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Cited by 3Diagnosis and treatment of tuberculosisTuberculosis Research and EpidemiologyLymphadenopathy Diagnosis and Analysis

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The Role of Surgery in the Treatment of Cervical Lymph Node Tuberculosis

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Tahiri, Ilias, Yacoubi, Rim, Elhouari, Othman, Anajar, Said, Loubna, Taali, Hajjij, Amal, Zalagh, Mohammed, Snoussi, Khalid, Essaadi, Mustapha, Benariba, Fouad·2023·Cureus
DOI 10.7759/cureus.38824PMC PMC10251733
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Abstract

Cervical lymph node tuberculosis is a public health problem in Morocco and the rest of the world. Its paucibacillary nature makes diagnosis and treatment difficult. This is a descriptive-analytical retrospective study presenting 104 cases of patients with manifestations of cervical lymph node tuberculosis confirmed by pathological examination (100%), associated in some cases with positive bacteriology (40.6%), treated and followed up in the otolaryngology (ENT) department of the Cheikh Khalifa International University Hospital (HUICK) over a period of 5 years and 9 months (from January 01, 2017, to September 30, 2022). In our study, 14 patients (i.e., 13.5%) had a history of tuberculosis (all locations); only four (i.e., 3.8%) of them had confirmed cervical lymph node tuberculosis, of which three were still under treatment: two of them presented for treatment failure (i.e., 1.9%) and one patient for a paradoxical reaction (i.e., 1%). Three pulmonary locations (i.e., 2.9%) and one mediastinal location (i.e., 1%) were found. Surgery associated with histological study was the key to the diagnosis of tuberculosis in our study. Its procedures were: excisional biopsy for 26 patients (i.e., 25%), adenectomy for 54 patients (i.e., 51.9%), lymph node dissection for 15 patients (i.e., 14.4%), and lymphadenectomy for nine patients (i.e., 8.7%). In some cases, drainage (+/- curettage) was recommended in addition to the surgical procedure in 14 patients (i.e., 13.5%). All our patients benefited from post-surgical anti-bacillary treatment. Lymphorrhea was the only operative complication and it affected two patients (i.e., 1.9%). Meanwhile, the relapse rate was 10.6% (i.e., 11 patients), the treatment failure rate was 3.8% (i.e., four patients), and the paradoxical reaction affected 2.9% (i.e., three patients). The latter had all benefited from a simple biopsy. This indicates that a more extensive surgical procedure gives better results with a better healing rate. In conclusion, anti-bacillary treatment remains the reference treatment for lymph node tuberculosis. However, surgery holds great promise as the first-line treatment in case of fistula or abscess or in the event of failure or if complications occur.

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Crossref · 10.7759/cureus.38824

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Figure 1 Case distribution by age
Figure 1 Case distribution by ageCC BY · PubMed Central
Figure 2 Surgical specimen A : Specimen of single large adenopathy B : Specimen of polyadenopathy Photos from Cheikh Khalifa International University Hospital ENT department.
Figure 2 Surgical specimen A : Specimen of single large adenopathy B : Specimen of polyadenopathy Photos from Cheikh Khalifa International University Hospital ENT department.CC BY · PubMed Central
Figure 3 Types of incisions A: Arciform incision centered on the adenopathy 1: Earlobe 2: Incision 3: Clavicle B: Incision of Paul-Andre 4: Chin 5: Internal jugular vein 6: Sternocleidomastoid muscle Photos from Cheikh Khalifa International University Hospital ENT department
Figure 3 Types of incisions A: Arciform incision centered on the adenopathy 1: Earlobe 2: Incision 3: Clavicle B: Incision of Paul-Andre 4: Chin 5: Internal jugular vein 6: Sternocleidomastoid muscle Photos from Cheikh Khalifa International University Hospital ENT departmentCC BY · PubMed Central
Figure 4 Intra-operative aspect before the drainage of a cold abscess 1: Earlobe 2: Pus Photo from Cheikh Khalifa International University Hospital ENT department
Figure 4 Intra-operative aspect before the drainage of a cold abscess 1: Earlobe 2: Pus Photo from Cheikh Khalifa International University Hospital ENT departmentCC BY · PubMed Central
Figure 5 Jugular chain before and after lymph node removal A: Before lymph node removal B: After lymph node removal 1 : Earlobe 2 : Chin 3 : Adenopathy 4 : Internal jugular vein 5 : Chain of adenopathies 6 : Spinal nerve Photos from Cheikh Khalifa International University Hospital ENT department
Figure 5 Jugular chain before and after lymph node removal A: Before lymph node removal B: After lymph node removal 1 : Earlobe 2 : Chin 3 : Adenopathy 4 : Internal jugular vein 5 : Chain of adenopathies 6 : Spinal nerve Photos from Cheikh Khalifa International University Hospital ENT departmentCC BY · PubMed Central
Figure 6 Incision centered on the adenopathy Photo from Cheikh Khalifa International University Hospital ENT department
Figure 6 Incision centered on the adenopathy Photo from Cheikh Khalifa International University Hospital ENT departmentCC BY · PubMed Central
Figure 7 Polyadenopathy adherent to the spinal nerve 1 : Earlobe 2 : Polyadenopathy 3 : Spinal nerve 4 : Clavicle Photo from Cheikh Khalifa International University Hospital ENT department
Figure 7 Polyadenopathy adherent to the spinal nerve 1 : Earlobe 2 : Polyadenopathy 3 : Spinal nerve 4 : Clavicle Photo from Cheikh Khalifa International University Hospital ENT departmentCC BY · PubMed Central

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Cited by

Metadata

Authors
Tahiri, I., Yacoubi, R., Elhouari, O., Anajar, S., Loubna, T., Hajjij, A., Zalagh, M., Snoussi, K., Essaadi, M., & Benariba, F.
Affiliations
Université Mohammed VI des Sciences et de la Santé (MA)
Corresponding author
Yacoubi, Rim
ORCID
Hajjij, Amal
Venue
Cureus
Publisher
Springer Science and Business Media LLC
Published
2023-05-10
Volume
15
Issue
5
Pages
e38824-e38824
ISSN
2168-8184 (ISSN-L)
DOI
10.7759/cureus.38824
PMC
PMC10251733
OpenAlex
W4380290558
Cited by
3
References
2
Citations by year
2025: 3
FWCI
0.80
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Cureus (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Diagnosis and treatment of tuberculosis
  • Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphadenopathy Diagnosis and Analysis
Keywords
scrofula, paucibacillary tuberculosis, surgical treatment, excisional biopsy, lymph node dissection, lymphatic leakage, paradoxical reaction, relapse, tuberculosis treatment, histopathological diagnosis, treatment failure, fistula, Morocco

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