Treatment outcomes for nontuberculous mycobacterial cervicofacial lymphadenitis in children based on the type of surgical intervention

Abstract

NTM infections require high levels of suspicion for timely diagnosis, and complete excisional biopsy results in least likelihood of persistent/recurrent disease.

Surgical treatment for chronic cervical lymphadenitis in children. Experience from a tertiary care paediatric centre on non-tuberculous mycobacterial infections

“…Moreover, the natural history of the disease leads to a longer time to diagnosis compared to acute bacterial adenitis. In fact, the persistence of the lymphadenitis is usually the reason for referring to a tertiary care centre, when a median delay of 8-12 weeks is commonly reported in 44% of cases before specialist evaluation [19,46], with a maximum interval between cervical lymphadenitis appearance to definitive treatment reported to be up to one year [41,47]. In the present study the mean interval between symptoms onset and final diagnosis was of 7 Fig.…”

“…To summarise, an individualised management approach is recommended, with excisional biopsy as the preferred surgical option when feasible [17,19,43,58,59]. The following factors should be addressed in the decision making process: 1) potential facial nerve injury; 2) cosmetic results; 3) parental tolerance for a protracted clinical course; 4) status of the lesion (i.e.…”

“…They are usually located in the anterior submandibular triangle, and in the high cervical neck including jugodigastric levels, posterior triangle lymph nodes, or preauricular/parotid area. Their clinical course could vary from spontaneous cure to progression and spontaneous fistulisation; the latter situation is usually due to the liquefying process of the affected lymph node, which turns into a fluctuant lesion with necrosis in the granulomatous centre and with a characteristic changing in its overlying skin to a purple colour [18,19]. 80% of the patients presenting to a head and neck surgeon are at this stage [20,21].…”

Atypical mycobacteriosis in children: a diagnostic and therapeutic challenge

“…The Mendel-Mantoux test or the RT23 test can be false positive, as there is a cross reactivity between MOTT and mycobacteria tuberculosis. The rate of false-positive results indicating a tuberculosis is reported with 19-67 % [13,23]. In the present study, in 22 out of 29 patients, a Mendel-Mantoux test was performed with false-positive results in 45 % of these patients.…”

Management of lymphadenitis due to non-tuberculous mycobacterial infection in children

“…Advantages of complete excision over non-excisional surgery (incomplete excision, incision and drainage, or fine needle aspirate) are: (1) higher cure rates [20]; (2) significantly quicker healing times [21]; (3) lower number of reoperations [22], and (4) improved cosmetic results, with less sinus formation and purulent drainage and less disfiguring scarring [23,24]. Incision and drainage is specifically not recommended due to the risk of sinus formation, scarring and recurrence of disease [1,25,26].…”