Retropharyngeal Abscess

Excerpt

Retropharyngeal abscesses are rare but potentially life-threatening infections that primarily affect children of age 5 and younger and, occasionally, adults. Retropharyngeal abscesses are pus-filled collections within the retropharyngeal space, located between the buccopharyngeal fascia anteriorly and the alar fascia posteriorly. In younger pediatric patients, antecedent upper respiratory tract infections (URIs) commonly lead to suppurative cervical lymphadenitis and retropharyngeal abscesses. Conversely, in older children and adults, retropharyngeal abscesses can be triggered by trauma to the posterior pharynx, leading to the inoculation of the retropharyngeal space and subsequent abscess formation. Although a viral URI typically precedes abscess formation, retropharyngeal infections may also arise from oropharyngeal trauma or dental disease.

Primary infections of tonsils and teeth can potentially progress to retropharyngeal abscesses, although they more commonly lead to peritonsillar abscess (quinsy) or parapharyngeal abscess, respectively. Direct expansion from spinal discitis or osteomyelitis is a rare cause of retropharyngeal abscess and can be considered a complication. As a retropharyngeal abscess enlarges, it can result in upper airway obstruction and potentially lead to asphyxiation.

Untreated retropharyngeal abscesses can result in upper airway obstruction and respiratory distress. Treatment of retropharyngeal abscesses involves the administration of prolonged courses of broad-spectrum intravenous (IV) antibiotics, with or without surgical incision and drainage. Patients diagnosed with retropharyngeal infection may also necessitate hospital admission and consultation with otolaryngology. Following infection resolution, some patients may require extended hospitalization, tracheostomy, and/or nasogastric tube feeding due to prolonged inflammation in the upper aerodigestive tract.