative imaging modalities were associated with increased LOS and TTS. Repeat surgery was associated with increased LOS. Pre-admission antibiotic use was associated with increased LOS and TTS. Younger patients were more likely to have a longer LOS. CONCLUSIONS: A variety of factors can influence TTS, LOS, and time from surgery to discharge including patient age, abscess location, a non-optimized utilization of imaging modalities, the utilization of pre-admission antibiotics, and the need for repeat operations.

A Case of Pediatric Thyroid Abscess: A Rare Entity.

Acute Suppurative Thyroiditis (AST) is a rare, but potentially fatal emergency in the pediatric age group. With a mortality of 3.7% to 9% in AST, it is imperative to make a timely diagnosis and start treatment accordingly. In this case report, we discuss a case of thyroid abscess in a six-year-old, which was diagnosed on ultrasonography (USG)(machine: GE logic 9 USG, Milwaukee) and Contrast-Enhanced Computed Tomography (CECT) (machine: 32 slice GE revolution act machine, Milwaukee) of the neck. With this article, we attempt to stress upon the need for quick and accurate diagnosis and timely intervention to prevent complications as the condition is rare and unusual.

A Diagnostic Conundrum: Tuberculosis or Salmonella Neck Abscess?

Granulomatous neck abscesses are commonly associated with tuberculosis (TB). These chronic inflammatory reactions are rarely seen in Salmonella non-typhi (SN) infections. We report two cases of SN granuloma presenting as neck abscesses in poultry farmers. TB polymerase chain reactions (PCR) were negative. Histopathology reported necrotizing granulomatous inflammation. Salmonella species are known to cause true granulomas in bone marrow, liver, and spleen. To the best of our knowledge, true granulomas have not been described in cervical lymph nodes. The aim of this report was to highlight the importance of considering other causative microbiological agents in cases of granulomatous neck abscesses. The patients recovered after receiving treatment with surgical drainage and intravenous antibiotics.

The first case of deep neck abscess due to Filifactor alocis co-infected with Eggerthia catenaformis, Parvimonas micra, and Streptococcusconstellatus.

Filifactor alocis, an anaerobic Gram-positive rod, has garnered interest from its association with periodontal disease. Extraoral infections by F. alocis are rare; only seven cases have been reported. We report the first case in which we identified F. alocis as one of the causative organisms of a deep neck abscess. A 71-year-old male on hemodialysis came to our hospital with a fever and left buccal pain. The patient's left neck was swollen, and contrast-enhanced computed tomography showed an abscess with gas extending from the left cheek to the deep neck. We diagnosed the patient with a deep neck abscess and performed an urgent neck drainage. We isolated F. alocis, Eggerthia catenaformis, Parvimonas micra, and Streptococcus constellatus in the abscess and identified them using matrix-assisted laser desorption ionization-time of flight mass spectrometry. Blood cultures were negative. We initiated treatment with piperacillin-tazobactam and vancomycin. The patient improved but developed a hemorrhagic duodenal ulcer on the third day of admission. We attempted endoscopic hemostasis, but the patient's bleeding continued. Ultimately, he died of the duodenal ulcer hemorrhage on the sixth day of admission. This is the first case of F. alocis detected in a deep neck abscess.

Deep cervical abscesses in children: efficacy of the cefotaxime-rifampicin combination.

The objective is to determine whether a medical treatment, the combination of cefotaxime and rifampicin, is effective in avoiding surgery for managing deep cervical abscesses in children and to determine prognostic factors in the efficacy of this medical treatment. This is a retrospective analysis of all patients under 18 presenting with para- or retro-pharyngeal abscess over the period 2010-2020 in two hospitals' pediatric otorhinolaryngology departments. One hundred six records were included. Multivariate analyses were performed to study the relationship between the prescription of the Cefotaxime-rifampicin protocol at the onset of the management and the use of surgery and to evaluate the prognostic factors of its efficacy. The 53 patients who received the cefotaxime-rifampicin protocol as first-line treatment (vs. 53 patients receiving a different protocol) required surgery less frequently: 7.5% versus 32.1%, validated by a Kaplan-Meier survival curve and a Cox model analysis adjusted for age and abscess size (Hazard Ratio = 0.21). This good outcome of the cefotaxime-rifampicin protocol was not demonstrated when it was instituted as a second-line treatment after the failure of a different protocol. An abscess larger than 32 mm at hospitalization was significantly associated with more frequent use of surgery in multivariate analysis adjusted for age and sex (Hazard Ratio = 8.5).    Conclusions: The cefotaxime-rifampicin protocol appears to be an effective first-line treatment in managing non-complicated deep cervical abscesses in children. What is Known: • Nowadays, medical treatment is preferred for managing deep neck abscesses in children. There has yet to be a consensus on the antibiotic therapy to be proposed. • Staphylococcus aureus and streptococci are the most frequent causative organisms. What is New: • The cefotaxime-rifampicin protocol introduced at first intention is effective, with only 7.5% of patients requiring drainage surgery. • The only risk factor for failure of the medical treatment is the initial size of the abscess.

Sensitivity and Specificity of US and CT as Diagnostic Tools for Pediatric Lateral Neck Abscesses.

