Tunkel D E
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Arch Otolaryngol Head Neck Surg. 1999 Oct;125(10):1109-13. doi: 10.1001/archotol.125.10.1109.
To assess optimal surgical treatment with excision or curettage techniques in children with cervicofacial nontuberculous mycobacterial (NTM) adenitis.
Retrospective case series.
Tertiary university-based pediatric referral center.
Patients younger than 18 years diagnosed as having cervicofacial NTM adenitis by positive mycobacterial cultures or stains, or by histopathologic evaluation.
Fine-needle aspiration biopsy for diagnosis, surgical excision and/or curettage of head and neck lesions for treatment.
Number of procedures per patient, complications, resolution of mass.
A total of 32 surgical procedures were performed in 25 children with cervicofacial NTM adenitis (mean, 1.3 procedures per patient; range, 1-3): 19 excisional and 13 curettage procedures. The 14 children who had excision as an initial procedure required no additional surgery. Of 11 children who had curettage as an initial procedure, 6 (55%) required additional procedures. Three of these children had additional surgery as planned staged procedures. Excisional surgery after initial curettage (5 patients) was simplified by initial debridement and secondary healing. No complications of curettage were noted. Transient marginal mandibular nerve weakness was seen in 4 patients who had excision. Fourteen of 16 fine-needle aspiration biopsy specimens were diagnostic for NTM adenitis.
Cervicofacial NTM adenitis can be treated with excision or curettage. Excision remains the treatment of choice because of the high cure rate with a single procedure. We now consider curettage as a staged procedure for lesions in proximity to the facial nerve or with extensive skin necrosis, with initial curettage simplifying subsequent excision and wound closure. Preoperative counseling should include discussion of planned or unplanned revision surgery after curettage. Fine-needle aspiration biopsy allows early diagnosis of NTM adenitis.
评估采用切除或刮除技术对儿童颈面部非结核分枝杆菌（NTM）腺炎进行最佳手术治疗的效果。
回顾性病例系列研究。
以大学为基础的三级儿科转诊中心。
年龄小于18岁，经分枝杆菌培养或染色阳性，或经组织病理学评估确诊为颈面部NTM腺炎的患者。
采用细针穿刺活检进行诊断，对头颈部病变进行手术切除和/或刮除治疗。
每位患者的手术次数、并发症、肿块消退情况。
25例颈面部NTM腺炎患儿共接受了32次手术（平均每位患者1.3次手术；范围为1 - 3次）：19例切除术和13例刮除术。14例首次接受切除术的患儿无需再次手术。11例首次接受刮除术的患儿中，6例（55%）需要再次手术。其中3例患儿按计划分期进行了再次手术。初次刮除术后进行切除术（5例患者）因初次清创和二期愈合而简化。未发现刮除术的并发症。4例接受切除术的患者出现短暂性下颌缘支神经麻痹。16例细针穿刺活检标本中有14例诊断为NTM腺炎。
颈面部NTM腺炎可采用切除或刮除治疗。由于单次手术治愈率高，切除术仍是首选治疗方法。对于面神经附近或伴有广泛皮肤坏死的病变，我们现在将刮除术视为一种分期手术，初次刮除可简化后续的切除和伤口闭合。术前咨询应包括讨论刮除术后计划内或计划外的修复手术。细针穿刺活检可实现NTM腺炎的早期诊断。
