US-guided percutaneous catheter drainage of parotid abscesses

Ultrasound-Guided Needle Aspiration vs. Surgical Incision of Parotid Abscesses

OBJECTIVE

Standard treatment of parotideal abscesses consists of surgical drainage. This often has to be carried out in general anesthesia and carries the risk of iatrogenic injury of the facial nerve. Ultrasound-guided needle aspiration is an alternative therapy. Up until now a lack of systematic data concerning this subject exists. The study at hand aims to answer the question whether needle aspiration is a viable alternative for surgical drainage.

METHODS

All patients who had been treated surgically (n = 39) or via ultrasound-guided needle aspiration (n = 18) at our clinic were included into this monocentric retrospective analysis.

RESULTS

There was no statistically significant difference (p = 0.142) regarding the mean abscess volume in both groups (5.7 vs. 10.1 mL). Therapy of the abscesses on average required 1.88 (1-5) ultrasound-guided needle aspirations or 1.10 (1-4) surgical interventions. There was a trend to a shorter inpatient treatment period (5.88 vs. 7.33 days) after ultrasound-guided needle aspiration. This trend did not reach statistical significance (p = 0.301). Facial nerve alterations did not occur in any of the patients. Postoperative bleeding did never occur after needle aspirations but in 2% of the patients after surgical abscess revision.

CONCLUSION

Ultrasound-guided needle aspiration is safe and effective in the treatment of parotid abscesses.

Comparison of ultrasound-guided puncture drainage and incision drainage for deep neck abscess

Background

Deep neck space abscess is a common disease in otolaryngology-head, and neck surgery emergencies that result in significant morbidity with potential mortality. Traditional incision drainage with antibiotics is widely accepted worldwide. Recent studies have shown that ultrasound-guided drainage is an effective strategy and is less invasive for patients. The present study aimed to explore the difference between puncture and drainage guided by B-ultrasound and traditional surgical incision in treating deep neck space abscess.

Methods

A total of 60 patients with deep neck abscess were enrolled in the present study; 43 were distributed to the B-ultrasound puncture drainage group and 17 to the incision drainage group. Clinical data were collected, and differences between the 2 treatment options were compared.

Results

There were no differences in patients' systemic illness, age, and clinical features (diameter of an abscess, amount of drainage in first 3 days, and body temperature). The cure rate of both groups was 100%; the number of hospitalization days of the B-ultrasound-guided puncture group (8 days) was significantly less than that of the incision drainage group (10.8 days).

Conclusions

Puncture drainage of neck abscess guided by B-ultrasound is a safe and effective treatment method and can reduce the patient's hospital stay.

Is ultrasonography-guided drainage a safe and effective alternative to incision and drainage for deep neck space abscesses?

Background:

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.

Methods:

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.

Results:

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).

Conclusion:

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.

Interventional radiology neck procedures

Ultrasonography has become extremely useful in the evaluation of masses in the head and neck. It enables us to determine the anatomic location of the masses as well as the characteristics of the tissues that compose them, thus making it possible to orient the differential diagnosis toward inflammatory, neoplastic, congenital, traumatic, or vascular lesions, although it is necessary to use computed tomography or magnetic resonance imaging to determine the complete extension of certain lesions. The growing range of interventional procedures, mostly guided by ultrasonography, now includes biopsies, drainages, infiltrations, sclerosing treatments, and tumor ablation.

