THROAT - Retropharyngeal abscess

What is Retropharyngeal abscess?

 It is a condition that occurs due to infection and suppuration of the retropharyngeal lymph nodes in the neck area

Surgical Anatomy : The retropharyngeal space lies behind the pharynx between the buccopharyngeal fascia and prevertebral fascia. It extends from base of skull to the tracheal bifurcation.

Types of retropharyngeal abscess:
1) Acute relropharyngeal abs,cess
2) Chronic retropharyngeal abscess

What is Aetiology of acute retropharyngeal abscess?

1)      Age :Usually in children below 1 year of age
2)      Sex: M > F
3)      Oral  infection or nasopharyngeal infection
4)      Trauma by a sharp foreign body like a fish bone
5)      Rarely pus from acute mastoiditis tracks along the petrous bone
to form retropharyngeal abscess

What is Aetiology of chronic retropharyngeal abscess ?

1)      Tuberculous caries of the cervical spine which is central
2)      Tuberculous infection of the retropharyngeal lymph nodes which
is usually on one side of the midline

What are the clinical features in acute retropharyngeal abscess?

1)      Dysphagia especially in acute cases
2)      Dyspnoea as abscess causes pressure symptoms on the larynx
3)      Torticollis due to spasm of neck muscles
4)      High grade fever
5)      Tender cervical lymphadenitis
6)      Croupy cough
7)      Child has a quacking voice
8)      Abscess presents as a bulge on the posterior pharyngeal wall

What are the clinical features of chronic retropharyngeal abscess?

1)      Dysphagia present but not fever
2)      Neck shows tuberculous lymph nodes
3)      Restricted neck movements
4)      Low grade fever, as seen in tuberculosis

What investigations are required for the diagnosis of retropharyngeal abscess?

1)      Routine blood investigations.
2)      X-ray cervical spine lateral view: It shows increase in the retropharyngeal         space with straightening of the cervical spine.
3)      CT Scan neck with chest shows extent of abscess superiorly
and inferiorly.

Treatment of retropharyngeal abscess

    Antibiotics                                                                 Chronic
Rounded Rectangle: Antibiotics  Nutrition  Tracheostomy if stridor  Incision and drainage  preferably under local  anaesthesia  Rounded Rectangle: Aspiration of abscess  at regular intervals  - Anti-tuberculous drugs  - Incision and drainage  Preferably under local  anaesthesia   

What are complications  of retropharyngeal abscess?

1. Laryngeal oedema
2. Rupture and aspiration of the abscess
3. Mediastinits




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