To compare ultrasonography-guided drainage versus conventional surgical incision and drainage in deep neck space abscesses.

The study was pre-registered on the National Institute of Health Research Prospective Register of Systematic Reviews (CRD42023466809) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Medline, Embase and Central databases were searched. Primary outcomes were length of hospital stay and recurrence. Heterogeneity and bias risk were assessed, and a fixed-effects model was applied.

Of 646 screened articles, 7 studies enrolling 384 participants were included. Ultrasonography-guided drainage was associated with a significantly shorter hospital stay (mean difference = −2.31, p < 0.00001), but no statistically significant difference was noted in recurrence rate compared to incision and drainage (odds ratio = 2.02, p = 0.21). Ultrasonography-guided drainage appeared to be associated with cost savings and better cosmetic outcomes.

Ultrasonography-guided drainage was associated with a shorter hospital stay, making it a viable and perhaps more cost-effective alternative. More randomised trials with adequate outcomes reporting are recommended to optimise the available evidence.

This paper reports a 10-year series of spontaneous nasal septal abscesses in immune-competent children, with suggestions for optimal management.

A retrospective case note review was conducted of children undergoing an operation for incision and drainage of nasal septal abscesses between 2013 and 2023.

Six children were identified via electronic hospital records during the 10-year review period, five with a spontaneous abscess. The children were aged 10–14 years. All were immunocompetent and none had active sinus infection. The most common presenting features were nasal swelling, facial swelling, headache, nasal congestion and fever. The most common bacterial isolate was Staphylococcus aureus. All children received prompt surgical drainage and intravenous antibiotic therapy. Complications were seen in three children, with one child developing significant intracranial complications.

To our knowledge, this is the first series of spontaneous nasal septal abscesses in immunocompetent children. The high prevalence of Staphylococcus aureus suggests spread from the nasal mucosa or vestibule. Early recognition, computed tomography scanning, surgical drainage and antibiotic therapy are the mainstays of treatment, to prevent potentially life-threatening complications.

Peritonsillar abscess is a localised infection in the peritonsillar space. Pus from the abscess can contain anaerobes. Many clinicians prescribe metronidazole in addition to penicillin, but evidence to support this is limited. This review assessed the evidence of benefit of metronidazole for the treatment of peritonsillar abscess.

A systematic review was conducted of the literature and databases including Ovid Medline, Ovid Embase, PubMed and Cochrane library. Search terms included all variations of peritonsillar abscess, penicillin and metronidazole.

Three randomised, control trials were included. All studies assessed the clinical outcomes after treatment for peritonsillar abscess, including recurrence rate, length of hospital stay and symptom improvement. There was no evidence to suggest additional benefit with metronidazole, with studies suggesting increased side effects.

Evidence does not support the addition of metronidazole in first-line management of peritonsillar abscess. Further trials to establish optimum dose and duration schedules of oral phenoxymethylpenicillin would benefit clinical practice.

To study unusual presentations of coronavirus-associated mucormycosis that are rarely seen in sinonasal mucormycosis cases.

The data of 400 rhino-orbito-cerebral mucormycosis patients admitted to Sawai Man Singh Hospital, Jaipur, from May 2021 to June 2021, were retrospectively collected. The diagnosis of mucormycosis was made by histological examination of biopsy samples.

Out of 400 patients, 62 had symptoms other than common symptoms of rhino-orbito-cerebral mucormycosis. Thirty-four patients had facial palsy, 19 complained of gum ulcers, 6 developed a cheek abscess, 2 complained of maggots in the nose along with common rhino-orbito-cerebral mucormycosis symptoms, and 1 had a cerebellar infarct.

Mucormycosis is a disease with various presentations, and coronavirus-associated mucormycosis has added unusual presentations to the existing list of manifestations of rhino-orbito-cerebral mucormycosis. In this coronavirus disease era, mucormycosis should always be considered as a diagnosis in patients with these unusual presentations.

To provide an update on the microbiology, sensitivity rates and antibiotic prescribing patterns for superficial neck lymph node abscesses at Scotland's largest paediatric tertiary centre. Findings were compared to historical data from our institution.

A retrospective case series was conducted of paediatric patients undergoing incision and drainage of a superficial neck lymph node abscess at the Royal Hospital for Children in Glasgow, from 2018 to 2021.

