Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery

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Context: Deep neck space infection is a potentially morbid condition characterized by pus collection in various potential and true spaces of the neck. With this study, we attempt to highlight, the changes in etiological factors in the current scenario, and management protocols for deep neck space infections. Furthermore, we studied the prevalence of antibiotic resistance in isolated microorganisms. Aims: To study the etiology, antibiotic sensitivity pattern, and management of deep neck space infections in adults and pediatric patients. Settings and Design: A retrospective analysis of patients undergoing surgical management of deep neck space infections at a tertiary care institute in India. Subjects and Methods: Analysis of records of 222 patients who underwent surgical management for deep neck space infections was done. All the patients received empirical antibiotic therapy within 30 min of hospital admission. The patients treated with conservative management were excluded from the study. Cultures and antibiotic sensitivities were obtained for patients undergoing surgical management. Results: Dental infection (52%) was the most common predisposing factor for deep neck space infections in adults followed by diabetes mellitus (28.2%). Multispace involvement was the most common presentation followed by parapharyngeal space involvement. The majority of the cultures were sterile (42.6%). The most common pathogen on cultures was Staphylococcus aureus (13.1% in adults and 47.4% in pediatric age group). The incidence of methicillin-resistant S. aureus (MRSA) was 22.7%, which was lower than what has been observed in the previous studies. Klebsiella pneumoniae isolates were found to have high incidence of resistance to cefotaxime (50%), cefepime (38.5%), and ceftazidime (75%). Complications were seen in 4.5% (n = 10) of patients with an overall mortality of 0.9% (n = 2). Conclusions: In view of comparatively lower incidence of MRSA, combination of amoxicillin-clavulanic acid along with clindamycin is a reasonable first-line antibiotic therapy for deep neck space infections. In patients with diabetes, amikacin or piperacillin-tazobactam can be added to the regime, as there is a higher incidence of infection by K. pneumoniae. Surgical management remains the mainstay of treatment and is associated with improved outcome.

Tonsillectomy is a common surgical procedure often done by otolaryngologist in his/her routine surgical practice. Transient facial nerve palsy is an extremely rare complication of tonsillectomy. The cause of the facial nerve palsy may be due to infiltration of local anesthetic agent into parapharyngeal space and affecting facial nerve. Infiltration of local anesthetic solution into the peritonsillar tissue is commonly used for reduction of pain, although the benefit and risk of complication of this technique have not yet been well established. Here, we presented a rare incidence of facial nerve palsy seen in a 14-year-old boy who underwent tonsillectomy under general anesthesia with local infiltration of bupivacaine at peritonsillar space. The facial nerve palsy was completely recovered by conservative treatment.

Thymic tumors are rare neoplasms that arise in the anterior mediastinum. The Incidence of ectopic cervical thymoma is very less. A 36-year-old female presented with a swelling in the front of the neck for the duration of around 1 year with a cytology report suggestive of lymphoma. She underwent positron emission tomography/computed tomography scan which showed only low-grade fluorodeoxyglucose uptake in the left neck node, no evidence of disease elsewhere. She underwent ultrasound-guided Tru-cut biopsy which was suggestive of round cell tumor favoring lymphoproliferative disorder which needed immunohistochemistry (IHC) for further confirmation. IHC was confirmative of thymoma, for which patient underwent surgery.. Final histology report was of Thymoma AB type, MASOKA Stage IIa. This case briefs about the diagnostic challenge in a case of neck swelling, for which none of the differential diagnosis was correlated. Surgery remains the mainstay of treatment for thymoma once the tissue diagnosis is confirmed.

A unique case of persistent endochondral cartilage in temporal bone in a child with profound hearing loss is being reported This has never been reported earlier. High-resolution computed tomography of the temporal bone suggested bilateral narrow internal auditory canal and absent semicircular canals with small vestibule but a normal cochlea. The mastoid cavity showed few lucent areas among the air cells. Magnetic resonance imaging showed similar findings along with bilateral thin auditory nerves. During the surgical procedure, the mastoid air cells on the right side were filled with cartilaginous tissue separating it from the posterior fossa. With absolutely no landmarks and a contracted antrum, further procedure was abandoned. Although there are a few contraindications for cochlear implantation, this unique case report highlights one of the rarest conditions which can provide a surgical challenge to the surgeon.

Aim: The aim of this study was to assess the benefits, impact, and efficacy of the adenotonsillectomy (AT) or tonsillectomy or adenoidectomy on quality of life among pediatric patients with chronic tonsillitis or adenotonsillar hypertrophy. Materials and Methods: This was an observational and retrospective study done among children who had undergone AT, tonsillectomy, and adenoidectomy between the ages of 3 years and 16 years during December 2015 to November 2018. Patients were asked by questionnaire for comparing the symptoms before and after 3 months of surgery. Results: There were 220 children who had undergone AT, tonsillectomy, and adenoidectomy. There were 122 male and 98 female children. The age of the children ranged from 3 to 16 years. The mean age of the children was 6.8 years. The mean duration of the clinical symptoms was 2.8 years. The mean attacks of tonsillitis per year, absent days from school, frequency of doctor visits were reduced postoperatively. There was a significant increase in quality of life after AT or tonsillectomy, which was confirmed by statistically validation (P < 0.005) in Student's t-test. Conclusion: AT, tonsillectomy, and adenoidectomy are commonly performed surgical procedures among pediatric patients. All the surgeries are considered as elective procedure often performed in day-care unit where children come by ambulatory, operated, and discharged on the same day of the surgery except if any complications.

Online since 12^th Sep, 2016