2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

ULTRASONOGRAPHY-GUIDED DRAINAGE FOR DEEP NECK ABSCESSES

TABLE I PATIENTS ’ CHARACTERISTICS ∗

Ultrasound-guided drainage †

Incision & drainage ‡

Characteristic

Total

p

Mean age (years)

34.97 18:12 38.25

35.73 19:11 37.94

35.35 37:23 38.10

0.832 0.791 0.700 0.382

Gender ratio (male:female) Mean temperature (°C) Mean white blood cell count

16 016

20 683

18 350

Abscess location ( n ) – Submandibular

13

13

26

– – – – – – – – – – – – –

– Buccal

3 3 5 3 0 3 0 4 0 0 0 9

5 3 3 2 2 1 1 3 1 1 1 6

8 6 8 5 2 4 1 7 1 1 1

– Pterygomandibular

– Parotid

– Masseteric

– Parapharyngeal – Submental – Neck level 2 Presumed cause ( n ) – Odontogenic

17

18

35

– Sialadenitis

– Adenitis

– Sialolithiasis

– Trauma – Unknown

15

– ∗ For 60 patients who underwent ultrasound-guided drainage or surgical incision and drainage of their neck abscess. † n = 30; ‡ n = 30

We found a significant difference ( p < 0.001) in the mean length of hospital stay between patients who underwent ultrasound-guided drainage (5.47 days) and those who underwent incision and drainage (9.70 days) ( Table III ). Five patients in the ultrasound- guided drainage group required a second drainage; a second drainage was only necessary for three patients in the incision and drainage group; this difference was not statistically significant ( p = 0.706). We also measured the pus-drained volume via the ultrasound-guided drainage method in each individual case. The mean pus-drained volume was 13.03 ml (range, 3 – 26 ml). There was no significant association between the isolated organism obtained from the abscess and the amount of pus drained. We drained sig- nificantly more pus from submandibular abscesses compared to abscesses in other spaces ( p = 0.020). Discussion Recent evidence suggests that ultrasound-guided drain- age is an effective alternative to incision and drainage in some cases of neck abscesses. Baatenburg de Jong et al . reported one of the first series of deep neck space abscesses that were drained successfully using TABLE III LENGTH OF HOSPITAL STAY AND RECURRENCE DIFFERENCES ∗ Parameter Ultrasound- guided drainage Incision & drainage p

drainage group. There were also two cases of methicil- lin-resistant S aureus in ultrasound-guided drainage cultures and two in the incision and drainage cultures. There was one case of Haemophilus influenzae in the incision and drainage group. Five patients in the incision and drainage group had diabetes mellitus; there was no history of diabetes mel- litus in the ultrasound-guided drainage patients. We analysed length of hospital stay in these patients and the non-diabetic patients who underwent incision and drainage. There was no significant difference in the length of hospital stay between these two groups ( p = 0.179). Therefore, we did not exclude these dia- betes mellitus patients from our final analysis in which length of hospital stay was compared between the two different drainage types.

TABLE II BACTERIAL CULTURE RESULTS ∗

Organism

Ultrasound- guided drainage ( n )

Incision & drainage ( n )

Total ( n )

8

8

16

Streptococcus pyogenes S pyogenes + anaerobic Staphylococcus aureus Unknown

7 6

7 5

14 11

4

5

9

Methicillin-

2

2

4

resistant S aureus

Mixed anaerobes

1 0 1 1

2 1 0 0

3 1

< 0.001

Mean hospital stay (days) Need for second drainage ( n )

5.47

9.70

Haemophilus influenzae Enterobacter Pseudomonas

1

5

3

0.706

1 ∗ For patients who underwent ultrasound-guided drainage or surgi- cal incision and drainage of their neck abscess

∗ Between ultrasound-guided drainage or surgical incision and drainage groups

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