Thirty-nine abscesses were identified. Methicillin-susceptible Staphylococcus aureus was the commonest micro-organism (28 per cent), followed by Streptococcus pyogenes (13 per cent). Eighty-two per cent of patients were administered a drug regimen containing co-amoxiclav. Only three children required a change in their antibiotics.

There was a significant change in causative micro-organisms, including a decrease in S aureus and an increase in the Streptococcus anginosus group. Empirical use of co-amoxiclav is recommended. In abscesses showing no clinical improvement, second-line options such as clindamycin, cefotaxime and vancomycin should be considered.

A 43-year-old woman presented with a 3-week history of globus sensation and malaise. A computed tomography scan of her neck showed a large right paratracheal abscess secondary to an infected tracheal diverticulum. The patient was admitted under the ENT surgical team, and underwent incision and drainage of the abscess. There were no post-operative complications and she was discharged home after 2 days, on oral antibiotics.

This case demonstrates that a tracheal diverticulum may become infected and present as a cervical abscess. To our knowledge, this is the fourth reported case in the international literature of abscess formation related to an infected tracheal diverticulum.

The long-term clinical and radiological outcomes of patients surgically treated for frontal sinus fracture were assessed.

A retrospective, single-centre analysis was conducted of patients treated for frontal sinus fracture in a tertiary trauma centre between 2000 and 2017. Patients who underwent surgical repair for frontal sinus fracture followed by clinical and radiographical evaluation for at least six months were included.

Of 338 patients admitted with frontal sinus fracture, 77 were treated surgically. Thirty patients met the inclusion criteria for long-term follow-up. The average follow-up duration was 37 months (range, 6–132 months). Reconstruction, obliteration and cranialisation of the frontal sinus fracture were performed in 14, 9 and 7 patients, respectively. Two patients with a reconstructed frontal sinus and one with an obliterated frontal sinus developed mucoceles. One patient developed forehead disfigurement following obliteration.

Long-term complications of frontal sinus repair using the chosen repair techniques are rare, but patients need to be made aware of these potential complications.

This study aimed to classify the pre-auricular sinus before performing radical dissection, so as to achieve optimal aesthetic results.

The recent five-year clinical data of 53 patients with a congenital pre-auricular sinus and infection treated in the hospital were reviewed. According to the sinus course, pre-auricular and post-auricular types were defined, and regional dissection was performed using the modified supra-auricular or post-auricular approach.

All patients achieved primary intention healing of the incision, and were followed up for six months to five years. No recurrence was found, and the incision scar was completely concealed.

Surgical approaches for regional dissection might be adopted based on the different types of pre-auricular sinuses, and further radical dissection might be performed to achieve optimal aesthetic results.

The incidence of deep neck space abscesses, which can result in significant morbidity and mortality, is rising. The aetiology is thought to be dental. However, this study suggests a reduction in tonsillectomies may be associated with the rise.

In a retrospective cohort study, patients were identified by a clinical code within one hospital over 10 years. Evidence of preceding infection source, management, lifestyle risks, comorbidities and demographics were extracted.

Fifty-two patients were included: 23 (44 per cent) had concurrent or recent tonsillitis; 11 (21 per cent) had poor dental hygiene; 22 (42 per cent) were smokers; and 9 (17 per cent) had diabetes. The incidence of deep neck space abscess cases increased from 1 in 2006, to 15 in 2015 (correlation value 0.9; p = 0.00019).

The incidence of deep neck space abscess cases is increasing. Risk factors include tonsillitis, smoking and dental infection. This paper adds to the growing evidence that deep neck space abscesses are increasingly related to tonsillitis, and questions whether the threshold for tonsillectomy has been raised too high.

To assess the diagnostic role of mean platelet volume in tonsillitis with and without peritonsillar abscess.

Mean platelet volume and other laboratory data were retrospectively investigated.

Mean platelet volume was significantly lower in the tonsillitis group (7.8 per cent ± 0.7 per cent) than in the control group (8.7 per cent ± 0.6 per cent; p < 0.0001), and it was significantly lower in the abscess group (7.5 per cent ± 0.6 per cent) than in the no abscess group (8.0 per cent ± 0.7 per cent; p = 0.0277). White blood cell counts and C-reactive protein levels were not significantly different between patients with an abscess and those without. The mean platelet volume cut-off values for the diagnosis of tonsillitis and peritonsillar abscess were 7.95 fl and 7.75 fl, respectively.

