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

Abstract:

Objective: The objective of this study was to review the management of deep neck space infections in pediatric patients and to evaluate the efficacy of intravenous antibiotic treatment alone before surgical drainage, and also to point out the indications for the drainage.

Methods: We reviewed sixty pediatric cases who were treated in our clinic 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 follow-up findings were collected. The bacteriological results, management, complications, follow-up data and outcomes were also noted. A basic treatment algorithm for the management of the pediatric deep neck space 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 - and it 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 large abscesses and infections without clinical improvement despite antibiotic treatment, and in complicated or life-threatening cases such as retropharyngeal abscess and mediastinitis. An otolaryngologist should be patient before any surgical intervention.