Olgu Sunumu Medial Calcific Sclerosis (Mönckeberg) Case Report

infected regions(9-11) and infection can easily spread
to neighborhood from here(12).
Although most deep neck infections are
polybacterial infections caused by both aerobic and
anaerobic microorganisms, it is not always possible to
document the responsible microorganisms(13) such as
in our patients.
Deep neck infections should be treated either
surgically or nonsurgically just after the correct
diagnosis has been established to prevent the bad
prognosis (14). Nonsurgical treatment should consist of
IV antibiotics that are either empirical, covering grampositive
and gram-negative organisms and aerobic
and anaerobic bacteria, including beta-lactamase
producing organisms, or based on cultures gained from
the abscess tissue (15). Antibiotics can be changed
according to culture and sensitivity results. Initiation
of antibacterial therapy in early stages of the infection
may lead to completely healing of the infection without
surgery in a selected number of clinically stable children
(15,17) like our patients. On the other hand, surgical
drainage for patients who do not improve within 48
hours of initiation of broad-spectrum intravenous
antibiotic should be thought (18,20)
Since culture results in our hospital aren’t satisfactory
in such infections we initiate empiric antibiotic regimens
before culture results are obtained based on the former
culture results and microorganisms resistance patterns.
As a results of this practice we got comparable results
from both antibiotic combinations except (9) patients
who required surgical drainage and one patient with
deep vein thrombosis. The number of the patients
recovered from IDNS without surgical intervention was
higher among our patients than those reported in the
literature(21).
Deep neck infections that are not correctly and
adequately treated, those that extend to other deep
neck spaces, and those that are complicated by a
delay in diagnosis and treatment are at particular risk
of complications (14). The total complication rate
due to deep neck infections in children is about 10%
and the most common complications are recurrence,
thrombosis of the main of jugular vein, rupture of
carotid artery, mediastinitis from inferior spread along
fascial lines, and suppurative thyroiditis (1,22). As a
severe complication, we reported deep vein thrombosis
only in one of our patients.
In conclusion; Deep neck infections of early
childhood may be treated substantially only with
antibiotics when the diagnosis is made and treatment is
initiated early. In case of the responsible microorganisms
can’t be determined, both of ampicillin plus sulbactam
and cephazoline plus clindamycin seem to be equally
effective.
Maltepe Tıp Dergisi/ Maltepe Medical Journal
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