High-frequency ultrasound in parotid gland disease

Parotid gland is involved in many inflammatory and neoplastic conditions. Many a times, it is difficult to ascertain the type of swelling by clinical examination. The anatomy and various abnormalities of the glands are very easily visualized by high-frequency ultrasound. Ultrasound can confirm the presence of the mass with sensitivity up to 100%. It can demonstrate whether a lesion is located in the parotid gland or outside. It can help in differentiating benign from malignant neoplasms and local staging of the mass in malignant lesions. In addition, ultrasound can identify those entities that may not need surgical intervention. The glands appear enlarged and show altered echopattern in acute inflammation and may be normal or reduce in size in chronic inflammation. Other pathologies that involve salivary glands are sialolithiasis and various benign and malignant neoplasms. Ultrasound many times suggests final diagnosis or supplies important differential diagnosis. In this article, the use of high-frequency ultrasound in parotid disease is discussed, and sonographic features of different parotid pathologies are reviewed with examples illustrated. High-frequency ultrasound is the first and many a times the only imaging investigation done for evaluation of parotid glands.

Surgical vs ultrasound-guided drainage of deep neck space abscesses: a randomized controlled trial: surgical vs ultrasound drainage

INTRODUCTION

Deep neck space abscesses (DNAs) are relatively common otolaryngology-head and neck surgery emergencies and can result in significant morbidity with potential mortality. Traditionally, surgical incision and drainage (I&D) with antibiotics has been the mainstay of treatment. Some reports have suggested that ultrasound-guided drainage (USD) is a less invasive and effective alternative in select cases.

OBJECTIVES

To compare I&D vs USD of well-defined DNAs, using a randomized controlled clinical trial design. The primary outcome measure was effectiveness (length of hospital stay (LOHS) and safety), and the secondary outcome measure was overall cost to the healthcare system.

METHODS

Patients presenting to the University of Alberta Emergency Department with a well-defined deep neck space abscess were recruited in the study. Patients were randomized to surgical or US-guided drainage, placed on intravenous antibiotics and admitted with airway precautions. Following drainage with either intervention, abscess collections were cultured and drains were left in place until discharge.

RESULTS

Seventeen patients were recruited in the study. We found a significant difference in mean LOHS between patients who underwent USD (3.1 days) vs I&D (5.2 days). We identified significant cost savings associated with USD with a 41% cost reduction in comparison to I&D.

CONCLUSIONS

USD drainage of deep neck space abscesses in a certain patient population is effective, safe, and results in a significant cost savings to the healthcare system.

The precision of four commonly used surgical landmarks for locating the facial nerve in anterograde parotidectomy in humans

In addition to using intra-operative facial nerve monitoring in helping to locate the position of the facial nerve in anterograde parotidectomy, numerous soft tissue and bony landmarks have been proposed to assist the surgeon in the early identification of this nerve. There is still dispute within the literature as to the most effective method, if any, of locating the nerve. The purpose of this study was to measure the distance (in twenty-six embalmed cadavers) from four of the most commonly used surgical landmarks to the main trunk of the facial nerve-the posterior belly of digastric muscle (PBDM), the tragal pointer (TP), the junction between the bony and cartilaginous ear canal (EAM) and the tympanomastoid suture (TMS). The main trunk of the facial nerve was found 5.5+/-2.1mm from the PBDM, 6.9+/-1.8 mm from the TP, 10.9+/-1.7 mm from the EAM and 2.5+/-0.4 mm from the TMS. From this, the TMS can be used as a reliable indicator for locating the main trunk of the facial nerve. In addition, this study also demonstrated a statistically significant difference between the sexes in relation to the two bony landmarks used here, the EAM and the TMS, with the facial nerve found further away from those landmarks in females compared to males. With the advent of 3D construction and reformatting of images, these values may come to the forefront in pre-operative planning for locating the facial nerve in anterograde parotidectomy.

