Retropharyngeal and parapharyngeal abscess in children—Epidemiology, clinical features and treatment

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Abstract

Objective

To describe the clinical presentation, diagnosis, management and complications of children with retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs).

Methods

A retrospective chart review was conducted at two tertiary care, pediatric hospitals in Israel. The medical records of all children <18 years who had been admitted with a diagnosis of RPA or PPA during an 11-year period (January 1997 to February 2008) were reviewed. Data on demographics, presenting symptoms, physical examination findings, imaging studies and interpretation, laboratory results, hospital course, medical treatment and surgical interventions were retrieved.

Results

A total of 39 children were diagnosed as having RPA (n = 26, 67%) or PPA (n = 13, 33%). There was a predominance of boys (61.5%). The mean age of all the children at diagnosis was 4 years. The annual incidence increased over the 11-year period. The most common symptoms at presentation included fever (n = 27, 70%) and neck pain (n = 24, 62%). The physical examination revealed cervical lymphadenopathy in 30 children (77%), limitation of neck movements in 25 (64%), torticollis in 21 (54%), drooling in three (8%), and stridor in two (5%). Computerized tomographic (CT) scanning with contrast was performed in 37 patients (95%), of whom 17 underwent surgical drainage. Thirteen children were positively diagnosed as having an abscess by the finding of pus at surgery, of whom 12 had been found to have an abscess on their CT scan. All the patients received intravenous antibiotics. There was no significant difference in the duration of hospital stay between those who underwent surgery and those who were treated with antibiotics alone. There were no treatment failures and no complications in either of the two groups.

Conclusion

Children with RPA most commonly present with restricted neck movements, fever and cervical lymphadenopathy, and rarely with respiratory distress or stridor. Many patients with RPA and PPA can be treated successfully without surgery. CT scans are helpful in diagnosing and assessing the extent of the infection, but they are not always accurate.

Introduction

Retropharyngeal abscesses (RPAs) are uncommon complications of upper respiratory infections in children. They result from the spread of the infection to and eventual suppuration of retropharyngeal lymph nodes. Historically, these processes had caused significant morbidity and mortality because of sepsis, mediastinitis, airway obstruction, internal jugular vein thrombosis, and carotid artery aneurysm. Advances in imaging, early detection, and antibiotic treatment have greatly reduced these devastating outcomes, and RPA now seldom lead to long-term consequences [1]. The presentation of RPA is sometimes subtle, and the constellations of findings are varied. Because of their relative infrequency, the variability in presenting symptoms and lack of readily visible physical signs, they present a diagnostic challenge to emergency physicians, pediatricians and otolaryngologists. In addition, the management of these infections is also controversial, especially with regard to the timing of surgical intervention [2].

In this study, our aim was to describe the clinical presentation, the complications, and the contemporary means of diagnosis and management of RPA and PPA in children.

Section snippets

Methods

We conducted a retrospective chart review at two tertiary care pediatric hospitals in Israel, Dana Children's Hospital at the Tel Aviv Medical Center and Safra Children's Hospital at the Sheba Medical Center. The medical records of all patients younger than 18 years of age who had been admitted with a diagnosis of RPA or parapharyngeal abscess (PPA) during a 10-year period (January 1997 to February 2008) were reviewed. Cases of posttraumatic RPA were excluded. All charts were retrieved by one

Results

During the 10-year study period, 39 children were discharged with a diagnosis of RPA (n = 26, 67%) or PPA (n = 13, 33%). There was a predominance of boys who comprised 61.5% of the study population (24 males and 15 females). Most of the 39 children (n = 28, 71%) were younger than 5 years at diagnosis (mean 4 years, range 0.5–15) (Fig. 1). Far more patients presented during the winter months (16 during the winter, 8 during the fall, 9 during the spring and 6 during the summer). The annual incidence of

Discussion

In the current study, infections of the retropharyngeal and parapharyngeal spaces (both abscesses and phlegmons) were more frequent in our younger study children, with 80% occurring in the ones under the age of 5 years. This incidence is similar to the findings in other series [2], [3], [4], [5], [6], [7]. It has been postulated that younger children are more likely to develop infections in this area because of the presence of lymph nodes that run in a paramedian chain in the retropharyngeal

Conflict of interest

None to declare.

Acknowledgment

Esther Eshkol is thanked for editorial assistance.

References (23)

  • J.B. Lazor et al.

    Comparison of CT and surgical findings in deep neck infections

    Otolaryngol. Head Neck Surg.

    (1994)
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      Retropharyngeal abscesses tend to be more frequent in children of young age (<4 years) due to the frequency of upper respiratory infections and the presence of retropharyngeal lymph nodes that involute after 7–8 years of age. Peritonsillar abscesses are more frequent in older children and adolescents [3,12]. None of our patients presented with breathing difficulties.

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