International Journal of Pediatric Otorhinolaryngology
Retropharyngeal and parapharyngeal abscess in children—Epidemiology, clinical features and treatment
Introduction
Retropharyngeal abscesses (RPAs) are uncommon complications of upper respiratory infections in children. They result from the spread of the infection to and eventual suppuration of retropharyngeal lymph nodes. Historically, these processes had caused significant morbidity and mortality because of sepsis, mediastinitis, airway obstruction, internal jugular vein thrombosis, and carotid artery aneurysm. Advances in imaging, early detection, and antibiotic treatment have greatly reduced these devastating outcomes, and RPA now seldom lead to long-term consequences [1]. The presentation of RPA is sometimes subtle, and the constellations of findings are varied. Because of their relative infrequency, the variability in presenting symptoms and lack of readily visible physical signs, they present a diagnostic challenge to emergency physicians, pediatricians and otolaryngologists. In addition, the management of these infections is also controversial, especially with regard to the timing of surgical intervention [2].
In this study, our aim was to describe the clinical presentation, the complications, and the contemporary means of diagnosis and management of RPA and PPA in children.
Section snippets
Methods
We conducted a retrospective chart review at two tertiary care pediatric hospitals in Israel, Dana Children's Hospital at the Tel Aviv Medical Center and Safra Children's Hospital at the Sheba Medical Center. The medical records of all patients younger than 18 years of age who had been admitted with a diagnosis of RPA or parapharyngeal abscess (PPA) during a 10-year period (January 1997 to February 2008) were reviewed. Cases of posttraumatic RPA were excluded. All charts were retrieved by one
Results
During the 10-year study period, 39 children were discharged with a diagnosis of RPA (n = 26, 67%) or PPA (n = 13, 33%). There was a predominance of boys who comprised 61.5% of the study population (24 males and 15 females). Most of the 39 children (n = 28, 71%) were younger than 5 years at diagnosis (mean 4 years, range 0.5–15) (Fig. 1). Far more patients presented during the winter months (16 during the winter, 8 during the fall, 9 during the spring and 6 during the summer). The annual incidence of
Discussion
In the current study, infections of the retropharyngeal and parapharyngeal spaces (both abscesses and phlegmons) were more frequent in our younger study children, with 80% occurring in the ones under the age of 5 years. This incidence is similar to the findings in other series [2], [3], [4], [5], [6], [7]. It has been postulated that younger children are more likely to develop infections in this area because of the presence of lymph nodes that run in a paramedian chain in the retropharyngeal
Conflict of interest
None to declare.
Acknowledgment
Esther Eshkol is thanked for editorial assistance.
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