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Retropharyngeal abscess is defined as an infection of the space between the posterior pharyngeal wall and the prevertebral fascia. Infections of the nasopharynx (usually pharyngitis) may spread to this space through the lymphatics, and the abscess can obstruct the trachea. Staphylococci and streptococci are the usual pathogens.
I. Clinical Evaluation
A. A history of pharyngitis usually precedes the development of retropharyngeal abscess. Fever is high, swallowing is painful, and there may be a history of refusing to eat. Older patients complain of sore throat.
B. Pressure on the larynx may produce stridor and symptoms of obstruction. Rupture of an abscess into the pharynx can lead to aspiration. Erosion into the carotid artery can occur.
C. Drooling is common, and opisthotonic posture and meningismus may be present. If the airway is obstructed significantly, the patient will have tachypnea and stridor.
D. A bulging posterior pharyngeal wall usually is visualized. Digital palpation of the posterior pharyngeal wall may cause the patient to aspirate if the abscess ruptures.
II. Radiography
A. The normal thickness of the retropharyngeal space on a lateral neck view is equal to that of one vertebral body. However, the area can expand to the width of three vertebral bodies with forceful exhalation, crying, and flexion. Therefore, inspiratory films are required for accuracy.
B. Gas-forming organisms can produce a bubble of air in the space, but this is a late sign. Computed tomography may be helpful.
III. Management
A. Treatment consists of parenteral antibiotics effective against staphylococcal and streptococcal organisms. Intravenous administration of a semisynthetic penicillin (eg, nafcillin) is recommended. A parenteral clindamycin (to treat oral anaerobes, group A streptococcus and other Streptococcus species, and penicillinase-producing Staphylococcus aureus) may also be effective.
B. Usually the abscess should be incised and drained. Caution should be exercised to avoid aspiration of the abscess contents preoperatively.