Acute Retropharyngeal Abscess: Causes, Features, Treatment

Aetiology

It is commonly seen in children below 3 years. It is the
result of suppuration of retropharyngeal lymph nodes
secondary to infection in the adenoids , nasopharynx,
posterior nasal sinuses or nasal cavity. In adults, it may
result from penetrating injury of posterior pharyngeal
wall or cervical oesophagus. Rarely, pus from acute mastoiditis
tracks along the undersurface of petrous bone to
present as retropharyngeal abscess.

Clinical Features
1. Dysphagia and difficulty in breathing are prominent symptoms
as the abscess obstructs the air and food passages.

2. Stridor and croupy cough may be present.
3. Torticollis. The neck becomes stiff and the head is
kept extended.
4. Bulge in posterior pharyngeal wall. Usually seen on
one side of the midline .
Radiograph of soft tissue lateral view of the neck
shows widening of prevertebral shadow and possibly
even the presence of gas.

Treatment
1. Incision and drainage of abscess . This is usually done
without anaesthesia as there is risk of rupture of
abscess during intubation. Child is kept supine with
head low. Mouth is opened with a gag. A vertical
incision IS given in the most fluctuant area of the
abscess. Suction should always be available to prevent
aspiration of pus.
2. Systemic antibiotics . Suitable antibiotics are given.
3. Tracheostomy. A large abscess may cause mechanical
obstruction to the airway or lead to laryngeal oedema.
Tracheostomy becomes mandatory in these cases.