What is the optimal management of pediatric nontuberculous mycobacterial cervicofacial lymphadenitis?

In Response to the Management of Nontuberculous Mycobacterial Cervicofacial Lymphadenitis: A View Beyond Surgery

“…We thank the authors for adding their perspective to our abbreviated summation of the evidence supporting conservative, medical, and surgical management of non-tuberculous mycobacterial (NTM) cervicofacial lymphadenitis in children. 1,2 We agree with their conclusions, similar to our own, that treatment decisions should be individualized and that complete excision of infected nodes offers the highest cure rate, albeit at the expense of risking marginal mandibular nerve branch injury.…”

“…Clearly, such discussion must involve an honest disclosure of the potential morbidity associated with surgical intervention, which incurs at least a 2% risk of permanent marginal mandibular nerve paralysis. [1][2][3]5,7 JENNIFER L. HARB, MD and REBECCA A. COMPTON, MD…”

In Reference to The Management of Nontuberculous Mycobacterial Cervicofacial Lymphadenitis: A View Beyond Surgery

“…We read with interest the article by Harb et al suggesting surgery should be offered to all children with cervicofacial nontuberculous mycobacterial (NTM) lymphadenitis. 1 This conclusion is based on only four cited studies. As summarized in our recent meta-analysis, many other studies have investigated the three main management options-complete excision, anti-mycobacterial antibiotics, and no intervention ('watchful waiting').…”

Current management of cervicofacial nontuberculous mycobacterial infections in the pediatric population

“…Cervicofacial NTM infections in children are challenging to diagnose as they often present with nonspecific symptoms [14,15,18]. A detailed clinical history, including possible exposure to potential sources of infection via environmental hazards, travel, or animal contact, is essential [1 & ].…”

“…3). Some families report malaise and occasional fevers [12,13], but systemic symptoms are otherwise absent in all phases [14,15]. The management of cervicofacial NTM infections has been studied extensively.…”