关键词: 喉脓肿, 甲状软骨, 粪肠球菌, 气管切开术

Abstract: Objective We summarized a case of laryngeal abscess with destruction of the thyroid cartilage caused by enterococcus faecails to improve the understanding of the disease and achieve early diagnosis and appropriate treatment. Methods The clinical data of a patient who had laryngeal abscess with destruction of the thyroid cartilage caused by enterococcus faecails was retrospectively analyzed. Additionally, a summarized systematic review of related literature was included. Results Twenty-one patients with laryngeal abscess were enrolled in the study, including the present case and cases from sixteen relevant literature published in Chinese and English between 1980 and 2022. The mean age at the time of presentation was 51 years(range 19-72 years), and males were more than females(14:7). The main symptoms were hoarseness(12/21), dyspnea /wheezing(8/21), and dysphagia(5/21). The predisposing factors included upper respiratory tract infection(4/21), immunosuppression of various etiologies(3/21), diabetes(2/21), laryngeal surgery(2/21), tuberculosis(1/21), head and neck trauma(1/21), accidental foreign body aspiration(1/21), and radiation injury(1/21). It was complicated by laryngeal carcinoma in five patients. The pus was extracted for bacterial culture to determine the causative pathogen; this yielded pseudomonas aeruginosa(3/21), methicillin-resistant staphylococcus aureus(1/21), nocardia farreri(1/21), mycobacterium tuberculosis(1/21), enterococcus faecalis(1/21), klebsiella pneumoniae, pseudomonas aeruginosa, or enterobacter cloacae mixed infection(1/21). The laryngeal cartilage affected was mainly the thyroid cartilage(4/21); the arytenoid cartilage(2/21)and cricoid cartilage(1/21)were also affected. Treatment methods included abscess drainage(13/21), tracheotomy(10/21), partial laryngectomy(7/21, 2 patients with laryngeal cancer), total(extended)laryngectomy(3/21, all patients with laryngeal cancer), and CO₂ laser surgery(2/21). Conclusion The main risk factor for laryngeal abscess is upper respiratory tract infection. Laryngeal abscess can be complicated by laryngeal cancer. The most common symptom of laryngeal abscess is hoarseness, which may lead to airway obstruction or even different degrees of vocal cord fixation. Therefore, preparedness to perform tracheotomy is necessary at all times. When laryngeal abscess occurs concurrently with laryngeal cartilage destruction, detailed knowledge of the associated symptoms and signs and confirmation with endoscopic and imaging examination are required. The best therapeutic approach can be determined based on the patient's condition, and it is necessary to differentiate the diagnosis from the laryngeal tumor. Surgery should be performed in a timely to completely remove the lesions, clarify the diagnosis, and optimize the final functional outcomes.

Key words: Laryngeal abscess, Thyroid cartilage, Enterococcus faecails, Tracheotomy