Cystic Swellings of the Anterior Triangle: Cervical Abscesses

Abstract

The etiology, pathology, clinical picture, diagnosis, and management of pyogenic cervical abscesses, cold abscesses (tuberculous), and suppurative Ludwig’s angina are all discussed in this chapter. A pyogenic cervical abscess may expand and push against the structures of the neck. Symptoms may include neck pain or stiffness, dysphagia, dyspnea, and, potentially, fatal airway obstruction. Culture from pus is recommended, primarily to identify methicillin-resistant Staphylococcus aureus (MRSA). A cold (tuberculous) abscess is caused by Mycobacterium tuberculosis (TB) that does not stimulate acute inflammation. It may occur in any group of cervical lymph nodes (LNs). Symptoms of TB toxemia or other TB lesions may be present. Treatment includes anti-TB drugs, aspiration, percutaneous drainage, and surgical management. Ludwig’s angina is a type of severe cellulitis involving the floor of the mouth. The majority of cases are “odontogenic.” Infection spreads through the connective tissue of the floor of the mouth and is normally caused by infectious and invasive organisms such as Streptococcus, Staphylococcus, and Bacteroides. Early in the infection, the floor of the mouth is raised due to swelling, leading to difficulty in swallowing saliva and hence drooling. As the condition progresses, the airway may be compromised. Prevention is by appropriate dental care, and initial treatment is generally with broad-spectrum antibiotics and corticosteroids. In more advanced cases, endotracheal intubation or tracheostomy to secure the airway may be required.