Cervicofacial non-tuberculous mycobacterial lymphadenitis: clinical determinants of incomplete surgical removal |
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| Affiliation: | 1. Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands;2. Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands;3. Department of Oral and Maxillofacial Surgery, Amstelland Hospital, Amstelveen, The Netherlands;4. Department of Social Dentistry, ACTA, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands;1. Department of Oral and Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil;2. Oral and Maxillofacial Surgery, Hospital São Lucas, Porto Alegre, Brazil;3. Department of Oral and Maxillofacial Surgery, Hospital del Salvador, Providencia, Región Metropolitana, Chile;4. Department of Oral and Maxillofacial Surgery, Hospital San Borja Arriarán, Santiago, Chile;5. Oral and Maxillofacial Surgery, Universidad de Chile, Santiago, Chile;6. Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain;7. Institute of Maxillofacial Surgery, Teknon Medical Centre, Barcelona, Spain;1. Department of Oral and Maxillofacial Surgery, Amsterdam UMC/Emma Children’s Hospital, and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands;2. Laboratory for Genome Diagnostics, Amsterdam UMC, University of Amsterdam, Department of Clinical Genetics, Amsterdam Reproduction and Development, Amsterdam, The Netherlands;3. Department of Oral and Maxillofacial Surgery, Spaarne Gasthuis, Haarlem, The Netherlands;4. Department of Paediatrics and Translational Genetics, Amsterdam UMC/Emma Children’s Hospital, University of Amsterdam, Amsterdam, The Netherlands;1. Stanford University School of Medicine, Stanford, CA, USA;2. Department of Otorhinolaryngology, Hopital de L''Universite d''Etat d''Haiti, Port-au-Prince, Haiti;3. Duke Global Health Institute, Duke University, USA;4. Family Health Ministries, 501-C3, Durham, NC, USA;5. Massachusetts Eye and Ear Infirmary, Harvard School of Medicine, USA;6. Department of Otolaryngology/Head & Neck Surgery, Stanford University, Stanford, CA, USA |
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| Abstract: | In patients with non-tuberculous mycobacterial cervicofacial lymphadenitis, incomplete surgical removal of infected lymph nodes leads to delayed healing and a higher recurrence rate, with eventual spontaneous drainage through the skin. However, complete surgical removal is not always achievable due to the extent of the infected tissue and proximity to vulnerable structures, such as the facial or accessory nerve. The aim of this study was to identify the clinical determinants of the (in)ability to perform complete surgical removal. The electronic health records of patients aged 0–15 years with bacteriologically proven non-tuberculous mycobacterial cervicofacial lymphadenitis, who underwent surgical treatment and preoperative sonographic imaging, were analysed. This was a case–control study. A total of 103 patients met the inclusion criteria. Most of the infections were unilateral, submandibular, and caused by Mycobacterium avium. Multiple logistic regression analysis revealed that higher age (odds ratio 1.24, 95% confidence interval 1.04–1.47) and fistulization (odds ratio 3.15, 95% confidence interval 1.13–8.75) were significantly associated with a limited ability to surgically remove all infected tissue. However, a larger sonographic lymph node size was not significantly associated. These findings could aid clinicians when informing the parent(s)/guardian(s) of the patient preoperatively and in properly estimating the intraoperative and postoperative course. |
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| Keywords: | non-tuberculous mycobacterial cervicofacial lymphadenitis surgery |
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