Esthetic Outcome of Surgical Excision Versus Antibiotic Therapy for Nontuberculous Mycobacterial Cervicofacial Lymphadenitis in Children

Abstract

One hundred children with microbiologically proven nontuberculous mycobacterial cervicofacial lymphadenitis were randomly assigned to excision of the involved lymph nodes, or antibiotic therapy consisting of clarithromycin and rifabutin. The esthetic outcome was rated using a revised and weighted Observer Scar Assessment Scale. The median weighted esthetic outcome in surgical patients was significantly better (30.6) than that for patients treated with antibiotics (42.2).

Clinical Manifestations, Diagnosis, and Treatment of Mycobacterium haemophilum Infections

“…The most common manifestation of M. haemophilum infection in immunocompetent children is cervicofacial lymphadenitis. Excisional surgery leads to a quick resolution and the best esthetic outcome (87,88). In more advanced stages with extensive necrosis and skin discoloration, excisional surgery can be technically difficult.…”

Nerve dysfunction following surgical treatment of cervical non‐tuberculous mycobacterial lymphadenitis in children

“…In the observational series of Zeharia et al (4), showing good results with observation alone, 90% of cases of lymphadenitis were caused by Mycobacterium haemophilum, probably reflecting the local environmental mycobacterial flora. In a study by Lindeboom et al (25), M. haemophilum was also a dominant pathogen. It is possible that M. haemophilum infections would heal more readily than those caused by MAC, which is known to possess a higher differential pathogenicity and caused the majority of infections among our patients (26).…”

“…In a study by Lindeboom et al. (25), M. haemophilum was also a dominant pathogen. It is possible that M. haemophilum infections would heal more readily than those caused by MAC, which is known to possess a higher differential pathogenicity and caused the majority of infections among our patients (26).…”

“…If radical surgery is considered, the risk of associated nerve injury, especially of facial motor branches, should be taken into account and the procedure, if possible, only carried out by experienced surgeons. The cosmetic results of surgery have been more successful than those of medical therapy (25), but careful incision may be a favourable alternative. Each case should be evaluated individually and treatment chosen accordingly.…”

Management of Extrapulmonary Nontuberculous Mycobacterial Infections

“…Randomized trials have demonstrated that surgical excision produces superior cure rates and esthetic outcomes to medical therapy. 113,114 Excision may be complicated by permanent paralysis of the marginal mandibular branch of the facial nerve. Surgical curettage may be an alternative to surgical excision in cases with necrotic nodes adherent to the facial nerve, although healing times are longer.…”