伴多项基础疾病的颈深部脓肿2例

颈部含诸多大血管、神经及淋巴结等重要组织,被颈部筋膜分为咽旁间隙、咽后间隙、椎前间隙、颈动脉鞘间隙等〔1〕。牙源性及咽喉部感染、淋巴结炎等均可致上述间隙脓肿形成,产生严重并发症,如侵蚀大血管引起致命性大出血,侵犯纵隔致纵隔脓肿〔2〕,甚至出现呼吸衰竭、败血症、中毒性休克等。当患者伴有多项基础疾病和全身状况较差     

Deep neck space abscesses of dental origin: the impact of Streptococcus group Milleri

In recent years, there has been rising interest in Streptococcus group Milleri (SM) because high mortality rates have been related to it. In case of deep neck infections (DNI), whatever the origin, mortality rates as high as 26 % were reported. But there are no data available for DNI with SM of purely dental origin. The aim of our article was to describe and analyse DNI of purely dental origin involving on one hand SM and on the other hand infections without presence of SM. We compared these two groups and statistically investigated if there were differences in clinical presentation (age, mouth opening, length of hospital stay, laboratory parameters) or clinical behaviour (re-operation, re-hospitalisation, secondary osteomyelitis, stay at intensive care, length of antibiotic treatment, presence of resistances against antibiotics, incapacity to work). For this, we retrospectively searched medical records of our institution for all purulent DNI treated from 2004 till 2012. We found 81 patients meeting all inclusion criteria. Thirty-four patients had involvement of SM, 47 did not. The only statistically significant difference between the SM group and the non-SM group was the length of incapacity to work. All other parameters were non-significant. Furthermore, there were no fatalities. In conclusion, the clinical importance of this article is that patients with deep neck abscesses of purely dental origin involving SM do not need more or different care when compared to all other DNI of dental origin.     

Needle aspiration of nonperitonsillar head and neck abscesses. A six-year experience

Twenty-five patients with various head and neck abscesses have been managed with needle aspiration as the initial surgical modality over a six-year period. Twenty (83%) of 24 patients' abscesses resolved without formal surgical intervention. Patient 25 in the series whose abscess, though initially resolving, reaccumulated within two weeks requiring an incision and drainage. Recurrent cancer was then diagnosed. Eight of ten large-volume abscesses (over 10 mL) were controlled with needle aspiration. Fourteen patients required multiple aspirations, five of whom had indwelling catheters placed to facilitate abscess decompression. These data confirm that needle aspiration is an effective means of controlling nonperitonsillar abscesses of the head and neck.     

Pediatric neck abscesses: changing organisms and empiric therapies

Objective: To examine the causative organisms in pediatric neck infections, delineate risk factors in methicillin‐resistant Staphylococcus aureus (MRSA) pediatric neck infections, and define patient populations that should be empirically treated with MRSA sensitive antibiotics. Study Design: Retrospective chart review. Methods: Two hundred twenty‐eight consecutive patients were reviewed, ages 0 to 17, presenting at a tertiary care center between 1999 and 2007 with computed tomography proven neck abscesses. Characteristics of patients with differing causative organisms were compared. Results: Forty‐eight percent of all pediatric patients' with head and neck abscesses had S. aureus as the causative organism, 29% of which were community‐acquired MRSA—recent years showed that up to 66% of pediatric neck abscesses were MRSA culture positive. When comparing MRSA infections vs. other causative organisms multiple clinical characteristics were found which did not help to differentiate those patients at a higher risk for MRSA. Characteristics which did trend to predict an MRSA infection were few. For example, the average age of patients with MRSA was 32.5 months compared with only 16 months for the methicillin‐sensitive S. aureus patients. MRSA sensitivities and resistances were also examined. Conclusions: This study presents a large cohort of pediatric neck abscess patients, in which the emergence and characteristics of MRSA are shown. As community‐acquired MRSA infections become more prevalent, empiric antibiotic therapy must be considered. The results of this study show that the incidence of MRSA has greatly increased and clinical risk factors are not helpful in choosing those patients which may be at higher risk for an MRSA infection.     

Otogenic abscesses — our experience

Otogenic abscesses are the result of acute or chronic suppurative inflammation of the middle ear cleft caused by pus forming organisms, which lead to extracranial or intracranial abscesses. When it leads to intracranial abscesses, it may be life- threatening. Otogenic abscesses are commoner in India than in the Western countries due to many factors which have been discussed in this paper. Here we publish a study of fifty cases of otogenic abscesses with reference to our experience of their presentation and management.     

