Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-17T21:29:23.269Z Has data issue: false hasContentIssue false
  • English
  • Français

Life-threating complication of parapharyngeal abscess and mediastinitis in a 10-year-old otherwise healthy girl following elective tonsillectomy – first reported paediatric case

Published online by Cambridge University Press:  21 March 2019

C C Holm-Hansen ,
E Thisted  and
M Kaltoft
C C Holm-Hansen*
Affiliation:
Department of Paediatrics, Zealand University Hospital, Roskilde, Denmark
E Thisted
Affiliation:
Department of Paediatrics, Zealand University Hospital, Roskilde, Denmark
M Kaltoft
Affiliation:
Department of Oto-rhino-laryngology – Head and Neck Surgery, Copenhagen University Hospital, Denmark
*
Author for correspondence: Dr Charlotte Carina Holm-Hansen, Juliane Marie Centre, 2nd Floor, Copenhagen University Hospital, Tagensvej 22, Copenhagen, Denmark E-mail: Charlotte.carina.holm-hansen@regionh.dk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Parapharyngeal abscess and mediastinitis are rare but very severe post-operative complications following an elective tonsillectomy. Parapharyngeal abscess as a complication to tonsilectomy is very seldom described in the literature and no cases in the paediatric population have been described.

Case report

This paper presents, to our knowledge, the first case of life-threatening parapharyngeal abscess and mediastinitis following elective adenotonsillectomy in an otherwise healthy, fully vaccinated 10-year-old girl.

Conclusion

Diagnosing parapharyngeal abscess and mediastinitis can be challenging, but should be suspected and ruled out in cases of post-operative odynophagia, fever, and/or neck swelling and thoracic pain. Diagnosis is made based on magnetic resonance imaging and computed tomography findings. Prompt broad-spectrum intravenous antibiotic treatment and surgical drainage should be initiated. Other severe complications such as meningitis should also be considered.

Keywords

Elective Surgical ProcedureTonsillectomyPostoperative ComplicationsRetropharyngeal AbscessMediastinitisInfectionPediatrics
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 2 , February 2019 , pp. 161 - 163
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr C C Holm-Hansen takes responsibility for the integrity of the content of the paper

References

1Isaacson, G. Pediatric tonsillectomy: an evidence-based approach. Otolaryngol Clin North Am 2014;47:673–90Google Scholar
2Subramanyam, R, Varughese, A, Willging, JP, Sadhasivam, S. Future of pediatric tonsillectomy and perioperative outcomes. Int J Pediatr Otorhinolaryngol 2013;77:194–9Google Scholar
3Glynn, F, Skinner, LJ, Riley, N, Donnelly, M. Parapharyngeal abscess in an insulin dependent diabetic patient following an elective tonsillectomy. J Laryngol Otol 2007;121:e16Google Scholar
4Patel, AA, Madigan, L, Poelstra, KA, Whang, PG, Vaccaro, AR, Harrop, JS. Acute cervical osteomyelitis and prevertebral abscess after routine tonsillectomy. Spine J 2008;8:827–30Google Scholar
5McEwan, JA, Dhingra, J, Rowe-Jones, J, Bleach, NR. Parapharyngeal abscess: a rare complication of elective tonsillectomy. J Laryngol Otol 2007;111:578–9Google Scholar
6Ehlers Klug, T, Rusan, M, Fuursted, K, Ovesen, T. Fusobacterium necrophorum: most prevalent pathogen in peritonsillar abscess in Denmark. Clin Infect Dis 2009;49:1467–72Google Scholar
7Gillot, C, Tombu, S, Crestani, V, Huvelle, P, Moreau, P. Subcutaneous emphysema and mediastinitis: unusual complications of tonsillectomy. B-ENT 2005;1:197–200Google Scholar
8Sørensen, WT, Wagner, N, Aarup, AT, Bonding, P. Beneficial effect of low-dose peritonsillar injection of lidocaine-adrenaline before tonsillectomy. A placebo-controlled clinical trial. Auris Nasus Larynx 2003;30:159–62Google Scholar
9Hollis, LJ, Burton, MJ, Millar, JM. Perioperative local anaesthesia for reducing pain following tonsillectomy. Cochrane Database Syst Rev 2000;(2):CD001874Google Scholar
10Nielsen, TR, Clement, F, Andreassen, UK. Mediastinitis – a rare complication of a peritonsillar abscess. J Laryngol Otol 1996;110:175–6Google Scholar
11Roberts, S, Chan, L, Eisenberg, R. Idiopathic pretracheal deep neck space infection with mediastinal extension: a series of 3 cases and review of the literature. Ear Nose Throat J 2017;96:221–4Google Scholar