Epidemiologic, imaging and clinical issues in Bezold’s abscess: A systematic review.

Bezold’s abscess is a deep neck abscess related to otomastoiditis. Due to the insidious clinical presentation, diagnosis can be extremely challenging, leading to delays in treatment and possi-ble life-threatening complications. The literature currently provides a fragmented picture, rep-resenting only a small number of cases. The present study aims at examining our expe-rience and the literature findings (based on PRISMA criteria) of 97 patients with Bezold’s abscess, summarizing their epidemiology, pathogenesis, clinical presentation, imaging findings, and treatments. Bezold’s abscess is found at any age, with overt male prevalence among adults. The clinical presentation, as well as the causative pathogens, are strikingly heterogeneous. Oto-mastoiditis and cholesteatoma are major risk factors. A clinical history of otitis is commonly reported (43%). CT and MRI are the main diagnostic tools, proving the erosion of the mastoid tip in 53% of patients and the presence of a concomitant cholesteatoma in 40%. Intracranial vascular (24%) or infectious (9%) complications have also been reported. Diagnosis might be easily achieved when imaging (CT) is properly applied. MRI has a limited diagnostic role, but it might be crucial whenever intracranial complications or the coexistence of cholesteatoma are suspect-ed, helping to develop proper treatment (prompt antibiotic therapy and surgery).