Cervical abscesses – analysis of 250 patients and proposal of a therapeutic algorithm for fulminant abscesses of the deep neck

Introduction Cervical or parotid abscesses have to be treated immediately and are potentially life-threatening. Clinical findings vary from focal abscess formations in lymph nodes in children to fulminant abscesses of the deep neck including the mediastinal space. Aim of this study was an analysis of 250 cases with cervical abscesses in order to deduse a treatment algorithm for large abscesses of the deep neck.

Methods 250 patients treated at our institution with a cervical or parotid abscess were assessed retrospectively. Localization and size of the abscess, cause of infection, kind and number of surgery, antibiotic therapy, microbiological results, length of hospitalization, complications and patients´ characteristics were analyzed.

Results One third of the patients were children presenting with milder symptoms, while 15 % had large and fulminant abscesses of the deep neck. Tonsillitis or an odontogenic cause of the infection were most common. For singular abscess formations a single surgical procedure was sufficient including a mean hospitalization of 5 days, while the large abscesses required more than 3 surgeries, more than 14 days of hospitalization and, in 90 % of the cases, a temporary tracheostomy. Overall, the mortality was low at 1 %.

Conclusion While the majority of cervical abscesses are healing fast after surgical drainage and antibiotic treatment, the large infections of the deep neck require intensive treatment with repeated surgical therapy and local treatment. Within our therapeutic concept, we emphasize the importance of surgical drainage even of small abscesses, regularly scheduled wound revisions as well as an early tracheostomy to prevent a life-threatening course of disease.

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Publication History

Article published online:
10 June 2020