Epidemiology a person of any age can develop a parapharyngea. Retropharyngeal abscess treatment algorithm bmj best. Anatomical complexity and etiology med j malaysia vol 62 no 5 december 2007 415 medial displacement of the lateral pharyngeal wall and tonsil is a hallmark of a parapharyngeal space infection. If the airway is not an immediate concern, initial treatment should be with empirical intravenous antibiotics. Peritonsillar abscess and tonsillitis may result in parapharyngeal abscess. Bezolds abcess presenting as parapharyngeal abcessc. Trismus, drooling, dysphagia, and odynophagia also are. Parapharyngeal abscesses are deep neck abscesses involving the parapharyngeal space. We believe that early diagnosis, broadspectrum antibiotics, surgery and pus drainage can. Children parapharyngeal abscess may cause lifethreatening complications. Print pdf need for drainagesource control of head and neck infections should be evaluated carefully in consultation with pediatric otolaryngology, head and neck surgery.
Resolution of hypoglossal nerve palsy associated with retropharyngeal abscess after prompt medical and surgical treatment. A retropharyngeal abscess is a bacterial infection that produces a pusfilled sore in the back of the throat. Treatment is directed at drainage of the sepsis via. Classic retropharyngeal abscess in children tends to spread from infected lymph nodes following upper respiratory tract infection such as pharyngitis, tonsillitis, sinusitis, cervical lymphadenitis or dental infections. It has clinical importance in otolaryngology due to parapharyngeal space tumours and parapharyngeal abscess developing. Parapharyngeal abscess ear, nose, and throat disorders merck. To study the circumstances of diagnosis, predisposing factors, bacteriology and therapeutic management of parapharyngeal abscesses. The parapharyngeal pharyngomaxillary space is lateral to the superior pharyngeal. Parapharyngeal abscess radiology reference article. An abscess in the parapharyngeal space may arise from direct extension of infection from the pharynx through the pharyngeal wall, as a consequence of odontogenic infection, local trauma, and occasionally peritonsillar abscess. Potential threat to airway should always be considered.
Reactive changes in the parapharyngeal and masticator spaces are also noted arrowhead, suggesting that an abscess was more likely. Management of the deep neck infection is governed by the general condition of the patient, the extent of disease and. Parapharyngeal space an overview sciencedirect topics. Get my notes in pdf files that are downloadable at s.
The electroacoustic stimulation eas of hearing aims to combine the. What is retropharyngeal abscesscausessymptomstreatment. A parapharyngeal abscess is a deep neck space abscess of the parapharyngeal space or pharyngomaxillary space, which is lateral to the superior pharyngeal constrictor muscle and medial to the masseter muscle. Although rarely, it can cause pharyngitis, tonsillitis, and peritonsillar abscess. Available formats pdf please select a format to send. Intravenous antibiotic therapy for deep neck abscesses defined by. As diving ranula and cystic hygroma are managed with different surgical approaches, avoidance of this pitfall is critical. C axial and d coronal plain ct scans showing disappearance of abscesses. It consists largely of fat, neurovascular structures, and, in some definitions, the. Medical and surgical treatment of peritonsillar, retropharyngeal, and. Resolution of hypoglossal nerve palsy associated with.
Children parapharyngeal abscess after dental extraction. Penetrating pharyngeal trauma is relatively common in children e. Deep neck infections include the parapharyngeal abscess, the retropharyngeal abscess and submandibular abscess. This can cause resolution or prevention of disease progression, in some patients with an early presentation e. It is an inverted coneshaped potential space that extends from the hyoid bone to the base of the skull.
All patients were treated by intravenous antibiotics and steroids for 57 days. It is a serious medical condition, potentially fatal, and requires prompt diagnosis and treatment. The size of the abscess in the responders ranged from 1. Pharyngeal mucosal space lesions, such as nasopharynx carcinoma, may have extensive submucosal and parapharyngeal space extension. Retropharyngeal and parapharyngeal abscess in children. The most common extrinsic tumors involving the prestyloid parapharyngeal space are parotid tumors arising from the deep lobe of the parotid gland 5. It occurs due to spread of infection form anatomical locations in the vicinity of the space. Parapharyngeal abscess two years after elective tonsillectomy.