US of the major salivary glands: anatomy and spatial relationships, pathologic conditions, and pitfalls

Ultrasonography (US) is useful for differential diagnosis of diseases of the salivary glands. In acute inflammation, salivary glands are enlarged and hypoechoic with increased blood flow; they may contain multiple small, oval, hypoechoic areas. In chronic inflammation, salivary glands are normal sized or smaller, hypoechoic, and inhomogeneous. Sialolithiasis appears as markedly hyperechoic lines or points with distal acoustic shadowing. Sialosis appears as enlarged hyperechoic glands without focal lesions or increased blood flow. The US features of advanced Sjögren syndrome include inhomogeneous salivary glands with scattered small, oval, hypoechoic or anechoic areas, usually well defined, and increased parenchymal blood flow. Pleomorphic adenomas are usually hypoechoic, well-defined, lobulated lesions with posterior acoustic enhancement that may contain calcifications; Warthin tumors are usually oval, hypoechoic, well-defined lesions that often contain anechoic areas and are often hypervascularized. Malignant neoplasms of the salivary glands may have irregular shapes, irregular borders, blurred margins, and a hypoechoic inhomogeneous structure or may have a benign appearance. Salivary gland cysts have well-defined margins, anechoic contents, posterior acoustic enhancement, and no internal blood flow. However, US appearances of some diseases may overlap, thus producing diagnostic pitfalls.

US-guided catheter drainage of postoperative head and neck fluid collections

PURPOSE

To analyze results of percutaneous catheter drainage of large fluid collections in the head and neck region noted in the immediate postoperative period.

MATERIALS AND METHODS

Thirty-four consecutive patients with 41 large fluid collections in the head and neck detected 7-10 days after oncologic surgery underwent percutaneous catheter drainage. There were 29 men and five women, with a mean age of 52.2 years (95% CI: 47.8-56.7). Each patient had a surgical drain placed in the posterior neck triangle; three patients had low-grade fever and six had diabetes at the time of percutaneous catheter drainage. Conventional management consisting of serial needle aspirations at bedside followed by pressure dressing failed in 15 of 34 patients (44%). Ultrasound-guided drainage was performed and catheters were connected to vacuum balls for continuous suction drainage.

RESULTS

The average fluid volume estimated by sonographic measurement was 84 cm(3) (95% CI: 57-112 cm(3)). The fluid content was serosanguinous in 46% (19 of 41), uncoagulated blood in 32% (13 of 41), pus in 15% (six of 41), and saliva in 7% (three of 41). The mean duration of catheter drainage was nine days (95% CI: 7-10 d) and mean fluid drainage was 287 mL (95% CI: 188-387 mL). Ninety-one percent of patients (31 of 34) were successfully treated with initial catheter drainage. Three patients had recurrent fluid collections at the same locations: two were treated with repeated catheter insertions and one required a limited open drainage. No complication related to catheter drainage was noted at 6-month follow-up.

CONCLUSION

Percutaneous catheter drainage is effective for large fluid collections in the head and neck region noted in the immediate postoperative period irrespective of contents.

US-guided needle aspiration and catheter drainage as an alternative to open surgical drainage for uniloculated neck abscesses

PURPOSE

To prospectively evaluate the effectiveness of ultrasound (US)-guided needle aspiration and catheter drainage as an alternative to open surgical drainage of uniloculated neck abscesses.

MATERIALS AND METHODS

Fifteen consecutive patients (11 female, four male; age range from 18 days to 78 years, mean 42.5 y +/- 22.4) diagnosed with deep neck infections associated with uniloculated neck abscesses were treated. The patients were originally scheduled for surgical incision and drainage after a period of unsuccessful treatment with antibiotics. US-guided needle aspiration (in 10 patients) and US-guided catheter drainage (in five patients) were performed under local anesthesia. Open surgical drainage was performed when US-guided drainage procedures failed.

RESULTS

Surgical open drainage was avoided in 13 of the 15 patients (87%). An average of 6 mL of pus was obtained in patients in the needle aspiration group and 140 mL of pus was drained by catheter. One patient had a recurrent pyogenic lymphadenitis at the same location and was treated successfully by repeated needle aspiration. No complications occurred in this study.

CONCLUSION

In a selected group of patients without imminent airway obstruction, most uniloculated neck abscesses may be managed initially by US-guided needle aspiration and catheter drainage before resorting to open surgical drainage.