Ulualp Seckin O, Koral Korgun, Margraf Linda, Deskin Ronald
Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas 75390-9035, USA.
Pediatr Int. 2013 Aug;55(4):455-60. doi: 10.1111/ped.12141.
The aim of this study was to assess outcomes of medical and surgical treatment of intratonsillar abscess in children.
The medical charts of children with intratonsillar abscess were reviewed to obtain information on history and physical examination, imaging, management, and follow-up assessment.
Eleven children (six male, five female; age range, 4-18 years) were identified. The common complaints included sore throat, fever, and odynophagia. Asymmetric tonsil hypertrophy was present in nine patients and erythema of tonsils in all patients. Peritonsillar fullness was present in three patients. One patient needed emergency intubation due to respiratory compromise. Computed tomography indicated unilateral intratonsillar abscess in nine patients, bilateral intratonsillar abscess in one, and unilateral phlegmon in one. Inflammatory changes were observed in the parapharyngeal space in all patients, retropharyngeal space in one, and pyriform sinus and aryepiglottic folds in two. Antibiotic treatment included clindamycin in seven patients, ampicillin/sulbactam in one, and clindamycin plus ceftriaxone in three. The patients with respiratory compromise underwent surgery prior to antibiotic treatment. Patients with isolated intratonsillar abscess or phlegmon had resolution of their symptoms with i.v. antibiotic treatment. Patients with combination of intratonsillar and peritonsillar abscess required incision and drainage of peritonsillar abscess.
Clinically stable children with intratonsillar abscess or phlegmon respond to i.v. antibiotic therapy. Surgical drainage can accomplish clinical resolution in the presence of a combination of intra- and peri-tonsillar abscess, airway compromise, or unresponsiveness to medical treatment.
本研究的目的是评估儿童扁桃体内脓肿的内科及外科治疗效果。
回顾扁桃体内脓肿患儿的病历，以获取病史、体格检查、影像学检查、治疗及随访评估等信息。
共纳入11名儿童（6名男性，5名女性；年龄范围4 - 18岁）。常见症状包括咽痛、发热及吞咽痛。9例患者存在不对称性扁桃体肥大，所有患者均有扁桃体红斑。3例患者有扁桃体周围饱满。1例患者因呼吸功能不全需要紧急插管。计算机断层扫描显示9例患者为单侧扁桃体内脓肿，1例为双侧扁桃体内脓肿，1例为单侧蜂窝织炎。所有患者咽旁间隙均有炎症改变，1例患者咽后间隙有炎症改变，2例患者梨状窝及杓会厌襞有炎症改变。抗生素治疗方面，7例患者使用克林霉素，1例使用氨苄西林/舒巴坦，3例使用克林霉素加头孢曲松。呼吸功能不全的患者在抗生素治疗前接受了手术。单纯扁桃体内脓肿或蜂窝织炎的患者经静脉抗生素治疗后症状缓解。扁桃体内脓肿合并扁桃体周围脓肿的患者需要切开引流扁桃体周围脓肿。
临床症状稳定的扁桃体内脓肿或蜂窝织炎患儿对静脉抗生素治疗有效。对于扁桃体内脓肿合并扁桃体周围脓肿、气道功能不全或内科治疗无效的情况，手术引流可实现临床治愈。
