Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses

Abstract

Deep neck infections (DNIs) include all the infections sited in the potential spaces and fascial planes of the neck within the limits of the deep layer of the cervical fascia. Parapharyngeal and retropharyngeal infections leading to parapharyngeal abscess (PPA) and retropharyngeal abscess (RPA) are the most common. DNIs remain an important health problem, especially in children. The aim of this narrative review is to describe the management of peritonsillar, retropharyngeal and parapharyngeal abscesses in pediatric age. Despite relatively uncommon, pediatric DNIs deserve particular attention as they can have a very severe course and lead to hospitalization, admission to the intensive care unit and, although very rarely, death. They generally follow a mild upper respiratory infection and can initially present with signs and symptoms that could be underestimated. A definite diagnosis can be made using imaging techniques. Pus collection from the site of infection, when possible, is strongly recommended for definition of diseases etiology. Blood tests that measure the inflammatory response of the patient may contribute to monitor disease evolution. The therapeutic approach should be targeted toward the individual patient. Regardless of the surgical treatment, antibiotics are critical for pediatric DNI prognosis. The diagnostic-therapeutic procedure to be followed in the individual patient is not universally shared because it has not been established which is the most valid radiological approach and which are the criteria to be followed for the differentiation of cases to be treated only with antibiotics and those in which surgery is mandatory. Further studies are needed to ensure the best possible care for all children with DNIs, especially in this era of increased antimicrobial resistance.

Management of Deep Neck Space Infections: A Large Tertiary Center Experience

“…For a correct diagnostic approach, a complete head and neck physical examination with a flexible fiberoptic evaluation of the upper airway is required in all patients with potential DNI [15]. Leukocytosis is typically present in these patients due to the infection.…”

Emerging findings for the assessment and treatment of pediatric deep neck abscesses

“…PTAs account for at least 50% of all DNIs within children [2]. This form of infection is most frequently seen in adolescents due to the age-related risk for oral and pharyngeal infection [2,3]. The development of a PTA is relatively uncommon in children less than age 5 but has been documented in several case reports [4,5].…”

“…However, unlike the PTA, the RPA and PPA are most frequently diagnosed in children between the ages of 2 and 4 [7,8]. For the first several years of life, the retropharyngeal space contains lymph nodes that drain the adenoids, sinuses, nose, and pharynx [3]. The predisposition of this age group for upper respiratory infections represents the primary risk factor for the development of an RPA.…”

“…The predisposition of this age group for upper respiratory infections represents the primary risk factor for the development of an RPA. Lymphatic drainage to the retropharyngeal region from a preceding upper respiratory infection may initiate abscess formation from suppuration and perforation of lymph nodes [3].…”

“…Severe infections may involve certain vital structures of the neck and result in airway compromise. Diagnosis of deep neck abscesses can be made clinically, but computed tomography (CT) imaging is often performed to aid in the diagnosis and determine the extent of infection [3]. Historically, treatment of deep neck abscesses has involved surgical drainage.…”