Retropharyngeal

ABSCESS

Chamithra Rupasinghe

RETROPHARYNGEAL SPACE

Superior- Base of the skull

Inferior- Mediastinum (till tracheal bifurcation)
Anterior- Buccopharyngeal fascia
Posterior- Alar fasia
Lateral- Parapharyngeal spaces
Divided into two lateral compartments (space of
Gillette by midline fibrous raphe)

PREVERTEBRAL SPACE

Anterior- Prevertebral fascia

Posterior- Vertebral bodies
Superior- Base of the skull
Inferior- coccyx

RETROPHARYNGEAL ABCESS

Collection of pus in retropharyngeal space

Acute
Classification
Chronic
Common in children 3-5 yrs

Acute
Retropharyngeal
Abscess

ETIOLOGY

Infection in the adenoids , nasopharynx , nasal

sinuses or nasal cavity

Suppuration of retropharyngeal lymph nodes

Penetration injury of posterior pharyngeal wall
Following endoscopic trauma to pharynx
Acute mastoiditis - pus tracking under petrous
bone

SYMPTOMS

History of upper respiratory tract infection

Dysphagia
Difficulty in breathing
Croupy cough
Neck stiffness

SIGNS

Febrile , ill looking , child with drooling

Tender neck swelling & fistula
Torticollis (neck twisted)on side of abscess
followed by hyper extension of neck
U/L bulge on posterior pharyngeal wall

Torticollis

Posterior pharyngeal wall

swelling on left side

NECK SWELLING WITH FISTULA

INVESTIGATIONS

FBC- Very high

CRP- High
Blood culture
Lateral X-ray

CT Scan vessel

Appear hypo dense lesion

Extent of abscess & relation to great

Differentiate b/w abscess & cellulitis

Lateral X-ray view

1.Widened pre-vertebral soft tissue shadow>7mm at C2 vertebra
> 14mm at C6 below 14yrs
> 22mm at C6 above 14yrs
2.Presence of air fluid level
3.Homogenous pre-vertebral shadow (chronic)
4.Straightening of cervical spine curve due to
spasm of pre vertebral muscle

AIR FLUID LEVEL & GAS

SHADOW

TREATMENT
IV antibiotic- Ceftrixone , Metronidazole
Incision & drainage
No anesthesia
Supine with head hanging low from table
Vertical or horizontal incision on fluctuant
area
Incision & suction of pus
Tracheostomy for airway obstruction

MANAGEMENT OF RETROPHARYNGEAL
SPACE INFECTION

Chronic Retropharyngeal
Abscess

ETIOLOGY

Carries of cervical spine

Tubercular infection of retropharyngeal lymph
node from deep cervical nodes
Post traumatic vertebral fracture
Spread from para pharyngeal abscess

CLINICAL FEATURES

Chronic mild dysphagia

Pain absent
Bulge of posterior pharyngeal wall with fluctuant
swelling
Neck show tuberculous lymph node
Investigations:- As in acute retropharyngeal
abscess
Ziehl Neelsen stain of pus after
aspiration

X-RAY SOFT TISSUE OF NECK(LATERAL)

HOMOGENOUS OPACITY

TREATMENT

IV antibiotics- Ceftriaxone & Metronidazole

Incision & drainageLow abscess:- along anterior border of

sternocleidomastoid muscle
High abscess:- along posterior border of
sternocleidomastoid muscle

Anti tubercular therapy for 9-12 months

COMPLICATIONS
1.
2.
3.
4.
5.
6.
7.
8.

Air way obstruction

Spread of abscess to other neck spaces
Spontaneous rupture of abscess
Septicemia
Cranial nerve IX & XII deficit
Mediastinitis
Osteomyelitis
Death