eMedicine Specialties > Emergency Medicine > Ear, Nose, & Throat

Retropharyngeal Abscess: Follow-up

Author: Joseph H Kahn, MD, Director of Medical Student Education, Associate Professor, Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine
Contributor Information and Disclosures

Updated: Sep 16, 2009

Follow-up

Further Inpatient Care

  • Once the diagnosis of retropharyngeal abscess is established, initiate intravenous antibiotics and admit the patient to the hospital.
  • If any signs of respiratory distress are present, admit the patient to the intensive care unit.
  • Careful monitoring of airway status is essential and may require intensive care unit admission, even in the absence of respiratory distress in the ED.
  • The ENT physician decides whether to incise and drain the abscess in the operating room or whether a trial of medical therapy is indicated first (eg, retropharyngeal cellulitis).
  • An 11-year chart review of 162 pediatric patients with retropharyngeal abscess at St. Louis Children's Hospital revealed that 126 of the patients required surgery initially, and, of the 36 patients treated medically initially, 17 required surgery.3
  • Of 24 pediatric RPAs in children treated at Starship Pediatric Hospital in Auckland, Australia, between 1999 and 2005, 10 (41.7%) required surgery, while 14 (58.3%) did not require surgery.15
  • Incision and drainage of retropharyngeal abscess in the ED may lead to aspiration and generally is not recommended.

Transfer

  • Community hospitals without CT scanning or access to an ENT surgeon may need to transfer patients with suspected or known retropharyngeal abscess.
  • Patients with known or suspected retropharyngeal abscess may need to be intubated before transport, depending on their clinical status.
  • Intravenous antibiotics may be given prior to transfer but should not delay the transfer.

Deterrence/Prevention

  • Good oral hygiene
  • Antibiotic therapy of bacterial oral and pharyngeal infections

Complications

  • Airway obstruction
  • Mediastinitis
  • Pleural involvement
  • Atlantooccipital dislocation
  • Epidural abscess
  • Sepsis
  • Acute respiratory distress syndrome (ARDS)
  • Erosion of the second and third cervical vertebrae
  • Cranial nerve deficits (cranial nerves IX-XII are contained in the cervical fascia)
  • Septic thrombosis of jugular vein or hemorrhage secondary to erosion into carotid artery17
  • Compression of carotid artery and internal jugular vein17
  • Facial nerve palsy

Prognosis

  • Prognosis generally is good if retropharyngeal abscess is identified early, managed aggressively, and complications do not occur.
  • The mortality rate may be as high as 40-50% in patients in whom serious complications develop.

Patient Education

  • Patients should be brought to the ED immediately if they develop the inability to swallow or have difficulty breathing in conjunction with a sore throat.
  • For excellent patient education resources, visit eMedicine's Infections Center. Also, see eMedicine's patient education articles Abscess and Antibiotics.

Miscellaneous

Medicolegal Pitfalls

  • Diagnosis may be overlooked if patients with retropharyngeal abscess are treated for an uncomplicated sore throat and released with or without antibiotics.
  • When patients with retropharyngeal abscess must be sent to the radiology department, emergency airway equipment and staff experienced with its use should accompany the patient.
  • Incising a retropharyngeal abscess in a child in the ED may lead to aspiration.
  • Intubation may be difficult because of swelling of the upper airway. Involve an ENT physician and an anesthesiologist if time permits. If intubating the patient proves difficult, vigorous bagging with high-flow oxygen may help.
  • Patients may need to be intubated before transport, depending on their respiratory status.
 


More on Retropharyngeal Abscess

Overview: Retropharyngeal Abscess
Differential Diagnoses & Workup: Retropharyngeal Abscess
Treatment & Medication: Retropharyngeal Abscess
Follow-up: Retropharyngeal Abscess
Multimedia: Retropharyngeal Abscess
References
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References

  1. Abdel-Haq NM, Harahsheh A, Asmar BL. Retropharyngeal abscess in children: the emerging role of group A beta hemolytic streptococcus. South Med J. Sep 2006;99(9):927-31. [Medline].

  2. Lander L, Lu S, Shah RK. Pediatric retropharyngeal abscesses: a national perspective. Int J Pediatr Otorhinolaryngol. Dec 2008;72(12):1837-43. [Medline].

  3. Page NC, Bauer EM, Lieu JE. Clinical features and treatment of retropharyngeal abscess in children. Otolaryngol Head Neck Surg. Mar 2008;138(3):300-6. [Medline].