Streptococcus milleri head and neck abscesses: a case series

Streptococcus milleri infections and abscesses in the head and neck region have been previously reported, but there is still a dearth of clinical literature on this topic. To add to the available reports and to promote a better understanding and awareness of this clinically important entity, we present this retrospective review of 7 cases of head and neck abscess caused by S milleri infection. We have placed particular emphasis on antibiotic sensitivity patterns. These patients-6 men and 1 woman, aged 28 to 73 years (mean: 42.7)-had been seen at a district general hospital in Gosford, Australia, over a 6-month period. All patients had undergone surgical intervention and had been treated with intravenous antibiotics. All the S milleri cultures were sensitive to penicillin G, cephalexin, and erythromycin. Six of these patients experienced a resolution of their abscess, while 1 patient died from overwhelming sepsis. We believe that the initiation of penicillin G, cephalexin, or erythromycin is a good starting point for empiric therapy. S milleri should be considered as a causative organism in a patient who presents with a head and neck abscess, especially in the presence of a dental infection. Such a patient should be monitored closely for airway obstruction and distal infective sequelae. Also in this article, we compare our findings with those reported in two other published series.     

Ultrasonography in the evaluation of neck abscesses in children

A prospective study evaluating the benefits of preoperative ultrasonography of paediatric neck abscesses is presented. Twenty-three consecutive children who presented with suspected neck abscesses to the Accident and Emergency Department at the Temple Street Children's Hospital between 1990 and 1992 have been evaluated prospectively. On admission, ultrasonography showed a collection of pus in 11 children and these underwent incision and drainage. The other 12 had intravenous antibiotics. Six of these remained pyrexial and had a repeat ultrasound after 72 h revealing pus which was drained. The remaining were managed successfully with medical treatment. In this study there were no negative surgical interventions and we recommend ultrasonography for preoperative evaluation of children with suspected inflammatory neck abscesses.     

Vacuum-assisted closure for managing neck abscesses involving the mediastinum

A 57-year-old immunocompetent male patient with a deep neck abscess involving the mediastinum was referred to us following unsuccessful treatment at his local hospital with medical therapy and ultrasound-guided aspiration. After initial evaluation and resuscitation, a contrast-enhanced computed tomography (CT) scan was performed, and the patient was transferred for surgical drainage. A vacuum-assisted closure (VAC) device was used as a surgical drain to help prevent reaccumulation of the purulent collections. A repeat CT scan on day 3 confirmed the absence of residual pus in the mediastinum and in the neck spaces, and the VAC device was removed. Perfect healing of the deep tissues with successful mediastinal toilette was observed. The patient resumed oral meals on postoperative day 10, and 2 days later he was discharged. A 1-month follow-up CT again demonstrated the complete healing and absence of the neck abscess. This case illustrates the possibility of avoiding more extensive and life-threatening procedures, such as open thoracotomy, in the treatment of neck abscesses extending into the mediastinum, and highlights the utility of VAC in the management of deep neck abscesses.     

Peritonsillar and neck abscesses in the pediatric age group

A retrospective study was performed on 93 abscesses in children admitted for diagnosis and treatment at Rainbow Babies and Childrens Hospital, University Hospitals of Cleveland, during a 15-year period from 1972 to 1987. Forty-five percent were peritonsillar, 20.5% superficial neck, 21.5% submandibular-submental, 9.6% retropharyngeal, and 3.4% parapharyngeal. All four complications resolved without sequelae. Early diagnosis and adequate treatment were of paramount importance to achieve a low complication rate and a short hospital stay. Bacteriology and antibiotic therapy, as well as surgical treatment, are discussed.     

Ultrasound-guided percutaneous drainage of deep neck abscesses

Deep neck abscesses may still result in significant morbidity and mortality. Surgical therapy carries the risk of damage to cranial nerves and arteries. Excellent results of ultrasound-guided percutaneous catheter drainage of abdominal abscesses led us to apply this technique to the management of deep neck abscesses. Five patients were treated with ultrasound-guided catheter drainage and antibiotics. All patients were cured without complications or recurrences. We consider this cheap and highly effective treatment as a valuable alternative to conventional therapy.     

