A case of a deep-neck abscess caused by tooth extraction in a patient with athetoid-type cerebral palsy

Abstract

A deep-neck abscess can be deadly or lead to life-threatening conditions such as necrotizing descending mediastinitis if not treated with appropriate surgical drainage. We herein report a case of parapharyngeal space abscess caused by tooth extraction successfully treated by surgical drainage. A 39-year-old man with athetoid-type cerebral palsy was referred to our hospital because of a fever and left submandibular swelling after tooth extraction. Because it was difficult to perform enhanced computed tomography (CT) with peripheral intravenous contrast infusion, we used a central venous catheter for contrast infusion with the cooperation of a physician. The CT findings confirmed the diagnosis of a parapharyngeal space abscess, and surgical drainage was carried out under general anesthesia. After the surgery, antimicrobial therapy and saline cleansing were performed. The patient was prone to involuntary movements because of the cerebral palsy, especially when under increased mental strain. Diazepam was used in such situations, after consulting with his physician. We also enlisted the help of speech therapists to recommend diet modifications and physical and occupational therapists to prevent disuse syndrome. This multidisciplinary collaborative approach enabled the patient to recover and leave the hospital relatively quickly.