Retropharyngeal Abscess

Epidemiology


Anatomy

  • Location
    • The retropharyngeal space is sometimes considered a third medial compartment within the parapharyngeal space because these two spaces communicate laterally
    • This space lies between the visceral division of the middle layer of the deep cervical fascia around the pharyngeal constrictors and the alar division of the deep layer of deep cervical fascia posteriorly
    • It extends from the skull base to the tracheal bifurcation around T2 where the visceral and alar divisions fuse
  • Contents: retropharyngeal lymphatics
  • Anatomic Communication
    • Entry
      • Traumatic/Foreign Body Perforation of Posterior Pharyngeal Wall: common in adult cases
      • Traumatic/Foreign Body Perforation of Esophagus: common in adult cases
      • Extension from Parapharyngeal Space Abscess (resulting from infections in nose, adenoids, nasopharynx, and sinuses): respiratory tract infections account for >60% of retropharyngeal abscesses in children
        • Retropharyngeal lymph nodes tend to regress by about age 5 years, making infection in this space much more common in children than adults
    • Exit
      • Extension into paravertebral space

Clinical Manifestations

  • Anterior Displacement of One/Both Sides of Posterior Pharyngeal Wall: due to involvement of lymph nodes, which are distributed lateral to the midline fascial raphe
  • Acute Upper Airway Obstruction (see Obstructive Lung Disease)
    • Acute Respiratory Failure (see Acute Hypoventilation): due to high-grade upper airway obstruction with excessive work of breathing

Treatment


References

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