Deep neck abscess as first manifestation of head and neck carcinoma - Implications for diagnostic management

Background: Neck abscesses and deep neck infections are common diseases in the field of otorhinolaryngology. However, malignant lymph node metastases presenting as abscesses are uncommon and have rarely been described up to n ow. Patients: A retrospective review between March 1997 and August 1999 was conducted of 40 patients with deep neck abscesses. Results: In five patien ts (12.5%) the histological diagnostics revealed a malignancy. From these, in 3 cases the cervical abscess was the primary clinical symptom of an orop haryngeal as well as a hypopharyngeal carcinoma. With further 2 patients, t he neck-abscess was located as first clinical sign of a metachroneous lymph node metastases after oropharyngeal carcinoma. Aerobic bacteria were recov ered in 18 patients, anaerobes alone in 3 and mixed aerobic and anaerobic b acteria in 6 patients. Bartonella henselae was recovered in 7, Mycobacteriu m tuberculosis in 3 and Adinomyces israelii in 1 patient. Conclusions: A bi opsy of the abscess wall is recommended in establishing the diagnosis. The indication for a simultaneous panendoscopy - especially in patients with ty pical risk for malignancies - to exclude a primary tumor in the aerodigesti ve tract should be regarded generously. Neck abscesses should be considered in the differential diagnosis of head and neck carcinoma.