Moe Justine, Rajan Roy, Caltharp Shelley, Abramowicz Shelly
Fellow in Oncology/Microvascular Surgery, University of Michigan, Ann Arbor, MI; Previously Chief Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA.
Assistant Professor, Departments of Otolaryngology/Head and Neck Surgery and Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
J Oral Maxillofac Surg. 2018 Sep;76(9):1902-1911. doi: 10.1016/j.joms.2018.03.016. Epub 2018 Mar 22.
Controversy exists regarding the most appropriate treatment strategy for children with nontuberculous mycobacterial (NTM) cervical lymphadenitis. Mycobacterium abscessus (MAB) is an uncommon cause of NTM cervical lymphadenitis. The purpose of the present study was to evaluate diagnosis, management, and treatment outcomes in children with MAB-associated cervical lymphadenitis resulting from a pulpotomy.
This was a retrospective chart review of children with NTM lymphadenitis of the head and neck caused by MAB treated at Children's Healthcare of Atlanta hospitals (Atlanta, GA). The predictor variables were patient demographics, dental history, clinical presentation, imaging characteristics, laboratory findings, histopathologic examination, treatment, and complications. The outcome variable was disease resolution or persistence.
Twenty-two patients (mean age, 6.5 yr) met the inclusion criteria. All patients had pulpotomy at 1 dental practice. The mean time from dental procedure to symptom onset was 43.1 days (range, 3 to 180 days). Children presented with cervical or submandibular swelling, facial swelling, gingival erythema, and skin erythema. Radiographic findings were submandibular or cervical lymphadenitis, maxillary or mandibular osteolysis, subcutaneous abscess, and pulmonary nodules. All children had confirmed or probable MAB infection diagnosed on the pathologic specimen. There were 2 distinct patient presentations that guided surgical management: isolated noninflammatory cervical lymphadenitis, which was partly or completely excised (n = 11), and adjacent extension or disseminated infection requiring subtotal lymph node excision, bone debridement, and postoperative antibiotics (n = 11). Most children required multiple surgical interventions to remove infected tissues. All achieved clinical resolution.
In this cohort, treatment of NTM lymphadenitis caused by MAB depended on extent of disease and virulence of bacteria. When complete surgical excision was possible, disease resolution was achieved. However, in cases with adjacent extension or dissemination infection, postoperative antibiotics were necessary.
对于非结核分枝杆菌（NTM）颈部淋巴结炎患儿，最合适的治疗策略存在争议。脓肿分枝杆菌（MAB）是NTM颈部淋巴结炎的一种罕见病因。本研究的目的是评估因牙髓切断术导致的MAB相关性颈部淋巴结炎患儿的诊断、管理及治疗结果。
这是一项对在亚特兰大儿童医疗保健医院（佐治亚州亚特兰大）接受治疗的由MAB引起的头颈部NTM淋巴结炎患儿的回顾性病历审查。预测变量包括患者人口统计学特征、牙科病史、临床表现、影像学特征、实验室检查结果、组织病理学检查、治疗及并发症。结果变量为疾病消退或持续存在。
22例患者（平均年龄6.5岁）符合纳入标准。所有患者均在1家牙科诊所接受了牙髓切断术。从牙科手术到症状出现的平均时间为43.1天（范围3至180天）。患儿表现为颈部或颌下肿胀、面部肿胀、牙龈红斑及皮肤红斑。影像学表现为颌下或颈部淋巴结炎、上颌或下颌骨质溶解、皮下脓肿及肺部结节。所有患儿的病理标本均确诊或可能诊断为MAB感染。有2种不同的患者表现指导了手术管理：孤立性非炎性颈部淋巴结炎，部分或完全切除（n = 11）；以及需要进行次全淋巴结切除、骨清创及术后抗生素治疗的相邻扩展或播散性感染（n = 11）。大多数患儿需要多次手术干预以清除感染组织。所有患儿均实现临床治愈。
在该队列中，MAB引起的NTM淋巴结炎的治疗取决于疾病范围和细菌毒力。当能够进行完全手术切除时，疾病得以治愈。然而，对于有相邻扩展或播散性感染的病例，术后抗生素治疗是必要的。
