Bezold's Abscess: Difference between revisions
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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 Temporal Bone | |||
* CT Soft Tissue Neck w/ Contrast | |||
== 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. | |||
=== Surgical Management === | === Surgical Management === | ||
Revision as of 23:15, 24 November 2023
Overview
A Bezold's abscess is a complication of mastoiditis where the mastoid infection erodes through the cortical surface of the mastoid bone and forms a secondary abscess pocket near the attachment of the sternocleidomastoid (SCM) muscle.[1]
History
Bezold's abscess is named after Friedrich Bezold, a German otologist that first described it in 1881.[2]
Pathophysiology
Relevant Anatomy
Bezold's abscess is an extension of mastoiditis into the neck space deep to the mastoid attachment of the sternocleidomastoid muscle.
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Transected view of the mastoid bone.
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Inferior view of the mastoid bone.
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Attachment of the sternocleidomastoid muscle to the mastoid bone.
Disease Etiology
[Needs added]
Diagnosis
Patient History
[Needs added]
Physical Examination
Patients can experience the following symptoms:[3]
- 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 should primarily focus on your typical infectious workup:
- CBC
- CRP / ESR
- Blood cultures
- Gram stain and culture of otorrhea (if present)
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 Temporal Bone
- CT Soft Tissue Neck w/ Contrast
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.
Surgical Management
[Needs added]
Outcomes
Complications
[Needs added]
Prognosis
[Needs added]
References
- ↑ Marioni, G., de Filippis, C., Tregnaghi, A., Marchese-Ragona, R., & Staffieri, A. (2001). Bezold's abscess in children: case report and review of the literature. International journal of pediatric otorhinolaryngology, 61(2), 173-177.
- ↑ Bezold, F. (1881). Ein neuer Weg für Ausbreitung eitriger Entzündung aus den Räumen des Mittelohrs auf die Nachbarschaft und die in diesem Falle einzuschlagende Therapie. DMW-Deutsche Medizinische Wochenschrift, 7(28), 381-385.
- ↑ Gaffney, R. J., O'Dwyer, T. P., & Maguire, A. J. (1991). Bezold's abscess. The Journal of Laryngology & Otology, 105(9), 765-766.