Our results suggest that a decreased mean platelet volume is associated with the development and severity of tonsillitis. This finding provides useful diagnostic information for physicians treating patients with tonsillitis.

To describe a newly observed frontal sinus anatomical variant, the fronto-septal rostrum.

Consecutive sinus computed tomography scans performed during 2013 were reviewed. The fronto-septal rostrum was defined as a mucosa-lined air space formed in the attachment of the most upper bony nasal septum and the central floor of the frontal sinuses.

The study included 400 computed tomography scans from 189 women (47.3 per cent) and 211 men (52.8 per cent), with a mean age of 46.8 years. A fronto-septal rostrum was observed in 122 patients (30.5 per cent), with a mean length of 10.63 mm, width of 4.52 mm, height of 2.18 mm and volume of 63.52 mm3. There was no statistically significant difference related to gender (p = 0.343), and no association between the side of the fronto-septal rostrum and age (p = 0.811) or volume (p = 0.203).

The newly described fronto-septal rostrum has possible clinical and surgical implications. It is suggested that this aerated space is used in specific surgical indications and its presence evaluated in cases of septal infection.

Acute mastoiditis remains the commonest intratemporal complication of otitis media in the paediatric population. There has been a lack of consensus regarding the diagnosis and management of acute mastoiditis, resulting in considerable disparity in conservative and surgical management.

To review the current literature, proposing recommendations for the management of paediatric acute mastoiditis and appraising the treatment outcomes.

A systematic review was conducted using PubMed, Web of Science and Cochrane Library databases.

Twenty-one studies were included, with a total of 564 patients. Cure rates of medical treatment, conservative surgery and mastoidectomy were 95.9 per cent, 96.3 per cent and 89.1 per cent, respectively.

Mastoidectomy may be the most definitive treatment available; however, reviewed data suggest that conservative treatment alone has high efficacy as first-line treatment in uncomplicated cases of acute mastoiditis, and conservative therapy may be an appropriate first-line management when treating acute mastoiditis.

Deep neck space abscesses are common head and neck surgery emergencies. Traditionally, surgical incision and drainage has been the main treatment for deep neck abscesses. Recently, it has been suggested that ultrasound-guided drainage of neck abscesses can be an effective and less invasive alternative to incision and drainage.

Patients with deep neck space abscesses referred to the emergency department of Amiralam Hospital were assessed and enrolled to the study if they met the inclusion criteria. Patients were randomly assigned to incision and drainage or ultrasound-guided drainage groups using sealed envelopes.

Sixty patients were evaluated, with 30 patients in each group. There was a significant difference (p < 0.001) in mean length of hospital stay between patients who underwent ultrasound-guided drainage (5.47 days) and those who underwent incision and drainage (9.70 days).

Ultrasound-guided drainage is an effective and safe procedure, leading to shorter hospital stay, and thus may be a suitable alternative to incision and drainage of deep neck abscesses.

In patients with uncomplicated abscesses receiving incision and drainage, does the addition of trimethoprim-sulfamethoxazole result in improved clinical resolution at 7 to 14 days after treatment when compared with placebo?

Talan DA, Mower WR, Krishnadasan A, et al. Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med 2016;374(9):823-32.

The primary objective of this study was to compare the clinical cure rates at 7 to 14 days after the end of the treatment period among patients receiving either trimethoprim-sulfamethoxazole (TMP-SMX) or placebo. Secondary outcomes included composite cure; surgical drainage procedures; change in erythema size; presence of swelling, induration, or tenderness; invasive infections; skin infections at the same site and different sites; hospitalizations; similar infections in household contacts; days missed from normal activities; days missed from school or work; and days of analgesic use.

Infratemporal fossa abscess following odontogenic infection is not rare, and usually occurs as a sequela of dental disease. Infratemporal fossa abscess was previously treated with the combination of buccal incision and temporal incision, or via a transoral approach.

This paper reports a case of infratemporal fossa abscess in a 51-year-old female.

The abscess was drained transnasally via an endoscopic modified medial maxillectomy approach, preserving the inferior turbinate and nasolacrimal duct. The pain remitted the next day and trismus had diminished in one week.

The transnasal approach with endoscopic modified medial maxillectomy is a direct, minimally invasive method that provides a direct field of view for drainage of infratemporal fossa abscess. This approach is recommended for infratemporal fossa abscess.