DEEP NECK INFECTIONS IN CHILDREN - A NEW APPROACH TO DIAGNOSIS AND TREATMENT

Forty-seven children presented with the diagnosis of a deep neck infec tion-either cellulitis or abscess-between January 1991 and July 1996. Forty-four (94%) had contrast-enhanced computed tomography (CT) imagin g consistent with this diagnosis. Three patients with no CT scan had c omfirmation of an abscess at surgical drainage. Parenteral antibiotics alone were effective in the treatment of 24 of 47 infections (51%): s even parapharyngeal, one retropharyngeal, and 16 combined. By CT scan these infections represented cellulitis in 17 of 24 (71%), an abscess in three of 24 (13%), and incomplete abscess in four of 24 (17%). The average duration of hospitalization for this group was 4.8 days, with symptomatic improvement usually seen within 24 hours. Surgical drainag e was performed on 23 of 47 infections (49%): three parapharyngeal, 17 combined, and three of unknown specific location. In 22 of these 23 c hildren (96%), transoral drainage of the abscess was used as the prima ry surgical approach. In 21 of these 22 (95%) there was complete resol ution without complications or recurrence; one abscess required a subs equent external approach. CT scanning with contrast revealed that all deep neck infections were located medial (usually anteromedial) to the great vessels. Abscesses with volumes estimated to be greater than 20 00 mm(3) were more likely to undergo surgery, but these differences we re not statistically significant. The use of contrast-enhanced CT scan ning provides information regarding abscess size, location, and relati ve position of the great vessels for safe and successful transoral dra inage. Thus we recommend CT-assisted transoral drainage for combined r etropharyngeal/parapharyngeal abscesses and selected isolated paraphar yngeal abscesses that do not respond to parenteral antibiotics.