Cervicofacial non-tuberculous mycobacterial lymphadenitis: clinical determinants of incomplete surgical removal

Cervicofacial non-tuberculous mycobacterial lymphadenitis: clinical determinants of incomplete surgical removal:



Publication date: Available online 4 May 2020

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): S.H. Willemse, L.H.E. Karssemakers, M.A.E.M. Oomens, W.H. Schreuder, J.A. Lindeboom, A.J. van Wijk, J. de Lange





Author links open overlay panelS.H.Willemse1L.H.E.Karssemakers12M.A.E.M.Oomens12W.H.Schreuder12J.A.Lindeboom13A.J.van Wijk4J.de Lange1

1

Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands

2

Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands

3

Department of Oral and Maxillofacial Surgery, Amstelland Hospital, Amstelveen, The Netherlands

4

Department of Social Dentistry, ACTA, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands

Accepted 31 March 2020, Available online 4 May 2020.



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https://doi.org/10.1016/j.ijom.2020.03.019Get rights and content

Abstract

In patients with non-tuberculous mycobacterial cervicofacial lymphadenitis, incomplete surgical removal of infected lymph nodes leads to delayed healing and a higher recurrence rate, with eventual spontaneous drainage through the skin. However, complete surgical removal is not always achievable due to the extent of the infected tissue and proximity to vulnerable structures, such as the facial or accessory nerve. The aim of this study was to identify the clinical determinants of the (in)ability to perform complete surgical removal. The electronic health records of patients aged 0–15 years with bacteriologically proven non-tuberculous mycobacterial cervicofacial lymphadenitis, who underwent surgical treatment and preoperative sonographic imaging, were analysed. This was a case–control study. A total of 103 patients met the inclusion criteria. Most of the infections were unilateral, submandibular, and caused by Mycobacterium avium. Multiple logistic regression analysis revealed that higher age (odds ratio 1.24, 95% confidence interval 1.04–1.47) and fistulization (odds ratio 3.15, 95% confidence interval 1.13–8.75) were significantly associated with a limited ability to surgically remove all infected tissue. However, a larger sonographic lymph node size was not significantly associated. These findings could aid clinicians when informing the parent(s)/guardian(s) of the patient preoperatively and in properly estimating the intraoperative and postoperative course.



Keywords

non-tuberculousmycobacterialcervicofaciallymphadenitissurgery

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© 2020 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.