OBJECTIVE: Ultrasound (US) and computed tomography (CT) are commonly used in the diagnosis of pediatric neck abscesses. The objective of this study is to determine the sensitivity and specificity of US and CT in the diagnosis of pediatric lateral neck abscesses, with a secondary objective of evaluating the association of specific clinical features with a positive US or CT scan. STUDY DESIGN: Retrospective review of pediatric patients admitted to a tertiary care center from January 1, 2011, to December 31, 2020, with neck abscesses. SETTING: Tertiary care center. METHODS: The sensitivity and specificity of US and CT were calculated by comparing imaging performed within 24 h of incision and drainage (I&D). Multiple regression was used to evaluate the association of clinical features with a true positive US or CT. RESULTS: There were 171 patients included in this study, with a median age of 1.5 years (interquartile range [IQR]: 1-5 years). I&D was done in 156 patients (91.2%), while 15 (8.8%) were treated with antibiotics. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US were 69.5%, 80%, 96.6%, and 24.2%. The sensitivity, specificity, PPV, and NPV of neck CT were 95.5%, 80%, 95.5%, and 57.1%. Length of symptoms, skin erythema, and fluctuance were not significantly associated with a positive US (F(3, 82) = 0.24, p = .9, R2 = 0.01) or CT scan (F(3, 30) = 0.84, p = .5, R2 = 0.08). CONCLUSION: Neck US has a low sensitivity for diagnosing pediatric neck abscesses, when compared to CT, but remains a useful initial investigation given its high PPV. Clinicians should have a low threshold for pursuing CT if there is a high suspicion of abscess formation. LEVEL OF EVIDENCE: Level 4.

A Very Rare Complication of Vocal Fold Augmentation With Calcium Hydroxylapatite: Neck Abscess.

INTRODUCTION: Vocal fold injection augmentation is performed routinely for the treatment of glottic insufficiency especially due to unilateral vocal fold paralysis. There are numerous materials that are used for injection laryngoplasty, calcium hydroxylapatite being one of them. CASE REPORT: We present an interesting case of a 64-year-old male patient with metastatic acinic cell carcinoma of the right parotid gland, who underwent right vocal cord injection laryngoplasty with calcium hydroxylapatite for right vocal cord paralysis with glottal insufficiency and developed a neck abscess. DISCUSSION: This is the first report in the literature of neck abscess following vocal fold injection laryngoplasty using calcium hydroxylapatite. It seems that over injection of the vocal fold gave rise to extravasation of the injected material outside the laryngeal framework which later became a nidus for infection. CONCLUSIONS: We present the first case in the literature of neck abscess following vocal fold injection laryngoplasty using calcium hydroxylapatite. Clinicians should be aware of this rare but dangerous complication.

Uncommon Find: An Unusual 10 cm Bezold's Abscess Involving Dural and Mastoid Erosion.

Bezold's abscess (BA) is a rare complication of otitis media that presents as a lateral neck abscess below the mastoid tip. BA incidence has recently decreased due to early diagnosis and prompt antibiotic intervention. We present a 42-year-old male with a complicated otitis media developing a 10 cm BA. Treatment of the lesion included surgical drainage and mastoidectomy, accompanied by intravenous (IV) broad-spectrum antibiotic administration. The patient experienced no adverse events during or after surgery and was placed on postoperative observation. However, on postoperative day (POD) 2, the patient left the hospital against medical advice and did not undergo further follow-up.

A comparison of patients with neck abscesses caused by esophageal foreign body impaction vs. inflammatory disease: a retrospective study.

OBJECTIVES: During clinical practice, we have detected a few cases of neck abscesses in patients diagnosed with esophageal foreign body impaction (EFB) but without the primary inflammatory disease. However, we do not know if neck abscesses caused by an inflammatory source are more like to be associated with a more severe progression or poorer prognosis. In this study, we aimed to identify differences between these two groups of patients by comparing progression and prognosis. MATERIALS AND METHODS: We retrospectively reviewed all patients who underwent neck abscess incisions between January 2011 and March 2022 and divided these patients into two groups: an EFB group and an inflammation group. Data were described by percentages, means, and standard deviations (SDs). Fisher's precision probability test was used to compare differences between the EFB and inflammation groups. Categorical variables were analyzed by Pearson's Chi-squared test. In addition, three factors including hospital days, intensive care unit (ICU) stay, and drainage-tube removal time were used for multivariate analysis to identify independent correlations separately. RESULTS: We enrolled a total of 33 patients with neck abscesses who received surgical incisions; the EFB group included 14 (42%) cases, while the inflammatory group included 19 (58%) cases. No significant differences were identified between the two groups in terms of surgery type (with or without mediastinotomy) and postoperative management (negative pressure drainage or postoperative irrigation). There were no significant differences between the two groups in terms of hospital stay, the timing of drainage-tube removal, the risk of ICU admission, and the probability of receiving intubation and tracheotomy. The incidence rate of esophageal perforation differed significantly between the two groups (p < 0.001). However, there were no significant differences in terms of other preoperative or postoperative comorbidities. The multivariate analysis revealed that the application of mediastinotomy (HR = 0.216 [0.049, 0.963]; p = 0.044) was correlated with a longer stay in the hospital. The time from symptoms to surgery was associated with a longer drainage tube removal time (HR = 0.392 [0.159, 0.967]; P = 0.042) and longer ICU stay (OR = 79.754[1.513, 4203.182]; P = 0.03). CONCLUSION: Patients with neck abscesses associated with EFB and inflammation received the same therapeutic management, and there were no significant differences between these two groups in terms of prognosis. Furthermore, esophageal perforation was found to be irrelevant to the aggravation of neck abscesses, and there was no need for additional surgery to repair a perforated esophagus in patients with neck abscesses. LEVEL OF EVIDENCE: Retrospective cohort (2b).

Fourth Branchial Pouch Sinus: A Rare, Often Misdiagnosed Congenital Anomaly.

Pathologies of the branchial apparatus originate from abnormal embryological development and frequently affects the second branchial cleft. Fourth branchial cleft lesions are exceptionally few and existing literature on it is scarce. We present a case of a fourth branchial pouch sinus, masquerading as a recurrent neck abscess.