Abscesos cervicales en el Servicio de Otorrinolaringología del Hospital Clínico Universitario de Valladolid durante el año 2018.

Abstract

Introduction: Cervical abscesses are usually polymicrobial infections (aerobic and anaerobic bacteria). They usually occur due to complications of contiguous infectious processes, such as acute pharyngotonsillitis and odontogenic infections. They often have a rapid onset and can progress to life-threatening complications. The incidence has decreased dramatically with the use of antibiotics, but they still occur with considerable frequency and are usually associated with high morbidity and mortality.Materials and methods: We have performed a review of medical records of all patients admitted to our service during 2018 with some type of cervical abscess. We analyzed the distribution by age and sex, evolution time, previous and intrahospital antibiotic treatment, microbiology, drainage type, hospital stay, imaging studies, and complications.Results: There were 96 admitted patients, 54 men (56%) and 42 women (44%). 23 cases had peritonsillar phlegmon and 2 parapharyngeal phlegmon. The abscesses were distributed as follows: 36 peritonsillar, 20 parapharyngeal, 1 retropharyngeal, 2 submandibular, 1 parotid, 1 masticator space, 3 deep neck abscess extended to the mediastinum. 2 patients had suppurative cervical adenitis and another 2 cervical adenophlegmon. The diagnosis of Ludwig's angina was made in 3 patients. The distribution by age had a very important variation according to the type of infection. The time of evolution of the symptoms in all cases was less than 7 days. All patients during admission had intravenous treatment with one or more antibiotics, the most frequent being amoxicillin-clavulanic acid (51 patients) and clindamycin + gentamicin (23 patients).  All patients received corticosteroid therapy. Regarding microbiological cultures, 86.44% were polymicrobial infections, being the most frequent agents the streptococcus (anginosus, oralis, constellatus and mitis). In 45 patients, an emergency computed tomography (CT) (46.87%) was requested, and 10 of them required 1 or more control CT (10.41%). 67 patients underwent drainage of the abscess; the most frequent route was the transoral, which was performed in 56 patients (50 under local anesthesia and 6 under general anesthesia). 10 patients required cervicotomy; in 5 of them it was necessary to perform tracheotomy and 2 of them remained intubated in the postoperative period. In 6 patients it was necessary to perform tonsillectomy to drain the collection. Percutaneous drainage was done in 1 patient.Conclusion: Cervical abscesses continue to be a frequent reason for hospital admission despite timely antibiotic treatment of the infections that cause them and can present serious complications such as airway obstruction, mediastinitis, involvement of the base of the skull and sepsis. It is essential to perform an early antibiotic treatment, the adequate management of the airway with the necessary measures to keep it permeable, as well as the drainage of the collections. The CT allows evaluating the extension of the lesions and planning the approach.