Parapharyngeal abscess in a child mimicking torticollis.Acute torticollis Torticollis Definition Torticollis (cervical dystonia or spasmodic torticollis) is a type of movement disorder in which the muscles controlling the neck cause sustained twisting or frequent jerking. may occur from trauma, neck infections, tumors, or drugs. The combination of a parapharyngeal abscess and torticollis due to spastic contractions of the sternocleidomastoid muscle is an extremely rare condition. It is important to recognize deep neck abscesses in children since rapidly developing compromise in respiratory function is a well-known complication. A 15-year-old presented to another institution with neck pain and headache and was presumptively diagnosed with viral meningitis. He then developed some cervical adenopathy and was placed on amoxicillin-clavulanate for a positive streptococcus test. Two weeks later he had pain to his left neck and torticollis. He had a low grade fever and a sore throat. PMH included asthma. He took amoxillic-clavunalate. Temperature was 37.9[degrees]C, blood pressure 98/56 mm Hg, heart rate 82/min, and respiratory rate 16/min. He had mild trismus trismus /tris·mus/ (triz´mus) motor disturbance of the trigeminal nerve, especially spasm of the masticatory muscles, with difficulty in opening the mouth (lockjaw); a characteristic early symptom of tetanus. and mild pharyngeal erythema. His neck showed right ward torticollis with mild neck swelling below his left angle of the mandible At the junction of the lower border of the ramus of the mandible with the posterior border is the angle of the mandible, which may be either inverted or everted and is marked by rough, oblique ridges on each side, for the attachment of the Masseter laterally, and the Pterygoideus . The were some small anterior cervical lymph nodes Cervical lymph nodes are lymph nodes found in the neck. Anterior cervical nodes The anterior cervical nodes are a group of nodes found on the anterior part of the neck. . WBC count was 13,800/[mm.sup.3] with 89% neutrophils; hemoglobin 14.5 g/dl and platelets 366,000/[mm.sup.3]. His CT scan of the neck revealed a 1.3 by 1.7 cm parapharyngeal abscess. He was hospitalized and started on ceftriaxone and clindamycin and he improved and was discharged in 5 days. Parapharyngeal abscess is a rare occurrence in children. Persistent neck pain, dysphagia, trismus, torticollis, neck mass, and respiratory distress should all lead to the suspicion of a deep neck infection. Infection in the parapharyngeal space can result from an original infection in the tonsils tonsils, name commonly referring to the palatine tonsils, two ovoid masses of lymphoid tissue situated on either side of the throat at the back of the tongue. , pharynx, dentition dentition, kind, number, and arrangement of the teeth of humans and other animals. During the course of evolution, teeth were derived from bony body scales similar to the placoid scales on the skin of modern sharks. , salivary glands, and nasal cavity that spread into the pharyngeal space. The most common organisms include S aureus and Streptococcus. Treatment may include surgical drainage, percutaneous drainage and intravenous antibiotics in children with deep neck infection who remain stable without respiratory compromise. Antonio E. Muniz, MD. Department of Emergency Medicine and Pediatrics, Virginia Commonwealth University Formed by a merger between the Richmond Professional Institute and the Medical College of Virginia in 1968, VCU has a medical school that is home to the nation's oldest organ transplant program. Medical Center, Richmond, VA. |
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