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A - MSRA ENT [6] > [10] Retropharyngeal Abscess > Flashcards

[10] Retropharyngeal Abscess Flashcards

1
Q

What is a retropharyngeal abscess?

A

A neck infection involving abscess formation in the space between the prevertebral fascia and constrictor muscles

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2
Q

What is essential in retropharyngeal abscess?

A

Early recognition and aggressive management

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3
Q

Why is early recognition and aggressive management important in retropharyngeal abscess?

A

There is significant morbidity and mortality

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4
Q

What is the retropharyngeal space?

A

A potential space in the head and neck

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5
Q

What is the anterior border of the retropharyngeal space?

A

Buccopharnygeal fascia

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6
Q

What is the posterior border of the retropharyngeal space?

A

Alar fascia

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7
Q

What is contained within the retropharyngeal space?

A

Retropharyngeal lymph nodes

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8
Q

What is the consequence of the anatomy of the retropharyngeal space?

A

If an abscess develops it is limited to one side of the midline by the median raphe of the buccophrayngeal fascia

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9
Q

What communicates with the retropharyngeal space?

A

The parapharnygeal space

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10
Q

What does the retropharyngeal space’s communication with the parapharyngeal space allow?

A

Spread of infection down behind the oesophagus and into the mediastinum

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11
Q

What usually causes a retropharyngeal abscess to form?

A

Spread of a bacterial infection from other sites

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12
Q

Bacterial infection in what sites can cause retropharyngeal abscess?

A
  • Nasopharynx
  • Tonsils
  • Sinuses
  • Adenoids
  • Molar teeth
  • Middle ear
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13
Q

What must a bacterial infection of the retropharyngeal space do to form an abscess?

A

Suppurate (produce pus)

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14
Q

What are the most common bacterial causes of retropharyngeal abscess?

A
  • Beta haemolytic strep
  • Staph aureus
  • Haemophilus influenzae
  • Anaerobes
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15
Q

What can also cause a retropharnygeal abscess (besides spread of infection)?

A

Direct infection due to penetrating injury or foreign body

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16
Q

What are the risk factors for retropharyngeal abscess?

A
  • Diabetes mellitus
  • Male gender
  • Adenotonsillectomy
17
Q

What are the symptoms of retropharyngeal abscess?

A
  • Severe sore throat
  • Dysphagia
  • Trismus
18
Q

What are the potential signs of retropharyngeal abscess?

A
  • Smooth bulge on one side of posterior pharyngeal wall
  • Stridor
  • Posterior pharyngeal oedema
  • Cervical adenopathy
  • Drooling
  • Fever
  • Stiff neck, head tilted to one side
19
Q

What additional features may be present on history taking and examination of retropharyngeal abscess?

A

Indication of initial causative infection

20
Q

What investigations should be conducted when diagnosing retropharyngeal abscess?

A
  • Bloods
  • Culture of aspirate during surgical drainage
  • Lateral neck x-ray
  • CT of neck with IV contrast
21
Q

What blood results are seen in retropharyngeal abscess?

A
  • Very high WCC

- Very high CRP

22
Q

What are the potential differentials of retropharyngeal abscess?

A
  • Retropharyngeal cellulitis
  • Angio-oedema
  • Dental infections
  • Epiglottitis
  • Pharyngeal pouch
  • Mediastinitis
  • Peritonsillar abscess
23
Q

What is the important initial step in managing retropharyngeal abscess?

A

Maintaining airway

24
Q

What can be given initially if there is airway compromise in retropharyngeal abscess?

A

IV corticosteroids and nebulised adrenaline

25
Q

If IV corticosteroids and nebulised adrenaline fail what should be done in retropharyngeal abscess?

A

Take to theater for anesthesia, intubation or surgical airway, surgical examination and drainage

26
Q

How is a retropharyngeal abscess drained?

A

Transoral incision

27
Q

What should the patient receive after surgical treatment of retropharyngeal abscess?

A

Antibiotics to cover common organisms

28
Q

What antibiotic therapies are usually given in retropharyngeal abscess?

A

Ampicillin/sulbactam or ceftriaxone and clindamycin

29
Q

How should antibiotics be initially administered in retropharyngeal abscess?

A

IV

30
Q

When can IV antibiotics be switched for oral in retropharyngeal abscess?

A

Until the patient is afebrile or can complete a 14 day day course orally

31
Q

How may antibiotic of choice change in treating retropharyngeal abscess?

A

Based on culture from drainage

32
Q

What supportive care should be given in retropharyngeal abscess?

A
  • Analgesia
  • IV hydration
  • Nutrition
33
Q

If there is no initial airway concern how should retropharyngeal abscess be managed?

A

Same as for post surgery with additional IV corticosteroids

34
Q

If initial medical management of retropharyngeal abscess fails in the long term what should be done?

A

Surgical drainage and post-op care

35
Q

What are the potential complications of retropharyngeal abscess?

A
  • Airway obstruction
  • Mediastinitis
  • Pericarditis
  • Aspiration pneumonia
  • Epidural abscess
  • Sepsis
  • ARDS
  • Erosion of second and third cervical vertebrae
  • Cranial nerve palsies

A - MSRA ENT [6] (22 decks)

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