Deep neck infections

Deep neck infections are charts potentially dangerous though of low incidence. Few times linked to severe complications, as mediastinitis, of high morbi-mortality. They call for emergency procedures combining neck and thorax surgery, if there is a mediastinitis, with a broad-spectrum antibiotherapy within an Intensive Care Unit, with the aim of the maintain the patients's equilibrium constant till their reestablishment. We report 3 cases seen in a term lesser than one year at the Universitary Hospital of Salamanca. The 3 presented with thoracic complication because the spread of the neck's infect. Nevertheless the pending severity all three survived. We emphasize the necessity of realizing the pressing surgery and the utilitarianism of broad-spectrum antibiotherapy as key elements in order to get the patient's reestablishment. Literature review on the subject.     

Deep neck infection

Deep neck infections present significant morbidity and mortality, particularly when associated with predisposing factors that impair a functional immunologic response. Familiarity with deep neck spaces and fascial planes is critical, because these form the basis for the emergent nature of the disease process. Common and potentially life-threatening complications include airway obstruction, jugular vein thrombosis, descending mediastinitis, sepsis, acute respiratory distress syndrome, and disseminated intravascular coagulation. The most common primary sources of deep neck infection are odontogenic, tonsillar, salivary gland, foreign body, and malignancy. Microbiology typically reveals mixed bacterial flora, including anaerobic species, that can rapidly progress to a fulminating necrotizing fasciitis. The treatment cornerstone remains securing the airway, providing efficient drainage and appropriate antibiotics, and improving immunologic status. A prolonged hospital stay should be anticipated.     

Deep neck infections

Deep neck infection is relatively rare but potentially life threatening complication of common oropharyngeal infections. This retrospective study was aimed at analyzing the occurrence of complications, diagnostic methods and proper management of deep neck infection. A review was conducted in 32 cases who were diagnosed as having deep neck infection from 1995 to 2005. The causes of deep neck infections were tonsillitis (16 cases), tooth diseases (6 cases), paratonsillar abscess (4 cases), parotitis (1 case), pussy lymphonodes after tonsillectomy (2 cases), pussy congenital neck cyst (1 case), chronic otitis media (1 case), parotitis (1 case), foreign body of the esophagus (1 case). All the puss bacterial cultivation were positive. All the patients were treated by different ways of chirurgical drainage and use of large dosage of antibiotics. Deep neck infection should be suspected in patients with long lasting fever and painful swelling of the neck and treatment should begin quick as possible.     

Auricular pseudocyst in the tropics: a multi-racial Singapore experience

Endochondral pseudocyst of the auricle is an uncommon condition that affects predominantly Chinese males, with many reports studying this condition in homogenous Chinese populations. There have been few large-scale reports describing the features of this disease among the other Asian groups. In one of the largest series described to date, we report the epidemiological features, clinico-pathologic characteristics, and success of surgical treatment in 40 patients of different Asian groups presenting with pseudocyst of the auricle. Results showed a Chinese predominance (90 per cent), followed by Malays (five per cent) and Eurasians (five per cent). All had unilateral presentations apart from one patient. Most (55 per cent) presented within two weeks of auricular swelling. Few (10 per cent) had a history of trauma. The pseudocysts predominantly affected the concha (61 per cent). Surgery comprised excision of the anterior wall followed by local pressure application. Only 2.5 per cent had recurrence after surgery. These findings confirm earlier understood features of this disease while revealing some notable variations.     

Head and neck sarcomas: the UCLA experience

Purpose

To profile the clinical presentation, subtype distribution, and treatment results of sarcomas of the head and neck at a single tertiary academic center over an 11-year period.

Materials and methods

A retrospective review was performed by examining the records and reviewing the pathology of 186 patients with head and neck sarcomas treated at UCLA Medical Center from 2000 to 2011.

Results

The mean age of the study population was 49 ± 22 years. 58% of the patients were male and 42% were female. Median duration of follow-up for the entire group was 18.5 months. The most common presenting symptom was a mass lesion in 59.9% of patients. The nasal cavity/sinus was the most common presenting site seen in 22% of patients. Solitary fibrous tumor/hemangiopericytoma was the most common subtype. 15% of patients had evidence of prior radiation exposure. 26.3% of tumors were greater than 5 cm and 35.5% were high-grade. Margins were positive in 31.2% of patients. Lymph node metastasis was rare at 6.5%. Perineural invasion was identified in 6.5%. Among all subtypes, 5-year recurrence-free survival and overall survival were 50% and 49%, respectively. Multivariate analysis demonstrated that grade and margin status were predictors of recurrence-free survival while grade and age affected overall survival.

Conclusions

Head and neck sarcomas are a rare entity frequently presenting as a mass lesion. In our series, lesions tended to be high-grade with a significant portion of surgical specimens having positive margins. Grade and margin status were the most important predictors of survival.