Parapharyngeal abscess, odontogenic infection, pus drainage. Parapharyngeal abscesses the journal of laryngology. Parapharyngeal abscess is a lifethreatening infection. To show the role of ultrasound us in distinguishing retropharyngeal abscess. The treatment of a tuberculous retropharyngeal abscess by drugs. The posterior compartment contains the carotid artery, internal jugular vein, and many.
In this case report, we describe an adult case of retropharyngeal abscess who presented to us with symptoms of sore throat and dysphagia for 1. Retropharyngeal abscess is generally caused during throat infection as an after effect of throat infection. Know the causes, symptoms, treatment, recovery, prognosis and complications of retropharyngeal abscess. Trismus, drooling, dysphagia, and odynophagia also are observed commonly. We report two cases of parapharyngeal abscesses in immunocompromised patients. The parapharyngeal space or lateral pharyngeal or pharyngomaxillary space is in the upper neck above the hyoid bone. A 56yearold woman presented to the emergency department with complaints of sore throat and cervical swelling, and a diagnosis of parapharyngeal abscess was established. Retropharyngeal abscess occurs less commonly today than in the past because of the widespread use of antibiotics for suppurative upper respiratory infections. Parapharyngeal abscesses caused by group g streptococcus. Peritonsillar abscess is the most common deep infection of the head and neck, with an annual incidence of 30 cases per 100,000 persons in the united states.
Surgical drainage of neck abscesses vula university of cape town. Since the introduction of antibiotics, the incidence of parapharyngeal abscess secondary to tonsillitis and peritonsillar abscess has decreased dramatically. Lateral pharyngeal space infection most often arises via contiguous spread of infection from a peritonsillar or retropharyngeal abscess. Bezolds abcess presenting as parapharyngeal abcessc ameya bihani, jyoti dabholkar, yogesh dokhe and priyanka hardikar corresponding author. This space is divided by the styloid process into anterior and posterior compartments. The parapharyngeal pharyngomaxillary space is lateral to the superior pharyngeal constrictor and medial to. If initial nonoperative management is chosen, a narrow spectrum regimen i.
About europe pmc funders joining europe pmc governance roadmap outreach tools tools overview orcid article claiming journal list grant. Retropharyngeal abscess pediatric infectious diseases. Parapharyngeal abscess msd manual professional edition. The parapharyngeal space, also known as the prestyloid parapharyngeal space, is a deep compartment of the head and neck around which most other suprahyoid fascial spaces are arranged. Its incidence has dramatically decreased since the advent of antibiotics.
Here, we report a case of a woman with parapharyngeal abscess caused by ggs. Ct and ultrasound imaging of retropharyngeal abscesses in children charles m. Parapharyngeal abscess merck manuals professional edition. A axial and b coronal plain ct scans showing multiple abscesses and air accumulation in the right parapharyngeal space pps, submasseteric space, and submandibular space before the treatment. Surgical treatment of paraphyrngeal and retropharyngeal abscesses. Parapharyngeal abscess secondary to lymphovenous malformation volume 3 issue 3 s khosla, n caton, tt zhang, c r davieshusband.
Frequently, the causative organism was identified as communityacquired methicillinresistant staphylococcus aureus. Fiftyfive patients were diagnosed with deep neck space infections abscesses during the period under. Intravenous antibiotic therapy for deep neck abscesses. Retropharyngeal abscess rpa is an abscess located in the tissues in the back of the throat behind the posterior pharyngeal wall the retropharyngeal space.
