Age-, site-, and time-specific differences in pediatric deep neck abscesses

Arch Otolaryngol Head Neck Surg. 2004 Feb;130(2):201-7. doi: 10.1001/archotol.130.2.201.

Abstract

Objective: To clarify presentations, organisms, and locations of deep neck abscesses in children.

Design: Retrospective review.

Setting: Tertiary children's hospital. The study population comprised 169 patients younger than 19 years who were surgically treated for deep neck abscesses between 1989 and 1999.

Main outcome measure: Resolution of abscess.

Results: Neck mass (91%), fever (86%), cervical adenopathy (83%), poor oral intake (66%), and neck stiffness (59%) were common in all ages. Patients younger than 4 years, compared with patients 4 years or older, presented with agitation (50% vs 14%), cough (35% vs 14%), drooling (27% vs 12%), lethargy (46% vs 33%), oropharyngeal abnormalities (45% vs 60%), respiratory distress (5% vs 2%), retractions (5% vs 2%), rhinorrhea (53% vs 15%), stridor (4% vs 2%), and trismus (14% vs 53%). Children younger than 1 year were infected with Staphylococcus aureus (79%) vs group A streptococcus (6%). Children 1 year or older were infected with group A streptococcus (29%) vs S aureus (16%). Retropharyngeal or parapharyngeal regions were involved in children 1 year or older (49%) vs younger than 1 year (21%). Anterior or posterior triangles and submandibular or submental regions were involved in 39% and 36%, respectively, of children younger than 1 year vs 30% and 23%, respectively, of children 1 year or older. Retropharyngeal and parapharyngeal abscesses yielded group A streptococcus (34%) vs S aureus (11%). Anterior and posterior triangle abscesses yielded S aureus (35%) vs group A streptococcus (19%), as did submandibular and submental abscesses (42% vs 19%).

Conclusions: Abscesses in children younger than 1 year affected anterior or posterior triangles and submandibular or submental regions, yielding S aureus. Abscesses in children 1 year or older affected retropharyngeal or parapharyngeal regions, yielding group A streptococcus.

MeSH terms

  • Abscess / diagnosis*
  • Abscess / drug therapy
  • Abscess / microbiology
  • Adolescent
  • Age Factors
  • Anti-Bacterial Agents
  • Child
  • Child, Preschool
  • Drug Therapy, Combination / therapeutic use
  • Female
  • Humans
  • Infant
  • Neck*
  • Retropharyngeal Abscess / diagnosis*
  • Retropharyngeal Abscess / drug therapy
  • Retropharyngeal Abscess / microbiology
  • Retrospective Studies
  • Staphylococcal Infections*
  • Streptococcal Infections*
  • Streptococcus pyogenes
  • Submandibular Gland
  • Time Factors

Substances

  • Anti-Bacterial Agents