title: Complex nontuberculous mycobacterial cervicofacial lymphadenitis: What is the optimal approach?
abstract: Assess the role of combined antimicrobial and surgical therapy for difficult-to-treat nontuberculous mycobacteria (NTM) lesions of the head and neck in children.
  
  
  
  Retrospective cohort.
  
  
  
  Retrospective review of pediatric head and neck NTM lesions at a tertiary children's hospital from 1999 to 2012.
  
  
  
  Seventy-one children were diagnosed with NTM lesions. Age of presentation ranged between 7 and 204 months of age. Most patients (62%) had multiple lesions. Treatments included incision and drainage, curettage, antibiotics, excision, and any combination of surgery and antibiotics. Upon initial presentation, the most common treatment was surgical excision alone (n = 34) with a high complication rate (50%). In 18 cases, patients were initially treated with a combination of antibiotics and surgical excision due to the extent or location of the lesion(s). Complication rate in these patients was also high (67%). The most common complications in surgically excised NTM lesions included temporary or persistent facial nerve dysfunction (24.6%), poor wound healing/scarring (10.8%), and Frey's syndrome (6.2%).
  
  
  
  Surgical excision with or without medical therapy for NTM cervicofacial lymphadenitis in high-risk regions commonly resulted in marginal mandibular nerve dysfunction (24.6%). Postoperative facial nerve weakness generally resolved within a year. High rates of complications and a lack of proven best approaches suggest tailoring the approach to address the potential risks in that particular patient based on location and severity.
  
  
  
  4 Laryngoscope, 126:1677-1680, 2016.
authors.affiliation: University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Cristian D
authors.initials: CD
authors.lastname: Gonzalez
authors.affiliation: University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Petersen
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa.
authors.forename: Matthew
authors.initials: M
authors.lastname: Miller
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Albert H
authors.initials: AH
authors.lastname: Park
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005145:Face; D005260:Female; D006801:Humans; D007223:Infant; D008199:Lymphadenitis / Q000382:microbiology* / Q000628:therapy*; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000628:therapy*; D009333:Neck; D012189:Retrospective Studies
keywords: Atypical mycobacteria; lymphadenitis; nontuberculous mycobacteria; pediatrics