Grant, in pediatric respiratory medicine second edition, 2008. Retropharyngeal abscess rpa produces the symptoms of sore throat, fever, neck stiffness, and stridor. Delay in treatment of parapharyngeal abscesses can. Parapharyngeal abscess is a serious medical condition that may lead to lifethreatening complications. Pdf parapharyngeal abscess two years after elective. Rare condition, which can be a lifethreatening infection if not detected early. Parapharyngeal abscess in immunocompromised patients. The aetiology of the parapharyngeal abscess was odontogenic in two patients and remained unknown in the other seven. Retropharyngeal abscess fkc chu retropharyngeal abscess is a condition commonly seen in children but not so common in adult. Most of frontal, parietal and occipital abscesses were associated with cyanotic heart disease aetiology in 27. Differentials of abscess and neoplasm were considered.
Discussion in contrast to the retropharyngeal space, parapharyngeal space abscesses in the pediatric population are unusual. Because rpas typically occur in deep tissue, they are difficult to diagnose by physical examination alone. It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of the neck. Occasionally, diving ranulas may attain large dimensions giant ranula. Retropharyngeal abscesses occur in the back of the throat. This retrospective study over a period of 7 years concerned 16 patients hospitalized in an ent and head and neck surgery department for parapharyngeal abscess. Retropharyngeal abscess ear, nose, and throat disorders. The parapharyngeal pharyngomaxillary space is lateral to the superior pharyngeal constrictor. Symptoms include fever, sore throat, odynophagia, and swelling in the neck down to the hyoid bone. The parapharyngeal space is a potential space in the head and the neck. Ameya bihani, department of ent, kem hospital, mumbai. The clinical features, evaluation, and management of retropharyngeal cellulitis and abscess in children will be discussed here. Ct and ultrasound imaging of retropharyngeal abscesses in.
He was admitted to the hospital for further management after the presentation of unilateral nuchal swelling. This program is a must read for anyone suffering from candida or ones like me who has ever taken antibiotics and is now experiencing any of the many problems that go along with intestinal flora imbalance. The parapharyngeal space also termed the lateral pharyngeal space, is a potential space in the head and the neck. Transoral approach for draining parapharyngeal space. A retropharyngeal abscess is medical situation where there is a pus abscess formation in the tissue located on the back of the patients throat. The importance of the parapharyngeal space also lies in its relationship with the other spaces of the neck. Pharyngeal abscess a parapharyngeal abscess is a deep neck abscess. Although these two infections have some differing symptoms,bothusuallycausefever,sorethroat,anddifficulty eating. Surgical treatment of paraphyrngeal and retropharyngeal.
There have been few reported pediatric cases of bilateral parapharyngeal space abscesses, and none of sequential. Diabetes is the most common systemic condition predisposing one to parapharyngeal abscess. Surgical drainage of neck abscesses johan fagan, jean morkel. Treatment options vary between immediate surgical drainage of the abscess to. Parapharyngeal abscess is a difficult diagnosis to make in the pediatric population. Among the responders, 8 of 10 abscesses were located in the retropharyngeal space alone, and 2 of 10 abscesses involved a combination of the retropharyngeal and parapharyngeal spaces. We present five cases of parapharyngeal abscess resulting from tonsillitis and peritonsillar. Peritonsillar, retropharyngeal, and parapharyngeal abscesses are the most common. A retropharyngeal abscess forms when lymph nodes in the back of the throat become infected, break down, and form pus.
Because these nodes begin to disappear by age 4 to 5 years, retropharyngeal abscesses occur mainly in children age 1 to 8 years and are uncommon in adults. It has clinical importance in otolaryngology due to parapharyngeal space tumours and parapharyngeal abscess developing in this area. It consists largely of fat, neurovascular structures, and, in some definitions, the retromandibular part of the deep lobe of the parotid gland. Nine of these patients had abscesses localized to the pharapharyngeal space and form the basis of this study. The parapharyngeal space may be divided into two compartments on the basis of its relationship to the styloid process or, more precisely, to the tensorvascularstyloid fascia fig.
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