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Retropharyn geal Abscess
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Page 1: Retropharyngeal Abscess

Retropharyngeal Abscess

Page 2: Retropharyngeal Abscess

Cervical Fascia - Anatomy

Cervical fascia

Superficial Deep

Superficial Deep

Alar layer

Prevertebral layer

Middle

Muscular divisionVisceral division

Page 3: Retropharyngeal Abscess

Retropharyngeal Space

Retropharyngeal space is a deep neck space extending along its entire length situated posterior to the pharynx and the oesophagus and anterior to the alar layer of deep cervical fascia

It extends from the skull base to T4 i.e. the level of bifurcation of the trachea

Synonyms : Posterior visceral space ; space of Gillette; Lincoln’s Highway ; Retroesophageal space

Page 4: Retropharyngeal Abscess

Retropharyngeal Space and other spaces in relation to pharynx

Page 5: Retropharyngeal Abscess

Boundaries and Contents

Anterior : Buccopharyngeal Fascia Posterior : Alar Fascia Lateral : Parapharyngeal Space Medial : A fibrous raphe which divides it into 2 spaces Superior : Base of the skull Inferior : Extends upto the superior mediastinum till

the level of bifurcation of the trachea

Each lateral space contains retropharyngeal lymph nodes which disappear at 3-4 years of age. Also contained in this space is loose areolar tissue and fat.

Page 6: Retropharyngeal Abscess

Spaces related to retropharyngeal space

Prevertebral Space – Between vertebrae on one side and prevertebral muscles and fascia on the other

Parapharyngeal space – Between buccopharyngeal fascia covering lateral aspect of the pharynx medially and fascia covering pterygoid muscles, mandible and parotid gland laterally

Danger space – Between prevertebral fascia and alar fascia

Peritonsillar space – Lateral to the tonsil

Page 7: Retropharyngeal Abscess

Retropharyngeal Abscess

 Retropharyngeal abscess (RPA) is a collection of pus in the tissues in the back of the throat behind the posterior pharyngeal wall (the retropharyngeal space)

Types: Acute Retropharyngeal Abscess Chronic Retropharyngeal Abscess

Page 8: Retropharyngeal Abscess

Acute Retropharyngeal

Abscess

Page 9: Retropharyngeal Abscess

Aetiology

Children Below 3 years of age - Suppuration of retropharyngeal lymph nodes secondary to infection of theAdenoidsNasopharynxPosterior nasal sinusesNasal cavity

Adults - Penetrating injury of posterior pharyngeal wall or cervical oesophagusPus from acute mastoiditis tracks along the undersurface of petrous bone to present as retropharyngeal abscess(rare)

Page 10: Retropharyngeal Abscess

SymptomsDysphagia and difficulty in breathing due to obstruction of the air and food passages

Stridor and croupy cough

Torticollis – stiff neck and extended head

Bulge in the posterior pharyngeal wall – usually seen on one side of the midline

Page 11: Retropharyngeal Abscess

Signs

Systemic Fever Toxic look of the child

Local Paramedian bulge in the posterior pharyngeal wall Grossly inflamed mucosa Dribbling and pooling of saliva Larynx and trachea pushed forwards Trismus is often absent

Page 12: Retropharyngeal Abscess

Differential Diagnosis

Croup- Breathing difficulty and a "barking"

cough

common in infants and children due

to

swelling around the vocal cords

Acute epiglottitis

Peritonsillar Abscess

Eosinophilic granuloma of cervical spine

Page 13: Retropharyngeal Abscess

Investigations

1)Lateral neck radiographs Widening of the prevertebral

shadow Displacement of larynx and

trachea forwards Straightening of cervical

spine due to prevertebral muscle spasm

Air shadow in prevertebral space with or without fluid level

2) CT Scan or MRI

Page 14: Retropharyngeal Abscess

Treatment1) Hospitalisation

2) I.V. fluids and antibiotics

3) Incision and drainage of the abscess Usually done without anaesthesia due to risk of

rupture of abscess during intubation/difficulty due to displaced or inflamed larynx/ posterior pharyngeal bulge/ non compliant patient

Page 15: Retropharyngeal Abscess

Treatment

Child is kept supine with head low. Mouth is opened with a gag

A vertical incision is given in the most fluctuant area of the abscess.

Suction should always be available to prevent aspiration of pus.

4) Tracheostomy – Indicated when a large abscess causes

mechanical obstruction to the airway or leads to laryngeal

oedema leading to stridor

Page 16: Retropharyngeal Abscess

Complications

MeningitisHaemorrhageLaryngeal spasmBronchial erosionSepticaemiaMetastatic abscessJugular vein thrombosis

Rupture with aspiration pneumoniaPericardial tamponadeMediastinitisAcute hemiplegia of childhoodSpread into other spaces

Page 17: Retropharyngeal Abscess

Chronic Retropharyngeal Abscess

Page 18: Retropharyngeal Abscess

Aetiology

Being tubercular in nature, it is a result of

Caries of the cervical spine – presents centrally behind the prevertebral fascia

Tuberculous infection of the retropharyngeal lymph nodes secondary to tuberculosis of deep cervical nodes – limited to one side of the midline as in true retropharyngeal abscess behind the buccopharyngeal fascia

Page 19: Retropharyngeal Abscess

SymptomsDiscomfort in the throat

Dysphagia (though present is not marked)

Fluctuant swelling centrally or on one side of the midline of the posterior pharyngeal wall

Systemic features of tuberculosis may or may not be present

Cervical pain may radiate to the upper limbs with/without neurological deficits

Page 20: Retropharyngeal Abscess

Investigations and Signs

Plain radiograph, CT scan or MRI of cervical spine show

Caries of the spine with collapse of the body of vertebrae

Prevertebral widening may be seen

Median bulge on the posterior pharyngeal wall

Signs of cervical spine or lymph node tuberculosis and neurological radiculopathies may be present

No signs of acute inflammation

Page 21: Retropharyngeal Abscess

TreatmentIncision and drainage of the abscess

It can be done through a vertical incision along the anterior border of sternocleidomastoid (for low abscess) or along its posterior border (for high abscess)

Full course of anti- tubercular therapy to be given

Page 22: Retropharyngeal Abscess

Complications

Pus from various spaces can extend caudally Danger space : extends from base of the skull

to the diaphragm and lies between prevertebral fascia and alar fascia

Prevertebral Space : extends from the base of the skull to the coccyx and lies between vertebrae on one side and prevertebral muscles and fascia on the other

Page 23: Retropharyngeal Abscess

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