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Open Access Highly Accessed Original research article

Surgical vs ultrasound-guided drainage of deep neck space abscesses: a randomized controlled trial: surgical vs ultrasound drainage

Vincent L Biron, George Kurien, Peter Dziegielewski, Brittany Barber and Hadi Seikaly*

Author Affiliations

Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4.34 WMC, 8440 112 Street, T6G 2B7, Edmonton, Alberta, Canada

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Journal of Otolaryngology - Head and Neck Surgery 2013, 42:18  doi:10.1186/1916-0216-42-18

Published: 26 February 2013

Abstract

Introduction

Deep neck space abscesses (DNAs) are relatively common otolaryngology-head and neck surgery emergencies and can result in significant morbidity with potential mortality. Traditionally, surgical incision and drainage (I&D) with antibiotics has been the mainstay of treatment. Some reports have suggested that ultrasound-guided drainage (USD) is a less invasive and effective alternative in select cases.

Objectives

To compare I&D vs USD of well-defined DNAs, using a randomized controlled clinical trial design. The primary outcome measure was effectiveness (length of hospital stay (LOHS) and safety), and the secondary outcome measure was overall cost to the healthcare system.

Methods

Patients presenting to the University of Alberta Emergency Department with a well-defined deep neck space abscess were recruited in the study. Patients were randomized to surgical or US-guided drainage, placed on intravenous antibiotics and admitted with airway precautions. Following drainage with either intervention, abscess collections were cultured and drains were left in place until discharge.

Results

Seventeen patients were recruited in the study. We found a significant difference in mean LOHS between patients who underwent USD (3.1 days) vs I&D (5.2 days). We identified significant cost savings associated with USD with a 41% cost reduction in comparison to I&D.

Conclusions

USD drainage of deep neck space abscesses in a certain patient population is effective, safe, and results in a significant cost savings to the healthcare system.