Nagy M, Pizzuto M, Backstrom J, Brodsky L
Department of Otolaryngology, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, and the Children's Hospital of Buffalo, 14222-2006, USA.
Laryngoscope. 1997 Dec;107(12 Pt 1):1627-34. doi: 10.1097/00005537-199712000-00010.
Forty-seven children presented with the diagnosis of a deep neck infection--either cellulitis or abscess--between January 1991 and July 1996. Forty-four (94%) had contrast-enhanced computed tomography (CT) imaging consistent with this diagnosis. Three patients with no CT scan had confirmation of an abscess at surgical drainage. Parenteral antibiotics alone were effective in the treatment of 24 of 47 infections (51%): seven parapharyngeal, one retropharyngeal, and 16 combined. By CT scan these infections represented cellulitis in 17 of 24 (71%), an abscess in three of 24 (13%), and incomplete abscess in four of 24 (17%). The average duration of hospitalization for this group was 4.8 days, with symptomatic improvement usually seen within 24 hours. Surgical drainage was performed on 23 of 47 infections (49%): three parapharyngeal, 17 combined, and three of unknown specific location. In 22 of these 23 children (96%), transoral drainage of the abscess was used as the primary surgical approach. In 21 of these 22 (95%) there was complete resolution without complications or recurrence; one abscess required a subsequent external approach. CT scanning with contrast revealed that all deep neck infections were located medial (usually anteromedial) to the great vessels. Abscesses with volumes estimated to be greater than 2000 mm3 were more likely to undergo surgery, but these differences were not statistically significant. The use of contrast-enhanced CT scanning provides information regarding abscess size, location, and relative position of the great vessels for safe and successful transoral drainage. Thus we recommend CT-assisted transoral drainage for combined retropharyngeal/parapharyngeal abscesses and selected isolated parapharyngeal abscesses that do not respond to parenteral antibiotics.
1991年1月至1996年7月期间，47名儿童被诊断为深部颈部感染——蜂窝织炎或脓肿。44名（94%）儿童的增强计算机断层扫描（CT）成像结果与该诊断相符。3名未进行CT扫描的患者在手术引流时确诊为脓肿。单独使用肠外抗生素治疗47例感染中的24例（51%）有效：7例咽旁感染、1例咽后感染和16例合并感染。通过CT扫描，这些感染在24例中的17例（71%）表现为蜂窝织炎，24例中的3例（13%）为脓肿，24例中的4例（17%）为不完全脓肿。该组患者的平均住院时间为4.8天，症状通常在24小时内改善。47例感染中的23例（49%）进行了手术引流：3例咽旁感染、17例合并感染和3例具体位置不明的感染。在这23名儿童中的22名（96%），脓肿的经口引流被用作主要手术方法。在这22名中的21名（95%）患者中，脓肿完全消退，无并发症或复发；1例脓肿需要随后采用外部手术方法。增强CT扫描显示，所有深部颈部感染均位于大血管内侧（通常为前内侧）。估计体积大于2000立方毫米的脓肿更有可能接受手术，但这些差异无统计学意义。增强CT扫描的应用提供了有关脓肿大小、位置以及大血管相对位置的信息，有助于安全、成功地进行经口引流。因此，我们建议对咽后/咽旁联合脓肿以及对肠外抗生素无反应的特定孤立性咽旁脓肿采用CT辅助经口引流。
