The Spanish Association of Pediatrics has as one of its main objectives the dissemination of rigorous and updated scientific information on the different areas of pediatrics. Annals of Pediatrics is the Body of Scientific Expression of the Association and is the vehicle through which members communicate. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published. Read more.
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The Spanish Association of Pediatrics has as one of its main objectives the dissemination of rigorous and updated scientific information on the different areas of pediatrics.
Annals of Pediatrics is the Body of Scientific Expression of the Association and is the vehicle through which members communicate. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years.
CiteScore measures average citations received per document published. Read more. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.
Deep neck space abscesses in infants are clinical entities of great importance due to their severity and possible complications. The aim of the study is to review our experience in the diagnostic and therapeutic management of deep neck space abscesses, and compare it with published literature..
Retrospective study was carried out on all patients diagnosed and treated for deep neck space abscesses over a year period — , including an analysis of the demographic, clinical, diagnostic and therapeutic characteristics.. A total of 72 cases were diagnosed. An increase was observed in their incidence in recent years. The most frequent locations were peri-tonsillar The least frequent were submandibular abscesses The most frequent clinical symptom was fever The most used imaging tests were CT The treatment used was pharmacological in The other There was recurrence in When using more conservative surgery, there were Setenta y dos casos fueron diagnosticados.
Paediatric deep neck abscesses PDNAs are infrequent in clinical practice, yet important on account of their severity and potential complications, as they may even be life-threatening. The clinical presentation of PDNAs is nonspecific. This complicates their diagnosis, which in some cases leads to serious problems, such as upper airway obstruction.
When it comes to treatment, there seems to be no clear consensus in the medical literature, with many groups favouring a highly conservative approach to treatment 6,7 and resorting to surgery only in cases of clinical worsening despite treatment, respiratory compromise or abscesses larger than 2 cm. Few case series have been published in the literature on the subject of PDNAs, with small samples, differences in the methodology used and classifications that may be confusing due to the use of exclusively anatomical, radiological or clinical criteria.
The aim of our study was to describe our experience with this health problem in the past 15 years, analysing aspects relating to its clinical presentation, classification, diagnosis and management.
We present a retrospective observational study of the results obtained through the review of patients with PDNA admitted and managed in the paediatric otorhinolaryngology unit the referral unit for the entire province of the department of otorhinolaryngology of a tertiary care hospital over a period of 15 years — We included children aged 0—15 years with a diagnosis of PDNA, excluding patients with inflammatory processes that did not result in the development of an abscess, congenital malformations or with odontogenic or retromastoidal abscesses.
We considered the submandibular location as a separate location because it is the most common site of abscesses caused by nontuberculous mycobacteria.
We grouped cases by type of treatment into medical treatment no surgical intervention , incision and drainage incision in the lesion to drain the abscess tonsillectomy surgical removal of palatine tonsils and cervicotomy surgery exposing the deep spaces of the neck. The variables under study were age, sex, use of antibiotics prior to admission, location of the abscess LNA, PPA, RPA, AP, SA or PTA , symptoms, length of stay in days, imaging tests performed, size of the abscess, treatment used, complications, abscess recurrence and its treatment, results of bacteriological testing, results of pathological examination and treatment after discharge.
We divided the sample into 3 age groups based on the specific clinical, immunologic, anatomical and management characteristics of the patients: 0—2 years, 3—6 years and 7—15 years. In this study, we adhered to national and international ethics guidelines, and did not engage in any clinical intervention outside approved protocols.
We anonymised all the data, removing identifiable information. We calculated absolute and relative frequencies for qualitative variables and the mean and standard deviation or the median and interquartile range for quantitative variables based on whether their distribution was normal. In the year period under study, there were 72 cases of PDNA, with a mean frequency of 4.
Of all cases, Table 1 summarises the clinical characteristics of the patients. Of the 72 patients with PDNA, When it came to the type of abscess by location, the most frequent type was PTA, found in 22 patients The least frequent locations were SA, found in 9 patients Table 2 presents the distribution of PDNAs by location and age group, showing substantial differences between groups P. Distribution of the different types of PDNA by age group. PDNA, paediatric deep neck abscess.
Chi square test, P. The most frequent presenting symptom in the sample was fever, found in 51 patients The mean length of stay was 7 days 2— Table 3 presents the distribution of these variables by location of PDNA.
Distribution of clinical features by location of PDNA. We reviewed the results of 71 imaging tests performed in 63 patients. The imaging tests used most frequently were CT scans, performed in 36 patients In CT scan of retropharyngeal abscess. Sagittal plane. CT scan of parapharyngeal abscess. Axial plane. We analysed the longitudinal diameter of the abscess on CT images and calculated the mean value, comparing patients treated surgically to those who did not undergo surgery.
