Abstract
Objectives
To describe the presentation and management of pediatric deep neck space infections located at the skull base.
Methods
Design: Retrospective review. Setting: Tertiary children's hospital. The study population comprised pediatric patients admitted to the hospital for management of deep neck space infections between 2000 and 2007. Main Outcome Measure: Resolution of abscess.
Results
Over the study period, 179 patients were admitted for management of deep neck space infections. Of these, 10 (6%) were localized to the skull base by CT scan. 7 of the 10 met radiographic criteria for an abscess; the remaining 3 were designated edema or phlegmon. Patients ranged in age from 2 to 8 years old. The most common presenting symptoms were sore throat (60%), stiff or sore neck (50%), neck or facial swelling (20%), and drooling (20%). Otitis media and Streptococcal pharyngitis were the most common co-morbidities found in 40% of patients. Initial treatment consisted of IV antibiotics in all cases. 70% resolved with medical management alone. 3 patients failed to resolve following 48 hrs of IV antibiotics and were taken to the operating room for abscess drainage, which was unsuccessful in all cases. Repeat CT after an additional 48 hours of medical therapy indicated persistent abscess in 2 of the 3 operative cases. Repeat drainage was successful in only 1 of these.
Conclusions
Skull base abscesses in children can be effectively managed in most cases by IV antibiotics alone. Surgical drainage is difficult and often unsuccessful and therefore poses unnecessary risk to the patient.
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