Deep Neck Infections in Children: A Retrospective Analysis of 36 Cases

Abstract

Objective: Deep neck infections can cause significant morbidity and mortality in children. The aim of this study was to evaluate clinical and microbiological findings and treatment outcomes of radiologically confirmed deep neck infections in children. Material and Methods: This is a retrospective record review of pediatric patients with radiologically confirmed deep neck infections admitted to our clinic between January 2009 and December 2014. Results: During the study period, a total of 36 patients (23 boys/13 girls; mean age: 9.5±5.3 years, range 1-17 years) diagnosed with deep neck infections were followed. The number of cases increased towards the last years of the study. Twenty patients (55.5%) had peri-tonsillar, 8 (22%) had retropharyngeal, 4 (11%) had parapharyngeal, and 4 (11%) had mixed type infection. Most peritonsillar and parapharyngeal infections occurred in adolescents, whereas retropharyngeal infections occurred generally in preschool children. The most common presenting signs and symptoms were fever (86%), dysphagia (86%), sore throat (72%), and tonsillopharyngitis (72%). Group A beta-hemolytic streptococcus (GABHS) was the most frequently isolated pathogen. Fifteen patients (42%) recovered with only antibiotic treatment, and most of the patients (86%) were given intravenous ampicillin-sulbactam+clindamycin. Complications occurred in two patients (5.5%) with retropharyngeal infection, including airway obstruction, internal jugular vein thrombosis, and septic shock. Mortality was seen in only one patient (2.7%) with invasive GABHS infection. Conclusion: An increase in the incidence of pediatric deep neck infections has been observed in recent years, and this increase was congruent with the increase in group A streptococcal abscesses.