1. Serviço de Otorrinolaringologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
2. Unidade de Infecciologia, Área da Criança, Mulher e Adolescente, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
- 13th Congress of the European Society of Pediatric Otorhinolaryngology, 18-21/06/2016, Lisbon (Poster)
Introduction: Pharyngeal abscesses are purulent collections, usually with polymicrobial etiology, present in cervical virtual spaces surrounded by fascias. These spaces are contiguous and provide low resistance to infection. The risk of infection spreading and involvement of vital neck structures is high. Although rare in children, they can be associated with serious complications.
Objectives: Characterize the cases of pharyngeal abscesses in children admitted to a tertiary paediatric hospital.
Methods: Retrospective study of children with pharyngeal abscess admitted to Hospital Dona Estefania (Lisbon, Portugal) from January 2011 to December 2014 (4 years). Demographic data, clinical background, clinical manifestations, laboratorial and imaging alterations, medical and/or surgical treatment and evolution were analysed.
Results: We identified 87 cases, with an average age of 9.4 years. Clinical history was irrelevant in 56% and 27.6% had recurrent tonsillitis history. It was found that 40% of patients had a preceding upper respiratory infection and 40% had been treated with antibiotics. The most common type of abscess was the peritonsillar (77.9%), followed by the parapharyngeal (9.3%) and the retropharyngeal (6.9%). Signs and symptoms differed according to the type of abscess: peritonsillar - odynophagia (94%), tonsillar hyperemia (88%) and fever (69%); parapharyngeal - neck pain and torticollis (62.5%); retropharyngeal - neck pain (100%) and cervical tumefaction (83.3%). In what concerns peritonsillar abscesses, 36.7% underwent contrast CT which revealed alterations, compared to 87.5% of the parapharyngeal and 66.7% of the retropharyngeal abscesses. Considering the 3 groups, 39% of the patients underwent surgical drainage and Streptococcus pyogenes was the pathogen most frequently identified (6 of the total 8 identified). Association of penicillin with clindamycin was used in 77% of the cases. Two children had complications (2.3%): airway obstruction requiring intensive care (1) and respiratory failure at the 2nd day of admission, improved with corticotherapy (1). Among the 87 cases, 72.4% were evaluated by otorhinolaryngology after hospitalization, 26.4% underwent elective tonsillectomy and six cases relapsed.
Conclusions: Clinical findings continue to be determinant to pharyngeal abscess diagnosis. The interpretation of the imagiologic exams and the choice of medical versus combined medical and surgical treatment are still matter of debate.
Keywords: pharyngeal abscess, children, clinical presentation, diagnostic tools, antibiotics, surgical drainage.