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Kim, Jeon, Lee, Kim, and Kim: Deep Neck Abscesses in Children and Adolescents: 10 Year Experience in Two General Hospitals
Original Article

Korean J Pediatr Infect Dis 2011;18(2):163-172.

Published online: 10 January 2011

DOI: https://doi.org/10.14776/kjpid.2011.18.2.163

Deep Neck Abscesses in Children and Adolescents: 10 Year Experience in Two General Hospitals

Eunhee Kim, M.D., Ju Hee Jeon, M.D.*, Won Uk Lee, M.D., So Young Kim, M.D.†, Eun Ryoung Kim, M.D.*

Department of Pediatrics, Gwang Myeong Sung-Ae General Hospital, Gwang Myeong, Korea.

* Department of Pediatrics, Department of Radiology

† Sung-Ae General Hospital, Seoul, Korea

책임저자:김은령, 성애병원 소아청소년과 Tel: 02)840-7230, Fax: 02)840-7755 E-mail: eunicu@hotmail.com

Received 7 April 2011       Revised 1 September 2011       Accepted 9 September 2011

Copyright © 2011 The Korean Society of Pediatric Infectious Diseases

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to review our recent experiences with deep neck abscesses in children and adolescents and to provide helpful information in treatment and diagnosis by comparing them with those in other available literatures.

Methods

Medical records of 36 children and adolescents admitted for deep neck abscess at two hospitals from January 2000 to October 2010 were reviewed retrospectively.

Results

Male to female ratio was 1.4: 1 and the mean age was 6.5 years. Painful neck swelling and fever were the most frequent symptoms in patients under thirteen years of age whereas trismus and headache were frequent symptoms in patients over fourteen years of age. Submandibular space was the most common site of deep neck abscess in patients under thirteen years of age, whereas peritonsillar space was the most common site in patients over fourteen years of age. The results of bacterial cultures were positive in 61.5% of drained cases. Staphylococcus aureus was the most commonly identified bacteria in 6 patients (37.5%) and 5 of them were under 2 years of age. Twenty six patients received surgical drainage while the others were treated with antibiotics only. There were no statistically significant differences in the durations of admission, fever after admission, and antibiotic treatment between surgical and medical treatment groups.

Conclusion

The common sites of deep neck abscess, associated symptoms, and causative organisms were different between children and adolescents. As there were no differences in durations of admission, fever, or antibiotics treatments between surgical and medical treatment groups, surgical drainage may be avoided by early recognition and suspicion. However, if there is no improvement of symptoms or size of abscesses within 48–72 hours of antibiotic treatment, surgical drainage should be considered. (Korean J Pediatr Infect Dis 2011;18:163–172)

Keywords: Neck, Abscess, Child, Adolescent

References

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Table 1.
Associated Symptoms according to Age in Deep Neck Abscess
Symptom Age (year)
< 2 2–5 6–9 10–13 14–18 Total (%)
Painful neck swelling 12 10 1 4 2 29 (80.5)
Fever 10 8 2 2 4 27 (75.0)
Sore throat 0 4 2 1 5 12 (33.3)
Cough 4 6 1 0 0 11 (30.6)
Rhinorrhea & Nasal obstruction 3 4 0 0 0 7 (19.4)
Trismus 0 2 1 0 4 7 (19.4)
Poor oral intake 0 2 0 0 4 6 (16.7)
Headache 0 0 1 0 4 5 (13.9)
Sputum 2 1 0 0 2 5 (13.9)
Table 2.
Affected Spaces according to Age in Deep Neck Abscess
Space Age (year)
<2 2–5 6–9 10–13 14–18 Total
Submandibular 6 6 0 4 1 17
Parapharyngeal 2 0 1 0 1 4
Retropharyngeal 1 3 0 0 1 5
Parotid 1 0 0 0 0 1
Peritonsillar 0 1 0 0 4 5
Masticator 1 0 0 0 0 1
Pretracheal 1 1 0 0 1 3
Sublingual 0 0 1 0 0 1
Total 12 11 2 4 8 37
Table 3.
Causative Organisms Cultured from Aspirated Pus
organism Age (year)
<2 2–5 6–9 10–13 14–18 Total (%)
Staphylococcus aureus 5 0 0 0 1 6 (23.1)
–hemolyticα Streptococcus 1 2 0 0 1 4 (15.4)
Staphylococcus epidermidis 1 0 0 1 0 2 (7.7)
Staphylococcus hominis 0 2 0 0 0 2 (7.7)
G(−) cocci 0 1 0 0 1 2 (7.7)
Tuberculosis 0 0 0 0 1 1 (3.8)
No growth 2 4 0 3 1 10 (38.5)
Total 9 9 0 4 5 27 (100)

Abbreviation: G(−), gram negative organisms

Table 4.
Antibiotic Susceptibilities of Cultured Gram Positive Organisms
Organism No. of isolates sensitive to
Aug Cft Em Cn Ox Pc Va
Staphylococcus aureus 6/6 5/6 2/6 5/6 5/6 0/6 6/6
a-hemolyticα Streptococcus 4/4 4/4 2/4 4/4   3/4 4/4
Staphylococcus epidermidis 2/2 2/2 1/1 2/2 2/2 0/1 1/1
Staphylococcus hominis 2/2 2/2 1/2 2/2 2/2 1/2 1/1
Total (%)1 14/14 (100) 13/14 (92.9) 6/13 (46.2) 13/14 (92.9) 9/10 (90) 4/13 (30.8) 12/12 (100)

Abbreviations: Aug, amoxicillin-clavulanate (augmentin); Cft, cefotaxime; Em, erythromycin; Cn, clindamycin; Ox, oxa-cillin; Pc, penicillin; Va, vancomycin

Table 5.
Comparison of Medical vs Operative Treatment
  Antibiotics only (n=10) (days) Antibiotics plus drainage (n=26) (days) P-value*
Admission duration 9.9±3.6 10.5±4.7 0.165
Fever duration after admission 2.9±2.6 2.9±2.6 0.700
Duration of total antibiotics treatment 13.8±3.5 14.4±6.0 0.119
Duration of intravenous antibiotic treatment 9.9±3.6 10.5±4.7 0.230

* P-value <0.05 was considered statistically significant by t-test

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