Bezold's Abscess - Revision history

Jack.Dewey at 22:20, 10 December 2023

2023-12-10T22:20:33Z

← Older revision		Revision as of 22:20, 10 December 2023
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	Temporal bone imaging will typically reveal complete opacification of the ipsilateral middle ear and mastoid cavity. There will be erosion of the mastoid tip adjacent to the neck abscess, which is typically best visualized in the coronal view. Neck imaging will typically show an abscess extending from the inferior aspect of the mastoid bone near an area of cortical dehiscence. The abscess pocket is typically peripherally enhancing and irregular with loss of definition of fat and fascial planes. <ref>Castillo, M., Albernaz, V. S., Mukherji, S. K., Smith, M. M., & Weissman, J. L. (1998). Imaging of Bezold's abscess. ''AJR. American journal of roentgenology'', 171(6), 1491-1495.</ref>		Temporal bone imaging will typically reveal complete opacification of the ipsilateral middle ear and mastoid cavity. There will be erosion of the mastoid tip adjacent to the neck abscess, which is typically best visualized in the coronal view. Neck imaging will typically show an abscess extending from the inferior aspect of the mastoid bone near an area of cortical dehiscence. The abscess pocket is typically peripherally enhancing and irregular with loss of definition of fat and fascial planes. <ref>Castillo, M., Albernaz, V. S., Mukherji, S. K., Smith, M. M., & Weissman, J. L. (1998). Imaging of Bezold's abscess. ''AJR. American journal of roentgenology'', 171(6), 1491-1495.</ref>

			=== Differential Diagnosis ===
			Differential diagnosis should include other infectious complications of acute mastoiditis:
			* Subperiosteal Abscess
			* [[Citelli_Abscess\|Citelli Abscess]]

	== Management ==		== Management ==

Jack.Dewey: /* Disease Etiology */

2023-12-10T22:07:38Z

Disease Etiology

← Older revision		Revision as of 22:07, 10 December 2023
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	=== Disease Etiology ===		=== Disease Etiology ===
	~~[Needs added]~~		Bezold abscesses present in the setting of a long-standing untreated acute mastoiditis. It is typically more common in adults than younger children due to the degree of pneumatization of the mastoid bone and subsequent cortical thinning. Perforation of the mastoid infection through the digastric groove will result in extension of the infection into a space deep to the attachment of the sternocleidomastoid muscle.<ref>Smouha, E. E., Levenson, M. J., Anand, V. K., & Parisier, S. C. (1989). Modern presentations of Bezold's abscess. ''Archives of Otolaryngology–Head & Neck Surgery'', 115(9), 1126-1129.</ref> This infection can further spread to connecting deep neck spaces.

	== Diagnosis ==		== Diagnosis ==

Jack.Dewey: /* Surgical Management */

2023-11-27T19:07:34Z

Surgical Management

← Older revision		Revision as of 19:07, 27 November 2023
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	=== Surgical Management ===		=== Surgical Management ===
	Bezold's abscess requires surgical drainage. This		Bezold's abscess requires surgical drainage. This ***

	== Outcomes ==		== Outcomes ==
	=== Complications ===		=== Complications ===
	With patients that have Bezold's abscess, all [[~~Acute_Mastoiditis~~#Outcomes#Complications\|complications of mastoiditis]] should be considered. With the addition of the abscess in the neck, the following complications should be considered:		With patients that have Bezold's abscess, all [[Acute Mastoiditis#Outcomes#Complications\|complications of mastoiditis]] should be considered. With the addition of the abscess in the neck, the following complications should be considered:
	* Thrombosis of the internal jugular vein		* Thrombosis of the internal jugular vein

Jack.Dewey at 14:08, 25 November 2023

2023-11-25T14:08:06Z

← Older revision		Revision as of 14:08, 25 November 2023
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	== Outcomes ==		== Outcomes ==
	=== Complications ===		=== Complications ===
	With patients that have Bezold's abscess, all complications of mastoiditis should be considered. With the addition of the abscess in the neck, the following complications should be considered:		With patients that have Bezold's abscess, all [[Acute_Mastoiditis#Outcomes#Complications\|complications of mastoiditis]] should be considered. With the addition of the abscess in the neck, the following complications should be considered:
	* Thrombosis of the internal jugular vein		* Thrombosis of the internal jugular vein

Jack.Dewey at 01:50, 25 November 2023

2023-11-25T01:50:20Z

← Older revision		Revision as of 01:50, 25 November 2023
Line 72:		Line 72:

	=== Surgical Management ===		=== Surgical Management ===
	~~[Needs added]~~		Bezold's abscess requires surgical drainage. This

	== Outcomes ==		== Outcomes ==
	=== Complications ===		=== Complications ===
	~~[Needs added]~~		With patients that have Bezold's abscess, all complications of mastoiditis should be considered. With the addition of the abscess in the neck, the following complications should be considered:
			* Thrombosis of the internal jugular vein

	=== Prognosis ===		=== Prognosis ===

Jack.Dewey at 00:15, 25 November 2023

2023-11-25T00:15:23Z

← Older revision		Revision as of 00:15, 25 November 2023
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	== Diagnosis ==		== Diagnosis ==
	=== Patient History ===		=== Patient History ===
	~~[Needs added]~~		Patients presenting with Bezold's abscess typically have long-standing otologic issues. This can be in the form of untreated acute mastoiditis, chronic mastoiditis, or cholesteatoma. As Bezold's abscesses have become rare in the post-antibiotic world, this diagnosis should be lower on your differential diagnosis among patients that have been receiving antibiotics.

