Treatment of parapharyngeal abscesses in children

Objective. To develop a strategy for timely diagnosis of deep neck infections in pediatric patients and to ensure adequate conservative and surgical treatment. Materials and methods. During the period from 2020 to 2024, 46 children aged 1 to 17 years with signs of deep neck infection were treated. Results. 6 (13%) patients who were admitted within the first 2 days after the onset of the first symptoms, timely initiation of conservative treatment allowed to reverse the development of the inflammatory process and avoid surgery. 40 (86,9%) patients underwent surgical treatment using intraoral access in 6 (13%) cases and extraoral cervical access in 34 (28,2%). In the postoperative period, 8 (17,4%) children underwent hardware orthodontic treatment due to the development of persistent contracture of the lower jaw. Microbiological examination of the wound discharge in the operated patients revealed Streptococcus pyogenes and Staphylococcus aureus. We used semi-synthetic drugs from the penicillin group with beta-lactamase inhibitors, or an antibiotic resistant to beta-lactamases (cefoxitin, imipenem, meropenem) in combination with an anti-anaerobic drug (metronidazole). Hyperbaric oxygenation was mandatory for everyone. Conclusion. All 46 children were discharged home in satisfactory condition with full recovery of respiratory and chewing function, with recommendations for follow-up by a pediatrician and an otorhinolaryngologist at the polyclinic at their place of residence.