EMEL TAHİR, Nilda SÜSLÜ, R. Önder GÜNAYDIN, Oğuz KUflÇU, Onur ERGUN, Umut AKYOL

Pediyatrik derin boyun enfeksiyonlar>: Acil cerrahi giriflime karfl>l>k konservatif tedavinin etkinli¤i

Amaç: Bu çal>flman>n amac> pediyatrik hastalarda derin boyun enfeksiyonlar>n>n yönetimini gözden geçirmek, cerrahi drenajdan önce yaln>zca intravenöz antibiyotik tedavisinin etkinli¤ini de¤erlendirmek ve drenaj endikasyonlar>na dikkati çekmekti. Yöntem: Klini¤imizde derin boyun enfeksiyonu nedeniyle tedavi edilmifl 60 pediyatrik olguyu gözden geçirdik. Demografik veriler, t>bbi öykü, bafllang>ç yak>nmalar> ve fizik muayene, radyolojik inceleme, mikrobiyoloji ve laboratuvar sonuçlar> (C-reaktif protein düzeyi ve lökosit say>m>), tedavi yöntemi ve izlem bulgular>n>n ayr>nt>lar> topland>. Bakteriyolojik sonuçlar, tedavi komplikasyonlar>, takip verileri ve sonuçlar da kaydedildi. Pediyatrik derin boyun enfeksiyonlar> için bir temel tedavi algoritmas> oluflturuldu. Bulgular: Çocuklar>n 47'sinde (%78.3) enfeksiyon cerrahi giriflim veya ponksiyon, baflka bir deyiflle i¤ne aspirasyonu gerektirmemifl yaln>zca antibiyotiklerle baflar>l> bir flekilde tedavi edilmifllerdi. Elli alt> hasta (%93) bafllang>çta sulbaktam-ampisilinle tedavi edilmiflti. Sonuç: Fluktuasyon veren büyük apselerde ve antibiyotik tedavisine ra¤men klinik iyileflme olmayanlarda, retrofarengeal apse ve mediastinit benzeri komplike ve yaflam> tehdit edici olgularda cerrahi drenaj> önermekteyiz. Bir KBB uzman> herhangi bir cerrahi giriflimden önce sab>rl> olmal>d>r.

Pediatric deep neck infections: efficacy of conservative treatment versus immediate surgical intervention

Objective:The objective of this study was to review the managementof deep neck space infections in pediatric patients and to evaluate theefficacy of intravenous antibiotic treatment alone before surgicaldrainage, and also to point out the indications for the drainage. Methods:We reviewed sixty pediatric cases who were treated in ourclinic because of deep neck space infections. The details of demographic data, medical history, initial complaints and physical examination,radiological examination, microbiology and laboratory results (C-reactive protein level and leukocyte count), treatment modality and followup findings were collected. The bacteriological results, management,complications, follow-up data and outcomes were also noted. A basictreatment algorithm for the management of the pediatric deep neckspace infections was constituted. Results: In 47 (78.3%) of the children, infection did not require any surgical intervention or puncture - in other words, needle aspiration - andit was successfully treated with antibiotic therapy alone. Fifty-six patients(93%) were initially treated with sulbactam-ampicillin. Conclusion:We advise surgical drainage in cases of fluctuating largeabscesses and infections without clinical improvement despite antibiotictreatment, and in complicated or life-threatening cases such as retropharyngeal abscess and mediastinitis. An otolaryngologist should be patientbefore any surgical intervention.

PDF

___

1. Cheng J, Elden L. Children with deep space neck infections: our experience with 178 children. Otolaryngol Head Neck Surg 2013;148:1037-42.
2. Wong DK, Brown C, Mills N, Spielmann P, Neeff M. To drain or not to drain - management of pediatric deep neck abscesses: a case-control study. Int J Pediatric Otorhinolaryngol 2012;76: 1810-3.
3. Carbone PN, Capra GG, Brigger MT. Antibiotic therapy for pediatric deep neck abscesses: a systematic review. Int J Pediatr Otorhinolaryngol 2012;76:1647-53.
4. Songu M, Demiray U, Adibelli ZH, Adibelli H. Bilateral deep neck space infection in the paediatric age group: a case report and review of the literature. Acta Otorhinolaryngol Ital 2010;30:190- 3.
5. Bakir S, Tanriverdi MH, Gün R, et al. Deep neck space infections: a retrospective review of 173 cases. Am J Otolaryngol 2012;33:56- 63.
6. Meyer AC, Kimbrough TG, Finkelstein M, Sidman JD. Symptom duration and CT findings in pediatric deep neck infection. Otolaryngol Head Neck Surg 2009;140:183-6.
7. Eftekharian A, Roozbahany NA, Vaezeafshar R, Narimani N. Deep neck infections: a retrospective review of 112 cases. Eur Arch Otorhinolaryngol 2009;266:273-7.
8. Sauer MW, Sharma S, Hirsh DA, Simon HK, Agha BS, Sturm JJ. Acute neck infections in children: who is likely to undergo surgical drainage? Am J Emerg Med 2013;31:906-9.
9. Flanary VA, Conley SF. Pediatric deep space neck infections: the Medical College of Wisconsin experience. Int J Pediatr Otorhinolaryngol 1997;3:38:263-71.
10. Rozovsky K, Hiller N, Koplewitz BZ, Simanovsky N. Does CT have an additional diagnostic value over ultrasound in the evaluation of acute inflammatory neck masses in children? Eur Radiol 2010;20:484-90.
11. Meyer AC, Kimbrough TG, Finkelstein M, Sidman JD. Symptom duration and CT findings in pediatric deep neck infection. Otolaryngol Head Neck Surg 2009;140:183-6.
12. Raffaldi I, Le Serre D, Garazzino S, et al. Diagnosis and management of deep neck infections in children: the experience of an Italian paediatric centre. J Infect Chemother 2015;21:110-3.
13. Cramer JD, Purkey MR, Smith SS, Schroeder JW Jr. The impact of delayed surgical drainage of deep neck abscesses in adult and pediatric populations. Laryngoscope 2016;126:1753-60.
14. Bolton M, Wang W, Hahn A, Ramilo O, Mejias A, Jaggi P. Predictors for successful treatment of pediatric deep neck infections using antimicrobials alone. Pediatr Infect Dis J 2013;32: 1034-6.
15. Neff L, Newland JG, Sykes KJ, Selvarangan R, Wei JL. Microbiology and antimicrobial treatment of pediatric cervical lymphadenitis requiring surgical intervention. Int J Pediatr Otorhinolaryngol 2013;77:817-20.
16. Baek MY, Park KH, We JH, Park SE. Needle aspiration as therapeutic management for suppurative cervical lymphadenitis in children. Korean J Pediatr 2010;53:801-4.