	=== Physical Examination ===		=== Physical Examination ===

Jack.Dewey at 23:52, 24 November 2023

2023-11-24T23:52:26Z

← Older revision		Revision as of 23:52, 24 November 2023
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	=== Imaging ===		=== Imaging ===
	CT scan is the imaging modality of choice. It is important to get imaging early in these patients for identification of the extent of the neck abscess and subsequent surgical planning. The following scans should be considered, based on local ~~scaner~~ and sequencing availability:		CT scan is the imaging modality of choice. It is important to get imaging early in these patients for identification of the extent of the neck abscess and subsequent surgical planning. The following scans should be considered, based on local scanner and sequencing availability:
	* CT Temporal Bone		* CT Temporal Bone
	* CT Soft Tissue Neck w/ Contrast		* CT Soft Tissue Neck w/ Contrast

			Temporal bone imaging will typically reveal complete opacification of the ipsilateral middle ear and mastoid cavity. There will be erosion of the mastoid tip adjacent to the neck abscess, which is typically best visualized in the coronal view. Neck imaging will typically show an abscess extending from the inferior aspect of the mastoid bone near an area of cortical dehiscence. The abscess pocket is typically peripherally enhancing and irregular with loss of definition of fat and fascial planes. <ref>Castillo, M., Albernaz, V. S., Mukherji, S. K., Smith, M. M., & Weissman, J. L. (1998). Imaging of Bezold's abscess. ''AJR. American journal of roentgenology'', 171(6), 1491-1495.</ref>

	== Management ==		== Management ==

Jack.Dewey at 23:18, 24 November 2023

2023-11-24T23:18:02Z

← Older revision		Revision as of 23:18, 24 November 2023
Line 65:		Line 65:
	== Management ==		== Management ==
	=== Medical Management ===		=== Medical Management ===
	Patients with suspected Bezold's abscess should receive broad-spectrum intravenous antibiotics. Antibiotics should not be withheld in order to get accurate cultures in the operating room. Antibiotics are not definitive treatment; these patients require operative debridement of the infection.		Patients with suspected Bezold's abscess should receive broad-spectrum intravenous antibiotics. Antibiotics should not be withheld in order to get accurate cultures in the operating room. Antibiotics are not definitive treatment; these patients require operative debridement of the infection.

			In patients that have active otorrhea or a suspected tympanic membrane perforation, antibiotic drops can be considered with or without otowick placement.

	=== Surgical Management ===		=== Surgical Management ===

Jack.Dewey at 23:15, 24 November 2023

2023-11-24T23:15:52Z

← Older revision		Revision as of 23:15, 24 November 2023
Line 59:		Line 59:

	=== Imaging ===		=== Imaging ===
	~~[Needs added]~~		CT scan is the imaging modality of choice. It is important to get imaging early in these patients for identification of the extent of the neck abscess and subsequent surgical planning. The following scans should be considered, based on local scaner and sequencing availability:
			* CT Temporal Bone
			* CT Soft Tissue Neck w/ Contrast

	== Management ==		== Management ==
	=== Medical Management ===		=== Medical Management ===
	~~[Needs added]~~		Patients with suspected Bezold's abscess should receive broad-spectrum intravenous antibiotics. Antibiotics should not be withheld in order to get accurate cultures in the operating room. Antibiotics are not definitive treatment; these patients require operative debridement of the infection.

	=== Surgical Management ===		=== Surgical Management ===

Jack.Dewey at 22:54, 24 November 2023

2023-11-24T22:54:48Z

← Older revision		Revision as of 22:54, 24 November 2023
Line 23:		Line 23:
	Bezold's abscess is an extension of mastoiditis into the neck space deep to the mastoid attachment of the sternocleidomastoid muscle.		Bezold's abscess is an extension of mastoiditis into the neck space deep to the mastoid attachment of the sternocleidomastoid muscle.
	<gallery>		<gallery>
	Sobo 1909 61.png\|~~Anatomy~~ of the mastoid bone.		Sobo 1909 61.png\|Transected view of the mastoid bone.
	Sternocleidomastoideus.png\|~~Position and attachment~~ of the sternocleidomastoid muscle to the mastoid bone.		Sobo 1909 58.png\|Inferior view of the mastoid bone.
			Sternocleidomastoideus.png\|Attachment of the sternocleidomastoid muscle to the mastoid bone.
	</gallery>		</gallery>

	=== Disease Etiology ===		=== Disease Etiology ===
	~~=== Genetics ===~~		[Needs added]

	== Diagnosis ==		== Diagnosis ==
	=== Patient History ===		=== Patient History ===
			[Needs added]

	=== Physical Examination ===		=== Physical Examination ===
			Patients can experience the following symptoms:<ref>Gaffney, R. J., O'Dwyer, T. P., & Maguire, A. J. (1991). Bezold's abscess. ''The Journal of Laryngology & Otology'', 105(9), 765-766.</ref>
			* Neck pain
			* Neck stiffness
			* Dysphagia
			* Otalgia
			* Otorrhea (in the setting of a perforated tympanic membrane)


			Physical exam can reveal the following findings:
			* Neck swelling
			* Auricular proptosis
			* Mastoid swelling
			* Mastoid tenderness
			* Fever

	=== Laboratory Tests ===		=== Laboratory Tests ===
			Laboratory tests should primarily focus on your typical infectious workup:
			* CBC
			* CRP / ESR
			* Blood cultures
			* Gram stain and culture of otorrhea (if present)

	=== Imaging ===		=== Imaging ===
			[Needs added]

	== Management ==		== Management ==
	=== Medical Management ===		=== Medical Management ===
			[Needs added]

	=== Surgical Management ===		=== Surgical Management ===
			[Needs added]

	== Outcomes ==		== Outcomes ==
	=== Complications ===		=== Complications ===
			[Needs added]

	=== Prognosis ===		=== Prognosis ===
			[Needs added]

	== References ==		== References ==
	<references />		<references />