  4. Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. Mar-Apr 2003;24(2):111-7. [Medline].

  5. Ridder GJ, Technau-Ihling K, Sander A, Boedeker CC. Spectrum and management of deep neck space infections: an 8-year experience of 234 cases. Otolaryngol Head Neck Surg. Nov 2005;133(5):709-14. [Medline].

  6. Coticchia JM, Getnick GS, Yun RD, Arnold JE. Age-, site-, and time-specific differences in pediatric deep neck abscesses. Arch Otolaryngol Head Neck Surg. Feb 2004;130(2):201-7. [Medline].

  7. Nwaorgu OG, Onakoya PA, Fasunla JA, Ibekwe TS. Retropharyngeal abscess: a clinical experience at the University College Hospital Ibadan. Niger J Med. Oct-Dec 2005;14(4):415-8. [Medline].

  8. Craig FW, Schunk JE. Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. Pediatrics. Jun 2003;111(6 Pt 1):1394-8. [Medline].

  9. Ridder GJ, Technau-Ihling K, Sander A, Boedeker CC. Spectrum and management of deep neck space infections: an 8-year experience of 234 cases. Otolaryngol Head Neck Surg. Nov 2005;133(5):709-14. [Medline].

  10. Kamath MP, Bhojwani KM, Kamath SU, Mahabala C, Agarwal S. Tuberculous retropharyngeal abscess. Ear Nose Throat J. Apr 2007;86(4):236-7. [Medline].

  11. Carinci F, Polito J, Patore A. Pharyngeal actinomycosis: a case report. Gerodontology. June 2007;24:121-123. [Medline].

  12. Fleisch AF, Nolan S, Gerber J, Coffin SE. Methicillin-resistant Staphylococcus aureus as a cause of extensive retropharyngeal abscess in two infants. Pediatr Infect Dis J. Dec 2007;26(12):1161-3. [Medline].

  13. Elliott M, Yong S, Beckenham T. Carotid artery occlusion in association with a retropharyngeal abscess. Int J Pediatr Otorhinolaryngol. Feb 2006;70(2):359-63. [Medline].

  14. Oh JH, Kim Y, Kim CH. Parapharyngeal abscess: comprehensive management protocol. ORL J Otorhinolaryngol Relat Spec. 2007;69(1):37-42. [Medline].

  15. Courtney MJ, Mahadevan M, Miteff A. Management of paediatric retropharyngeal infections: non-surgical versus surgical. ANZ J Surg. Nov 2007;77(11):985-7. [Medline].

  16. Sanford JP, Gilbert DN, Moellering RC Jr. Parapharyngeal space infection. In: The Sanford Guide to Antimicrobial Therapy. 38th ed. 2008.

  17. Elliott M, Yong S, Beckenham T. Carotid artery occlusion in association with a retropharyngeal abscess. Int J Pediatr Otorhinolaryngol. Feb 2006;70(2):359-63. [Medline].

  18. Agada FO, Sharma R, Makura ZG. Atypical presentation of cutaneous tuberculosis and a retropharyngeal neck abscess. Ear Nose Throat J. Jan 2006;85(1):60-2. [Medline].

  19. Bank DE, Krug SE. New approaches to upper airway disease. Emerg Med Clin North Am. May 1995;13(2):473-87. [Medline].

  20. Beasley DJ, Amedee RG. Deep neck space infections. J La State Med Soc. May 1995;147(5):181-4. [Medline].

  21. Daya H, Lo S, Papsin BC, Zachariasova A, Murray H, Pirie J, et al. Retropharyngeal and parapharyngeal infections in children: the Toronto experience. Int J Pediatr Otorhinolaryngol. Jan 2005;69(1):81-6. [Medline].

  22. Fogeltanz KA, Pursel KJ. Retropharyngeal abscess presenting as benign neck pain. Journal of Manipulative & Physiological Therapeutics. February 2006;29:174-8. [Medline].

  23. Gaglani MJ, Edwards MS. Clinical indicators of childhood retropharyngeal abscess. Am J Emerg Med. May 1995;13(3):333-6. [Medline].

  24. Har-El G, Aroesty JH, Shaha A, Lucente FE. Changing trends in deep neck abscess. A retrospective study of 110 patients. Oral Surg Oral Med Oral Pathol. May 1994;77(5):446-50. [Medline].

