Publication:

Role of selective neck dissection over anti-TB therapy in retreating patients

Background Tuberculous cervical lymphadenopathy (TCL) remains a significant public health challenge, particularly in developing countries. This study aimed to analyze the demographic characteristics, treatment responses, and management outcomes in patients with TCL, focusing on the effectiveness of standard anti-TB medication and the role of surgical interventions in non-responsive cases.

Methods This retrospective comparative analysis was conducted at the Department of Otolaryngology, Dhaka Medical College Hospital, Bangladesh, from July 2019 to July 2023. The study included 189 patients diagnosed with TCL. Patients were categorized based on their response to standard anti-TB medication over a period of one year and the subsequent management strategies adopted for non-responsive or slow-responsive cases.

Results The study predominantly involved younger individuals (71.43% aged 15-30 years) with a higher representation of females (68.25%). A significant majority (61.38%) reported symptoms for more than one month. After six months of treatment, 33.86% showed a response to medication, increasing to 46.56% after one year. However, 19.58% exhibited slow or no response. Among non-responsive or slow-responsive cases, 18.92% opted for neck dissection, while 59.46% eventually showed a complete response to medication. The incidence of TB relapse was 6.35%, with the majority occurring at the primary infection site.

Conclusions The study underscores the effectiveness of standard anti-TB medication in most TCL cases, with surgery as a secondary option for specific non-responsive or complicated cases. These findings highlight the need for early detection and individualized treatment strategies, emphasizing medical management as the cornerstone of TB treatment, with surgical interventions reserved for select scenarios.