Complex nontuberculous mycobacterial cervicofacial lymphadenitis: What is the optimal approach?

Objectives/Hypothesis: Assess the role of combined antimicrobial and surgical therapy for difficult-to-treat nontuberculous mycobacteria ( NTM) lesions of the head and neck in children. Study Design: Retrospective cohort. Methods: Retrospective review of pediatric head and neck NTM lesions at a tertiary children's hospital from 1999 to 2012. Results: Seventy-one children were diagnosed with NTM lesions. Age of presentation ranged between 7 and 204 months of age. Most patients ( 62%) had multiple lesions. Treatments included incision and drainage, curettage, antibiotics, excision, and any combination of surgery and antibiotics. Upon initial presentation, the most common treatment was surgical excision alone ( n=34) with a high complication rate ( 50%). In 18 cases, patients were initially treated with a combination of antibiotics and surgical excision due to the extent or location of the lesion(s). Complication rate in these patients was also high ( 67%). The most common complications in surgically excised NTM lesions included temporary or persistent facial nerve dysfunction ( 24.6%), poor wound healing/ scarring ( 10.8%), and Frey's syndrome ( 6.2%). Conclusions: Surgical excision with or without medical therapy for NTM cervicofacial lymphadenitis in high-risk regions commonly resulted in marginal mandibular nerve dysfunction ( 24.6%). Postoperative facial nerve weakness generally resolved within a year. High rates of complications and a lack of proven best approaches suggest tailoring the approach to address the potential risks in that particular patient based on location and severity.