  25. Hughes J, Martin RJ, Clutterbuck EJ. Retropharyngeal infection with Staphylococcus aureus in a haemodialysis patient. Am J Nephrol. 1993;13(6):435-6. [Medline].

  26. Kelly CP, Isaacman DJ. Group B streptococcal retropharyngeal cellulitis in a young infant: a case report and review of the literature. J Emerg Med. Aug 2002;23(2):179-82. [Medline].

  27. Lazor JB, Cunningham MJ, Eavey RD, Weber AL. Comparison of computed tomography and surgical findings in deep neck infections. Otolaryngol Head Neck Surg. Dec 1994;111(6):746-50. [Medline].

  28. Philpott CM, Selvadurai D, Banerjee AR. Paediatric retropharyngeal abscess. J Laryngol Otol. Dec 2004;118(12):919-26. [Medline].

  29. Pontell J, Har-El G, Lucente FE. Retropharyngeal abscess: clinical review. Ear Nose Throat J. Oct 1995;74(10):701-4. [Medline].

  30. Pynn BR, Sands T, Pharoah MJ. Odontogenic infections: Part one. Anatomy and radiology. Oral Health. May 1995;85(5):7-10, 13-4, 17-8 passim. [Medline].

  31. Sato K, Izumi T, Toshima M, Nagai T, Muroi K, Komatsu N, et al. Retropharyngeal abscess due to methicillin-resistant Staphylococcus aureus in a case of acute myeloid leukemia. Intern Med. Apr 2005;44(4):346-9. [Medline].

  32. Schroeder LL, Knapp JF. Recognition and emergency management of infectious causes of upper airway obstruction in children. Semin Respir Infect. Mar 1995;10(1):21-30. [Medline].

  33. Sethi DS, Stanley RE. Deep neck abscesses--changing trends. J Laryngol Otol. Feb 1994;108(2):138-43. [Medline].

  34. Shefelbine SE, Mancuso AA, Gajewski BJ, Ojiri H, Stringer S, Sedwick JD. Pediatric retropharyngeal lymphadenitis: differentiation from retropharyngeal abscess and treatment implications. Otolaryngol Head Neck Surg. Feb 2007;136(2):182-8. [Medline].

  35. Simsek S, Yigitkanli K, Kazanci A, Belen D, Bavbek M. Medically treated paravertebral Brucella abscess presenting with acute torticollis: case report. Surg Neurol. Feb 2007;67(2):207-10. [Medline].

  36. Takao M, Ido M, Hamaguchi K, Chikusa H, Namikawa S, Kusagawa M. Descending necrotizing mediastinitis secondary to a retropharyngeal abscess. Eur Respir J. Sep 1994;7(9):1716-8. [Medline].

  37. Tannebaum RD. Adult retropharyngeal abscess: a case report and review of the literature. J Emerg Med. Mar-Apr 1996;14(2):147-58. [Medline].

  38. Ungkanont K, Yellon RF, Weissman JL, Casselbrant ML, Gonzalez-Valdepeña H, Bluestone CD. Head and neck space infections in infants and children. Otolaryngol Head Neck Surg. Mar 1995;112(3):375-82. [Medline].

  39. Vural C, Gungor A, Comerci S. Accuracy of computerized tomography in deep neck infections in the pediatric population. Am J Otolaryngol. May-Jun 2003;24(3):143-8. [Medline].

  40. Watanabe M, Ohshika Y, Aoki T, Takagi K, Tanaka S, Ogata T. Empyema and mediastinitis complicating retropharyngeal abscess. Thorax. Nov 1994;49(11):1179-80. [Medline].

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Further Reading

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Keywords

RPA, retropharyngeal space infection, mediastinitis, Staphylococcus aureus, Bacteroides, Veillonella, Haemophilus parainfluenzae, internal jugular vein thrombosis, carotid artery erosion, pericarditis, epidural abscess, deep cervical space infections, sepsis, airway compromise, upper respiratory infection

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Contributor Information and Disclosures

Author

Joseph H Kahn, MD, Director of Medical Student Education, Associate Professor, Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine
Joseph H Kahn, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, Physicians for Social Responsibility, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michael Glick, DMD, Professor and Acting Chair, Department of Diagnostic Sciences, New Jersey Dental School, University of Medicine and Dentistry of New Jersey
Michael Glick, DMD is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark W Fourre, MD, Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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