[10] Retropharyngeal Abscess Flashcards
What is a retropharyngeal abscess?
A neck infection involving abscess formation in the space between the prevertebral fascia and constrictor muscles
What is essential in retropharyngeal abscess?
Early recognition and aggressive management
Why is early recognition and aggressive management important in retropharyngeal abscess?
There is significant morbidity and mortality
What is the retropharyngeal space?
A potential space in the head and neck
What is the anterior border of the retropharyngeal space?
Buccopharnygeal fascia
What is the posterior border of the retropharyngeal space?
Alar fascia
What is contained within the retropharyngeal space?
Retropharyngeal lymph nodes
What is the consequence of the anatomy of the retropharyngeal space?
If an abscess develops it is limited to one side of the midline by the median raphe of the buccophrayngeal fascia
What communicates with the retropharyngeal space?
The parapharnygeal space
What does the retropharyngeal space’s communication with the parapharyngeal space allow?
Spread of infection down behind the oesophagus and into the mediastinum
What usually causes a retropharyngeal abscess to form?
Spread of a bacterial infection from other sites
Bacterial infection in what sites can cause retropharyngeal abscess?
- Nasopharynx
- Tonsils
- Sinuses
- Adenoids
- Molar teeth
- Middle ear
What must a bacterial infection of the retropharyngeal space do to form an abscess?
Suppurate (produce pus)
What are the most common bacterial causes of retropharyngeal abscess?
- Beta haemolytic strep
- Staph aureus
- Haemophilus influenzae
- Anaerobes
What can also cause a retropharnygeal abscess (besides spread of infection)?
Direct infection due to penetrating injury or foreign body
What are the risk factors for retropharyngeal abscess?
- Diabetes mellitus
- Male gender
- Adenotonsillectomy
What are the symptoms of retropharyngeal abscess?
- Severe sore throat
- Dysphagia
- Trismus
What are the potential signs of retropharyngeal abscess?
- Smooth bulge on one side of posterior pharyngeal wall
- Stridor
- Posterior pharyngeal oedema
- Cervical adenopathy
- Drooling
- Fever
- Stiff neck, head tilted to one side
What additional features may be present on history taking and examination of retropharyngeal abscess?
Indication of initial causative infection
What investigations should be conducted when diagnosing retropharyngeal abscess?
- Bloods
- Culture of aspirate during surgical drainage
- Lateral neck x-ray
- CT of neck with IV contrast
What blood results are seen in retropharyngeal abscess?
- Very high WCC
- Very high CRP
What are the potential differentials of retropharyngeal abscess?
- Retropharyngeal cellulitis
- Angio-oedema
- Dental infections
- Epiglottitis
- Pharyngeal pouch
- Mediastinitis
- Peritonsillar abscess
What is the important initial step in managing retropharyngeal abscess?
Maintaining airway
What can be given initially if there is airway compromise in retropharyngeal abscess?
IV corticosteroids and nebulised adrenaline
If IV corticosteroids and nebulised adrenaline fail what should be done in retropharyngeal abscess?
Take to theater for anesthesia, intubation or surgical airway, surgical examination and drainage
How is a retropharyngeal abscess drained?
Transoral incision
What should the patient receive after surgical treatment of retropharyngeal abscess?
Antibiotics to cover common organisms
What antibiotic therapies are usually given in retropharyngeal abscess?
Ampicillin/sulbactam or ceftriaxone and clindamycin
How should antibiotics be initially administered in retropharyngeal abscess?
IV
When can IV antibiotics be switched for oral in retropharyngeal abscess?
Until the patient is afebrile or can complete a 14 day day course orally
How may antibiotic of choice change in treating retropharyngeal abscess?
Based on culture from drainage
What supportive care should be given in retropharyngeal abscess?
- Analgesia
- IV hydration
- Nutrition
If there is no initial airway concern how should retropharyngeal abscess be managed?
Same as for post surgery with additional IV corticosteroids
If initial medical management of retropharyngeal abscess fails in the long term what should be done?
Surgical drainage and post-op care
What are the potential complications of retropharyngeal abscess?
- Airway obstruction
- Mediastinitis
- Pericarditis
- Aspiration pneumonia
- Epidural abscess
- Sepsis
- ARDS
- Erosion of second and third cervical vertebrae
- Cranial nerve palsies
