title: Non-tuberculous mycobacterial head and neck infections in children: Analysis of results and complications for various treatment modalities.
abstract: OBJECTIVE
  Analyze the results and complications of various surgical interventions in a large cohort of children with non-tuberculous mycobacterial (NTM) head and neck infections and suggest a heuristic treatment protocol for managing this condition while aiming to maximize cure and minimize complications.
  
  
  METHODS
  Retrospective chart review of 104 consecutive patients diagnosed with head and neck NTM at a tertiary paediatric hospital between January 1994 and December 2013 inclusive.
  
  
  RESULTS
  104 patients ranged in age between 8 months to 15 years (mean age 27 months) were reviewed and 97 patients were included in the final analysis. 6 patients excluded due to lack of follow-up and one excluded due to systemic immunocompromised condition. Sub-sites of NTM infections were submandibular (n=48, 46%), cervical (n=40, 38%), parotid (n=18, 17%) and submental (n=4, 4%). Some patients had more than one lesion so counted twice. Higher cure rates were demonstrated for primary excision (81%, p<0.01) versus incisional interventions (44%, p<0.01). Marginal mandibular nerve palsy following surgery was seen in 7 patients (7.2%). This was permanent in 4 patients (4%) and temporary in 3 patients (3%). All children who were complicated with marginal mandibular palsies had lesions in the submandibular region. The rate of palsy for submandibular disease alone was 15%, while 8% presented permanent palsy and 6% temporary. Marginal mandibular nerve palsy was more likely following excisional compared to incisional procedures (6 versus 1 patient, p<0.01). Hypertrophic scarring occurred in 7 patients: 3 patients following excision and 4 patients after an incisional procedure. One patient suffered long term spinal accessory nerve damage presented as winged scapula.
  
  
  CONCLUSIONS
  Excision of NTM provides better cure rates compared to incision although at the expense of long term post-surgical morbidity. Excision should probably be the first line of treatment when the risk for neural damage is low. Incision and drainage with or without antimycobacterial treatment may be the preferred option for at-risk sub-sites (submandibular or parotid) in order to reduce long term morbidity.
authors: Department of Paediatric Otolaryngology, Head and Neck Surgery, Starship Children's Hospital, Private bag 9204, Auckland 1142, New Zealand. Electronic address: MuraliM@adhb.govt.nz.
authors: M
authors: M
authors: Mahadevan
authors: Department of Paediatric Otolaryngology, Head and Neck Surgery, Starship Children's Hospital, Private bag 9204, Auckland 1142, New Zealand.
authors: M
authors: M
authors: Neeff
authors: Department of Paediatric Otolaryngology, Head and Neck Surgery, Starship Children's Hospital, Private bag 9204, Auckland 1142, New Zealand.
authors: G
authors: G
authors: Van Der Meer
authors: Department of Paediatric Otolaryngology, Head and Neck Surgery, Starship Children's Hospital, Private bag 9204, Auckland 1142, New Zealand.
authors: C
authors: C
authors: Baguley
authors: Department of Paediatric Otolaryngology, Head and Neck Surgery, Starship Children's Hospital, Private bag 9204, Auckland 1142, New Zealand.
authors: W K
authors: WK
authors: Wong
authors: Department of Paediatric Otolaryngology, Head and Neck Surgery, Starship Children's Hospital, Private bag 9204, Auckland 1142, New Zealand.
authors: M
authors: M
authors: Gruber
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003389:Cranial Nerve Diseases / Q000209:etiology; D003475:Curettage; D004322:Drainage; D005260:Female; D006801:Humans; D007223:Infant; D008199:Lymphadenitis / Q000382:microbiology / Q000628:therapy*; D008297:Male; D008340:Mandibular Nerve; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000628:therapy*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012466:Salivary Gland Diseases / Q000382:microbiology / Q000628:therapy*; D018461:Soft Tissue Infections / Q000382:microbiology / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Child; Lymphadenitis; Non-tuberculous mycobacteria; Treatment