We found an overall mean PDNA size of 2. The management was medical with antibiotherapy in 8 cases The management was surgical in the remaining 64 cases Table 4 presents the types of surgery that achieved a cure that is, excluding interventions after which the PDNA recurred , showing the different surgical interventions used based on the type of abscess P.
Type of surgical intervention by location of PDNA. Chi square, P. The most frequent complication was recurrence of the PDNA. There were 10 recurrences in 9 patients 1 patient experienced 2 recurrences , amounting to a proportion of recurrence in children with PDNA of The 10 recurrences developed in patients treated with incision and drainage, and the recurrence was treated with incision and drainage in 4 cases, tonsillectomy in another 4 and cervicotomy in 2.
None of the children initially treated with tonsillectomy or cervicotomy experienced a recurrence. Recurrences only occurred in patients with RPAs There was no case of recurrence in patients with PPAs.
We did not find evidence of any other type of complication. A histopathological examination was ordered in 27 of the 64 patients that underwent surgical intervention, and its results did not result in changes to the treatment approach except in 2 cases 7. Samples of purulent material were used for culture in 19 of the 64 patients treated with surgery. The microorganisms isolated most frequently were Staphylococcus aureus Of all patients, In children, the diagnosis of deep neck abscesses may be complicated and requires an appropriate history taking and physical examination.
Furthermore, our study found that the detection of cervical masses was more prevalent in abscesses in more superficial locations, such as LNAs, SAs and PAs, and less frequent in those in locations that were potentially more dangerous, such as PPAs and RPAs. We did not find cases with airway obstruction or stridor, as occurred in other studies, 1,4 possibly due to the early diagnosis and treatment of the abscesses, which may have prevented progression to more advanced stages.
Each was used under different circumstances: CT preferentially in deep abscesses and sonography in superficial abscesses. On the other hand, in recent years there has been an increase in the use of MRI both for diagnostic purposes and for radiologic follow-up in cases where persistence of the PDNA is suspected after surgery, as this technique avoids the exposure of children to radiation.
Many authors advocate for conservative treatment of PDNA, 6,7 while others call for surgical treatment only in case of respiratory compromise, clinical worsening or abscess size greater than 2 cm. Patients that did not undergo surgery all had LNAs with diameters of less than 1. This choice was based on previous studies whose authors estimated that an abscess section area greater than 2 cm 2 on CT correlated to the finding of purulent material during surgery.
Still, the type of surgery varied. In recent years, we have managed small-sized PDNAs with ultrasound-guided puncture and drainage 18 with favourable outcomes and few complications, although we continue to prefer surgical drainage for larger abscesses.
The type of surgery was directly correlated with PDNA recurrence, of which there were 10 instances in 9 patients one patient experienced 2 recurrences , amounting to a proportion of recurrence of None of the patients treated with tonsillectomy or cervicotomy experienced a recurrence.
The main strength of our study is its novel focus on the therapeutic approach to each of the different types of PDNA in relation to their location, the diagnostic tests used and the rate of recurrence associated with different surgical modalities.
The limitations of the study are those characteristic of retrospective studies, especially when the follow-up period is long, as this is associated with a greater heterogeneity in trends, protocols and the decision-making of the involved clinicians. One example is the small number of samples obtained for microbiological testing, an issue that we have been addressing after its identification in this study.
Another limitation was the small number of cases, which was due to the low incidence of PDNAs. As for the implications of our findings for clinical practice and future research, our study highlights the need to reach a nationwide consensus for the management of PDNA, which ideally would involve a global effort with participation of the different hospitals that manage this condition to establish protocols for different locations in the neck, determining the imaging tests to be performed and the criteria to be applied to select the timing and type of surgical intervention.
The results of this study may help adapt or update PDNA management protocols. We found a recurrence rate of The distribution of the different types of PDNA varied significantly between the established age groups.
We recommend neck ultrasound as the main imaging test for evaluation of PDNAs with a superficial location and CT for evaluation of PDNAs in a deep location or for the purpose of surgical planning. The authors have no conflicts of interest to declare. An Pediatr Barc.
Asociación Española de Pediatría de Atención Primaria
The Spanish Association of Pediatrics has as one of its main objectives the dissemination of rigorous and updated scientific information on the different areas of pediatrics. Annals of Pediatrics is the Body of Scientific Expression of the Association and is the vehicle through which members communicate. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published.