Diagnosis and Management of Children with Mycobacterium Abscessus Infections in the Head and Neck

Publication date: Available online 22 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Justine Moe, Roy Rajan, Shelley Caltharp, Shelly Abramowicz
PurposeControversy exists regarding the most appropriate treatment strategy for children with nontuberculous mycobacterial (NTM) cervical lymphadenitis. Mycobacterium abscessus (MAB) is an uncommon cause of NTM cervical lymphadenitis. The purpose of the present study was to evaluate diagnosis, management and treatment outcomes in children with MAB-associated cervical lymphadenitis resulting from a pulpotomy.Materials and MethodsThis was a retrospective chart review of children with NTM lymphadenitis of the head and neck caused by MAB treated at Children's Healthcare of Atlanta hospitals. The predictor variables were patient demographics, dental history, clinical presentation, imaging characteristics, imaging characteristic, laboratory findings, treatment, histopathology examination, treatment, and complications. The outcome variable was disease resolution or persistence.ResultsA total of 22 patients (mean age 6.5 years) met inclusion criteria. All patients had pulpotomy at one dental practice. The mean time from dental procedure to symptom onset was 43.1 days (range, 3 to 180 days). Children presented with cervical or submandibular swelling, facial swelling, gingival erythema, and/or skin erythema. Radiographic findings were submandibular/cervical lymphadenitis, maxillary/mandibular osteolysis, subcutaneous abscess and/or pulmonary nodules. All children had confirmed or probable MAB infection diagnosed on pathologic specimen. There were two distinct patient presentations that guided surgical management: isolated non-inflammatory cervical lymphadenitis which was partially or completely excised (n=11), and adjacent extension or disseminated infection requiring subtotal lymph node excision, bone debridement, and postoperative antibiotics (n=11). Most children required multiple surgical interventions to remove infected tissues. All achieved clinical resolution.ConclusionIn this cohort, treatment of NTM lymphadenitis caused by MAB depended on extent of disease and virulence of bacteria. When complete surgical excision was possible, disease resolution was achieved. However, in cases with adjacent extension or dissemination infection, postoperative antibiotics were necessary.



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