Retropharyngeal abscess:
Definition: Retropharyngeal abscess is a collection of pus between the poserior
pharyngeal wall and the fascia and muscles covering the cervical vertebrae.
Classification: Retropharyngeal abscess can be classified into:
1. Acute retropharyngeal abscess
2. Chronic retropharyngeal abscess
Acute retropharyngeal abscess:Occurs commonly in infants and is more dangerous. It is
common in the age group between 3 months to 3 years.
Etiology: scarlet fever, measles, infections from adenoid / tonsils, infections from
nasopharynx, long standing foreign bodies. Commonest cause is suppurative lymphadenitis
of Henle's retropharyngeal lymph node. This node is situated on either side of midline
between the posterior pharyngeal wall and the aponeurosis over the bodies of C2 and c3.
Chronic retropharyngeal abscess:It is commonly known to occur in adults. This condition
is commonly caused by tuberculosis. The tuberculous foci occurs in the bodies of the
cervical vertebrae (pott's disease), which later spread into the retropharyngeal space.
Primary syphilis of the mouth and pharynx may also cause retropharyngeal abscess. This
abscess usually is present in midline.
Symptoms:
1. Odynophagia (painful swallowing)
2. Drooling
3. Torticollis
4. Straightening of cervical spine
5. Stridor in rare cases
Investigations:
Xray soft tissue neck lateral view:
1. Widening of prevertebral shadow (more than twice the width of corresponding vertebral body)
2. Straightening of cervical spine (ram rod spine)
3. Prevertebral gas shadow above the mass (due to gas formed by pyogens)
CT scan Neck:
Is also helpful in confirming the diagnosis. It also helps to differentiate
potts spine from retropharyneal pyogenic abscess.
Management:
Incision and drainage. In children the child can be held by its feet while
incision and drainage is being performed. This is to prevent aspiration.
Adult patients can be put in tonsillectomy position and incision and drainge
done. This minimizes risk of aspiration. The whole procedure is peformed
without anesthesia to avoid aspiration.
Postoperative antibiotics is a must. The drugs of choice being:
ciprofloxacin and metrogyl. Metrogyl will help in combating anaerobes.
Definition: Retropharyngeal abscess is a collection of pus between the poserior
pharyngeal wall and the fascia and muscles covering the cervical vertebrae.
Classification: Retropharyngeal abscess can be classified into:
1. Acute retropharyngeal abscess
2. Chronic retropharyngeal abscess
Acute retropharyngeal abscess:Occurs commonly in infants and is more dangerous. It is
common in the age group between 3 months to 3 years.
Etiology: scarlet fever, measles, infections from adenoid / tonsils, infections from
nasopharynx, long standing foreign bodies. Commonest cause is suppurative lymphadenitis
of Henle's retropharyngeal lymph node. This node is situated on either side of midline
between the posterior pharyngeal wall and the aponeurosis over the bodies of C2 and c3.
Chronic retropharyngeal abscess:It is commonly known to occur in adults. This condition
is commonly caused by tuberculosis. The tuberculous foci occurs in the bodies of the
cervical vertebrae (pott's disease), which later spread into the retropharyngeal space.
Primary syphilis of the mouth and pharynx may also cause retropharyngeal abscess. This
abscess usually is present in midline.
Symptoms:
1. Odynophagia (painful swallowing)
2. Drooling
3. Torticollis
4. Straightening of cervical spine
5. Stridor in rare cases
Investigations:
Xray soft tissue neck lateral view:
1. Widening of prevertebral shadow (more than twice the width of corresponding vertebral body)
2. Straightening of cervical spine (ram rod spine)
3. Prevertebral gas shadow above the mass (due to gas formed by pyogens)
CT scan Neck:
Is also helpful in confirming the diagnosis. It also helps to differentiate
potts spine from retropharyneal pyogenic abscess.
Management:
Incision and drainage. In children the child can be held by its feet while
incision and drainage is being performed. This is to prevent aspiration.
Adult patients can be put in tonsillectomy position and incision and drainge
done. This minimizes risk of aspiration. The whole procedure is peformed
without anesthesia to avoid aspiration.
Postoperative antibiotics is a must. The drugs of choice being:
ciprofloxacin and metrogyl. Metrogyl will help in combating anaerobes.
Last modified: Sunday, 6 January 2008, 07:59 AM