BEZOLD’S ABSCESS MASQUERADING AS NECK CARBUNCLE

Abstract

 Introduction Bezold’s abscess occurs due to accumulation of pus in digastric sulcus which drains through the medial wall of the mastoid process. Since the advent of antibiotics, incidence and mortality have markedly decreased. We report a case of a late presentation of a large Bezold’s abscess with skin involvement.

 Report A 43-year-old male presented with left otalgia, otorrhoea, and neck swelling for 2 weeks. Examination showed left neck tender erythematous swelling which had multiple puncta. Pus was present in the external ear canal. CECT scan showed intramuscular rim enhancing collection at the left posterolateral aspect of the neck with intra-auricular extension with left mastoid air cells erosion. Intravenous piperacillin-tazobactam and metronidazole was commenced. He underwent left neck saucerization and cortical mastoidectomy. Subsequently about a month later, middle ear exploration and full thickness skin graft was performed to cover the area of skin loss.

 Discussions Antibiotics and early abscess drainage is essential for effective management for Bezold abscess. Surgery can be customised based on the extent of neck abscess. Left neck saucerization and canal wall-up procedure were performed for infection control. The diseased skin was removed. Obtaining intraoperative specimens for microbiological analysis is crucial to identify the causative organism and guide the adjustment of antibiotic therapy. Post-drainage reconstruction with full-thickness skin graft shows the need for continued attention to wound care and healing.

 Conclusions Prompt administration of broad-spectrum antibiotics and surgical drainage are essential to prevent life-threatening complications. Surgery should be tailored according to the severity of the disease.