What Is a Retropharyngeal Abscess?

Postpharyngeal abscess is a purulent inflammation of the posterior pharynx, which is divided into acute and chronic types due to different pathogenesis. Acute is common and is caused by suppurary lymph node suppuration. It is more common in children under 3 years old, and more than half of them occur within the age of one year. Chronic patients are rare, and abscesses are mostly formed by cervical tuberculosis, also known as cold abscess. The posterior pharyngeal space is a latent space, starting from the skull base occipital bone, inferior to the posterior mediastinum, bucopharyngeal fascia in the front, and anterior vertebral fascia in the back. The lower part is 3 to 4 planes of the cervical spine and adheres to each other, so abscesses rarely extend into the thorax after the mediastinum; incomplete fascia separates the two sides from the parapharyngeal space, so the infection may spread between the two spaces.

Basic Information

English name: pharyngeal keratosis
Visiting department: ENT
Multiple groups: Children under 3 years

Common locations: Retropharyngeal space
Common symptoms: Upper respiratory tract infection, posterior pharyngeal wall bulge, difficulty swallowing, and poor breathing
Contagious: no

Causes of retropharyngeal abscess

1. Posterior pharyngeal suppurative lymphadenitis: infants have 3 to 8 lymph nodes on each side of the posterior pharyngeal posterior space. Acute upper respiratory infections, acute pharyngitis, tonsillitis, sinusitis, and otitis media can easily cause posterior pharyngeal suppurative lymphadenitis. Formation of an abscess.

2. Foreign body in the pharynx and trauma: Foreign body in the back of the pharynx penetrates, which may cause infection.

3. Ear infections: Temporal petulitis complicated by otitis media can invade the posterior pharyngeal space through the rupture of the skull base and cause infection.

4. Lymph node tuberculosis of the posterior pharyngeal wall or cervical tuberculosis form cold abscess.

Clinical manifestations of retropharyngeal abscess

Most patients with acute type first have upper respiratory tract infection, have an acute onset, have fever, crying, irritability, and refuse to eat due to sore throat. Generally, abscesses can form within 2 to 3 days after the onset of the disease. To the pharyngeal cavity, there are varying degrees of difficulty in swallowing and poor breathing. Infants and young children cry like ducks, sucking milk can be reversed into the nasal cavity or cause choking. Older children can express ambiguity and snoring. In severe cases, there are inspiratory wheezing and inspiratory dyspnea, and cyanosis, dehydration, acidosis, and systemic failure can occur. If the abscess compresses the throat entrance or is complicated by laryngitis, suffocation may occur suddenly.

Chronic forms have systemic manifestations of tuberculosis, with slow onset, long duration, and no sore throat. With the increase of abscesses, a sense of throat obstruction or poor swallowing gradually develops.

Postpharyngeal abscess examination

Physical examination

The child's head is usually prone and leaning to the affected side, saliva overflows, enlarged neck lymph nodes on the affected side, and tenderness. For children with suspected postpharyngeal abscess, be careful when examining the pharynx to prevent abscesses from bursting and causing a large amount of pus to flow into the respiratory tract. Asphyxia has occurred, so a head-down supine position should be used for inspection, and a suction device should be prepared in case.

Examination shows that one side of the posterior pharyngeal wall bulges and the mucosa is congested. When the abscess is large, the affected side of the pharyngeal arch and soft palate is pushed forward. The abscess is soft to touch and fluctuating, but the operation must be gentle. Postpharyngeal abscesses should be carefully and gently when palpated with fingers, and sufficient emergency preparations should be made when puncturing or incision and drainage of pus, such as aspirator, direct laryngoscope, etc., so as to avoid abrupt abruption and pus flowing into the respiratory tract. Choking and even death.

2.X-ray film

The cold abscess caused by cervical spinal tuberculosis can be located in the central part, and there is no obvious congestion in the local mucosa. X-rays of the cervical spine can show the soft tissue shadows in front of the vertebra, and sometimes the liquid level and signs of cervical bone destruction can be seen, and the blood sedimentation rate increases.

Diagnosis of postpharyngeal abscess

According to the history, symptoms, signs, and puncture and abscess, diagnosis of postpharyngeal abscess is not difficult. X-rays of the cervical side can show the posterior pharyngeal wall advancement and the widening of the anterior vertebral soft tissue shadows. .

Postpharyngeal abscess treatment

Surgical treatment

As soon as an acute post-pharyngeal abscess is diagnosed, it should be opened and drained immediately. The patient took a supine position, lowered his head and chest, and raised his head later. Use a direct laryngoscope, anesthesia laryngoscope, or Davis opener to expose the posterior pharyngeal wall. Under direct vision, first puncture and pus, and then use a knife to make a longitudinal incision of about 1.5 cm in length. Drain while flushing the pus cavity with antibiotic solution. Note that the aspirator head is placed near the incision, and the pus flowing out is sucked up at any time. The postoperative dyspnea is often relieved. If the dyspnea does not improve after purulent discharge, tracheotomy is feasible. Tuberculous throat abscess: In addition to systemic anti-pimple treatment, puncture thick pus in the mouth, inject streptomycin, and avoid incision and discharge.

2. Supportive Therapy

Attention should be paid to systemic supportive therapies and the use of sufficient antibiotics to control infection. Large-dose intravenous penicillin is usually used. Laryngeal spasm may occur in children, and even dangerous situations such as breathing and cardiac arrest. First aid preparations must be done in advance in order to successfully carry out rescue; such as preparations for tracheotomy, rescue drugs, oxygen and sputum suction.