Vol.97 No.4 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 97 No. 4 April 2004
A Case of Deep Neck Infection Secondary to Peritonsillar
Abscess Extending to the Upper Mediastinum
Yukiko Mochizuki, Takayuki Mochizuki, Katsutoshi Tsuchiya and Hajime Hirose
(Yamato Tokushukai Hospital)
Mamoru Tsukuda
(Yokohama City University School of Medicine)
Deep neck infection is still a relatively common emergent condition in otolaryngological practice. We recently experienced a case of 57 year-old male who developed neck swelling with mild dyspnea and dysphagia after perioral administration of antibiotics by an internist for peritonsillar abscess. ENT examinations revealed a painful neck swelling with severe peritonsillar swelling extending to the hypopharynx in the left side. CT examination indicated abscess formation with gas in the neck extending to the upper mediastinum. Peritonsillar drainage was begun on an emergency basis, followed by tracheotomy and cervical drainage. The neck incision was kept open, and the patient was treated with intravenous antibiotics together with human immunoglobulin. The postoperative course was uneventful, and the mediastinal abscess was absorbed without direct drainage. We considered that immediate cervical drainage was essential for the treatment of acute deep neck infection. For the evaluation of the effect of treatments, CT examination and the measurement of CRP and WBC count appeared to be most useful.
Key words : deep neck infection, drainage, CT, CRP, WBC