title: Surgery for cervicofacial nontuberculous mycobacterial adenitis in children: an update.
abstract: OBJECTIVE
  To assess optimal surgical treatment with excision or curettage techniques in children with cervicofacial nontuberculous mycobacterial (NTM) adenitis.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Tertiary university-based pediatric referral center.
  
  
  METHODS
  Patients younger than 18 years diagnosed as having cervicofacial NTM adenitis by positive mycobacterial cultures or stains, or by histopathologic evaluation.
  
  
  METHODS
  Fine-needle aspiration biopsy for diagnosis, surgical excision and/or curettage of head and neck lesions for treatment.
  
  
  METHODS
  Number of procedures per patient, complications, resolution of mass.
  
  
  RESULTS
  A total of 32 surgical procedures were performed in 25 children with cervicofacial NTM adenitis (mean, 1.3 procedures per patient; range, 1-3): 19 excisional and 13 curettage procedures. The 14 children who had excision as an initial procedure required no additional surgery. Of 11 children who had curettage as an initial procedure, 6 (55%) required additional procedures. Three of these children had additional surgery as planned staged procedures. Excisional surgery after initial curettage (5 patients) was simplified by initial debridement and secondary healing. No complications of curettage were noted. Transient marginal mandibular nerve weakness was seen in 4 patients who had excision. Fourteen of 16 fine-needle aspiration biopsy specimens were diagnostic for NTM adenitis.
  
  
  CONCLUSIONS
  Cervicofacial NTM adenitis can be treated with excision or curettage. Excision remains the treatment of choice because of the high cure rate with a single procedure. We now consider curettage as a staged procedure for lesions in proximity to the facial nerve or with extensive skin necrosis, with initial curettage simplifying subsequent excision and wound closure. Preoperative counseling should include discussion of planned or unplanned revision surgery after curettage. Fine-needle aspiration biopsy allows early diagnosis of NTM adenitis.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Tunkel
mesh_terms: D002648:Child; D002675:Child, Preschool; D003475:Curettage; D005260:Female; D006257:Head; D006801:Humans; D007223:Infant; D008199:Lymphadenitis / Q000382:microbiology / Q000601:surgery*; D009164:Mycobacterium Infections / Q000601:surgery*; D009333:Neck