Shelly Abramowicz and Justine Moe Receive 1st Place Poster Award at AAOMS Meeting

September 2016

Emory oral and maxillofacial surgeon Shelly Abramowicz, DMD, MPH, and senior oral and maxillofacial resident Justine Moe, DDS, MD, were among the first place poster winners at the 98th Annual Meeting of the American Association of Oral and Maxillofacial Surgeons, September 18-23, in Las Vegas. Additional contributors to the poster included Emory faculty members Lindsay Hatzenbuehler, MD, Department of Pediatrics; Roy Rajan, MD, Department of Otolaryngology; and Shelley Caltharp, MD, Department of Pathology.

The poster, "Atypical Mycobacterial Lymphadenitis in the Head and Neck of Pediatric Patients," described a retrospective cohort study of pediatric patients with head and neck nontuberculous mycobacterial lymphadenitis (NML) that presented at Children's Healthcare of Atlanta between May 2014 through February 2016. NML is inflammation and/or enlargement of the lymph nodes in the neck typically caused by bacteria from soil and water environments. The study was significant for contributing new data to the understanding of the epidemiology, diagnosis, and optimal management of NML of the head and neck in children.

The physician team encountered a total of 21 patients (12 males, nine females) with a mean age of 6.57 years. All were healthy and underwent dental procedures between April 2014 and November 2015 at the same Atlanta pediatric dental clinic. The mean time before symptom onset following the procedures was 45.1 days. Over time, the source of the patients' exposure was identified as a single contaminated water source at the clinic; specifically, the lines supplying irrigation for dental drills.

The patients presented with enlargement of the lymph nodes in the neck (90.4%), inflammation of the gums near the teeth (57.1%), expansion of the lower jaw area (14.3%), skin redness or rash (14.3%), and pulmonary nodules (19.0%). Significant laboratory findings on presentation were a normal white blood cell count (88.9%), elevated sedimentation of red blood cells (58.3%), and elevated C-reactive protein (47.4%). Patients underwent one to five admissions with a mean number of 9.0 total inpatient days.

72.7% of the patients underwent lymph node excision, and 27.3% had subtotal lymph node excision. All pathologic specimens showed granulomatous inflammation; 72.7% had acid-fast bacteria, which are resistant to stains and dyes used for imaging and common to NML; and all grew mycobacterium abscessus.

Twelve patients required long-term intravenous dual or triple antibiotic therapy. Complications were noted in 14 patients, including marginal mandibular nerve weakness (33.3%), catheter-associated complications (33.3%), hearing loss (23.8%), exanthematous drug reaction (19%), and neutropenia (9.5%). Fifteen patients had complete resolution of lymphadenitis, and three had partial resolution.

Dr. Abramowicz, Dr. Moe, and their team concluded that surgical treatment of NML of the head and neck with anti-mycobacterial agents is effective, though there is a high risk of complications for each modality.

««return to top