Intraoral Drainage: Recommended as the Initial Approach for the Treatment of ParapHaryngeal Abscesses

Amar, Yannick G; Manoukian, John J.

doi:10.1016/j.otohns.2003.11.016

Cited by 41 publications

(43 citation statements)

References 8 publications

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“…It is generally accepted that retropharyngeal abscesses can be safely drained intraorally. Some authors consider an intraoral approach as a reasonable initial method of management also for lateral pharyngeal space abscesses, if CT scan shows the abscess to be medial to the great vessels of the neck [13,14] . The intraoral approach is simpler, less aggressive (no risk of keloids and of injury to the marginal mandibular nerve) and it requires shorter recovery time than external approach.…”

Section: Discussionmentioning

confidence: 99%

Deep Neck Infections: A Constant Challenge

Boscolo‐Rizzo¹,

Marchiori²,

Montolli³

et al. 2006

ORL

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Background: Although the advent of antibiotics and improved dental care decreased the incidence and mortality, deep neck infections (DNIs) are not uncommon and present a challenging problem due to the complex anatomy and potentially lethal complications that may arise. Objectives: This study reviews our experience with DNIs and tries to identify the predisposing factors of life-threatening complications. Methods: A retrospective review was conducted of patients who were diagnosed as having DNIs in the Department of Otolaryngology and in the Department of Infectious Diseases at Treviso Regional Hospital from 1995 to 2003. Associations between life-threatening complications and other factors were determined by χ² test, Fisher’s exact test and Student’s t test as appropriate. Results: One hundred sixty-seven charts were recorded; 95 (56.9%) were men, and 72 (43.1%) were women, with a mean age of 49.6 ± 20.4 years (range: 2–96). There were 39 patients (23.4%) who had associated systemic diseases, with 53.8% (21/39) of those having diabetes mellitus. The lateral pharyngeal and submandibular spaces were the most commonly involved spaces. Upper airway infections and odontogenic infections were the two most common causes of DNIs (47.5 and 27.9% of the known causes, respectively). The pathogenesis remained unknown in 45 patients (26.9%). Coagulase-negative staphylococcus (36.9%) and Streptococcusviridans (28.8%) were the most common organisms, identified through cultures. Of the abscess group (77 patients), 42 patients (54.5%) underwent surgical drainage under general anesthesia. Thirty-one patients (18.6%) developed life-threatening complications: airway obstruction (n = 18), descending mediastinitis (n = 6), jugular vein thrombosis (n = 4), and pneumonia (n = 3). Compared with other patients, the unique features of patients with life-threatening complications were as follows: older age (p = 0.04), a higher white blood cell count (p = 0.01), abscess formation (p = 0.02), associated systemic disease (p < 0.001), diabetes mellitus (p < 0.001), anterior visceral space involvement (p < 0.001), and multiple-space involvement (p < 0.001). Conclusions: DNIs continue to occur and these are associated with significant morbidity and mortality even in this era of antibiotics. Furthermore, the widespread and inappropriate use of antibiotics may change the clinical presentation and course of these infections, making them more elusive and less predictable also in complicated cases. The clinical assessment of patients who are older, with abscess formation, underlying systemic diseases, diabetes mellitus, visceral anterior space or multiple-space involvement requires careful consideration of potential complications.

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Section: Discussionmentioning

confidence: 99%

Deep Neck Infections: A Constant Challenge

Boscolo‐Rizzo¹,

Marchiori²,

Montolli³

et al. 2006

ORL

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“…Daya et al [12] preferred the intraoral approach for surgical drainage of infections of the retropharyngeal and parapharyngeal spaces unless the collection was lateral to the great vessels of the neck. Amar and Manoukian [13] compared intraoral drainage and external neck drainage in terms of duration of anesthesia, duration of postoperative intravenous antibiotics and length of postoperative hospital stay and concluded that intraoral drainage is a safe and effective initial treatment for parapharyngeal abscess in the pediatric population. However, abscesses located in the poststyloid compartment or that demonstrate extension to other spaces must be drained by the traditional transcervical approach.…”

Section: Discussionmentioning

confidence: 99%

“…In addition the transoral drainage had a shorter duration of admission than the transcervical drainage in our study. Furthermore the morbidity of transoral drainage is very low [6,13] . Rarely there are a few cases of pseudoaneurysm of the internal carotid artery related to parapharyngeal infection [15] .…”

Section: Discussionmentioning

confidence: 99%

Parapharyngeal Abscess: Comprehensive Management Protocol

Oh¹,

Kim²,

Kim³

2006

ORL

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Parapharyngeal infections are rare, but they cause serious morbidity and mortality. Therefore, until now, the recommended treatment of parapharyngeal abscess has been early open surgical drainage. The purpose of this study is to review the clinical course and outcome of treatment in parapharyngeal abscess according to method of treatment. A prospective study was designed for parapharyngeal abscess in patients admitted for deep neck infection. During an 8-year period, from June 1994 to January 2003, 34 patients were enrolled. All had contrast-enhanced computed tomography (CT) imaging and confirmation of an abscess in the parapharyngeal space. All patients were treated with intravenous antibiotics. We treated 19 cases (conservative group) with antibiotics only or needle aspiration and 15 (surgical group) with intraoral or external drainage. The mean duration of hospitalization was 8.2 days in the conservative group and 11.6 days in the surgical group. There was no complication except mediastinitis in 1 case of the conservative group. Because of severe dyspnea, 5 patients required tracheotomy. Neck CT scan is a useful diagnostic tool to detect and establish the treatment plan of parapharyngeal abscess. Parapharyngeal abscess may, in some cases, respond to antibiotics, become localized to the parapharyngeal space and be treated conservatively with no need for early open surgical drainage.

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“…Oral and Maxillofacial surgery text book described the incision to be made in healthy skin and mucosa when possible in a normal skin fold: Dissect bluntly, place a drain, followed by drain removal when the drainage becomes less. 10 Intraoral incisions are only indicated in uncomplicated infections limited to the sublingual compartment; otherwise an external approach is recommended.…”

mentioning

confidence: 99%

“…A short incision drainage as described in the literature includes placing the incision in healthy mucosa or skin and in an esthetic area, if possible; obtaining gravity-dependent drainage; and performing blunt dissection during drainage to avoid damage to adjacent vital structures. 10 Long dissecting incisions and open dissection are usually not necessary, except perhaps in cases of necrotizing fasciitis or descending necrotizing mediastinitis, in which repeated surgical exploration, debridement, and drainage can be anticipated. Abscess, without question, requires incision and drainage, whereas the surgical management of cellulitis is more controversial.…”

mentioning

confidence: 99%