Stergios Doumas

Background: Deep neck infections represent a common but heterogeneous medical condition, as clinical manifestations and outcomes vary, depending, among others, on the infection site. The pharyngeal mucosal space (PMS) represents the most superficial neck space, confined between the pharyngeal mucosa and the pharyngeal constrictor muscles. The collection of pus in the PMS (pharyngeal mucosal abscess (PMA)) is considered rare and is rarely reported in the literature. This study focuses on infections of the pharyngeal mucosal space, aiming to provide an elaborate description of the clinical behavior of this category and reporting its differences from other categories of deep neck infections (DNIs). Methods: A retrospective study of 743 cases of deep neck infections was conducted in a single tertiary center. Cases of abscesses, confined in the pharyngomucosal space (PMAs), were studied, reporting demographics, clinical features, imaging, bacteriology, and treatment data, and comparisons with other DNIs were made. Results: A total of 106 cases of pharyngomucosal space abscesses (PMAs) were reported, representing 14.3% of deep neck infections (DNIs). Dysphagia, odynophagia, and fever were the most common symptoms. Hospitalization with non-surgical drainage was the treatment of choice, resulting in complete recovery with no complications. Conclusions: In conclusion, the frequency of PMAs in our series suggests that they may not be as rare as they are considered to be. Symptoms and clinical findings can be similar to those of other DNIs, especially parapharyngeal abscesses, but, overall, PMAs seem to have a milder clinical behavior, highlighting the need for diagnosis and reporting as a separate, recognizable category.

Many studies have evaluated the clinical implications of lymph node ratio (LNR) as a prognostic factor in patients with oral squamous cell carcinoma (OSCC). The main purpose of this systematic review and meta-analysis was to address LNR as a prognosticator in patients with OSCC. A systematic search was conducted in the following databases: PubMed, EMBASE, Google Scholar, OpenGrey, Cochrane library, and ClinicalTrials.gov, and studies between 2009 and 2020 were sought. The pooled relative risk was calculated along with 95% confidence intervals for the following endpoints: overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), distant metastasis-free survival (DMFS), locoregional disease-free survival (LRDFS), local recurrence-free survival (LRFS), and recurrence-free survival (RFS) according to the random-effects model (Der Simonian–Laird approach). Subgroup and meta-regression analyses were performed as well. Finally, 32 cohort studies were eligible, which included 20,994 patients with OSCC. Patients were subdivided into two categories, group YES (studies that included in their analysis only patients with positive lymph nodes) and group NO (studies that did not exclude LNR = 0 patients). In the group YES, patients with high LNR had shorter OS (RR = 1.68, 95% CI: 1.47–1.91), DFS (RR = 1.68, 95% CI: 1.42–1.99), DSS (RR = 1.94, 95% CI: 1.56–2.42), DMFS (RR = 1.83, 95% CI: 1.13–2.96), LRDFS (RR = 1.55, 95% CI: 1.10–2.20), and LRFS (RR = 1.73, 95% CI: 1.41–2.13) compared to patients with low LNR. In the group NO, patients with high LNR in comparison had shorter OS (RR = 2.38, 95% CI: 1.99–2.85), DFS (RR = 2.04, 95% CI: 1.48–2.81), and DSS (RR = 2.90, 95% CI: 2.35–3.57) compared to patients with low LNR. Based on those findings, LNR might be an independent prognostic factor for OS in patients with OSCC and could be incorporated into future classification systems for better risk stratification.

Keypoints: • The presence of a pharyngeal mucosal space abscesses (PMA), being confined between the pharyngeal mucosa and the pharyngeal constrictor muscle, is considered rare. However, in our series represented 14,3% of deep neck infections (DNIs), suggesting that they may not be so rare as they are considered to be. • PMAs’ symptoms and clinical findings are similar to those of other DNIs, but trismus and neck swelling seem to be significant lower in PMAs. • Imaging studies will set PMA diagnosis, while CT with contrast is the modality of choice. • PMAs seems to be less dangerous than their deep-seated counterparts, since its superficial location renders them amenable to spontaneous drainage, aspiration, incision and drainage intraorally obviating spread to deeper structures.