Retropharyngeal Abscess Follow-up

Updated: Jan 08, 2021
  • Author: Joseph H Kahn, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Follow-up

Further Inpatient Care

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  • Once the diagnosis of retropharyngeal abscess is suspected, consult an ENT, initiate fluid resuscitation (if indicated), initiate intravenous antibiotics, and carefully monitor the airway.

  • If any signs of respiratory distress are present, the patient may require airway management in the OR, with surgeon and anesthesiologist present.

  • 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.

  • Incision and drainage of retropharyngeal abscess in the ED may lead to aspiration and generally is not recommended.

  • 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. [17]

  • 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. [59]

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Transfer

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  • 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.

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Deterrence/Prevention

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  • Good oral hygiene

  • Antibiotic therapy of bacterial oral and pharyngeal infections

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Complications

Complications of retropharyngeal abscess may include the following [62, 63, 64, 65, 4, 7] :

  • Airway obstruction
  • Acute necrotizing mediastinitis - 25% mortality in adults
  • Aspiration pneumonia
  • Sepsis
  • Pleural involvement
  • Atlanto-occipital dislocation
  • Erosion of the second and third cervical vertebrae
  • Cranial nerve deficits - Cranial nerves IX-XII are contained in the cervical fascia
  • Carotid sheath involvement
  • Carotid artery rupture
  • Suppurative jugular thrombophlebitis
  • Compression of carotid artery and internal jugular vein
  • Facial nerve palsy
  • Esophageal perforation
  • Purulent meningoencephalitis
  • Septic embolization
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Prognosis

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  • 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.

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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 patient education information, see Medscape Drugs & Diseases' Infections Center, as well as Skin Abscess and Antibiotics.

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