Retropharyngeal Abscess
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Basics
Description
- Deep tissue infection of the retropharyngeal space:
- Potential space bound anteriorly by buccopharyngeal fascia, posteriorly by alar fascia, superiorly by skull base, inferiorly by fusion of fascial layers at T2
- Space fused by raphe at midline with chains of lymph nodes extending down each side
- Alar fascia is poor barrier and allows retropharyngeal infections to spread into “danger” space and posterior mediastinum
- Primarily a disease of children, but increasing frequency in adults:
- Peak incidence at 3–5 yr when retropharyngeal nodes most prominent
- Prognosis is good when promptly diagnosed and aggressively managed with IV antibiotics and/or surgical drainage
- Complications due to mass effect, rupture, or spread are the major source of morbidity and include:
- Airway compromise (most common)
- Aspiration pneumonia due to rupture
- Sepsis
- Spontaneous perforation
- Necrotizing soft tissue infection
- Mediastinitis
- Thrombosis of the internal jugular vein
- Jugular vein suppurative thrombophlebitis (Lemierre syndrome)
- Erosion into carotid artery (primarily adults)
- Atlantoaxial dislocation from erosion of ligaments
- Cranial nerve palsies (typically IX–XII)
- Epidural abscess
- Recurrent abscess formation (1–5%)
Etiology
- Causes:
- Most often arises from infection of nasopharynx, paranasal sinuses, or middle ear
- Infection then spreads to lymph nodes between posterior pharyngeal wall and alar fascia
- Trauma, foreign bodies, and iatrogenic introduction of infection from instrumentation also common cause, especially in adults
- Diabetes and other immunosuppressed states may predispose to this infection
- Bacteriology: Predominately polymicrobial with anaerobes and aerobes
- Most common organisms are:
- Streptococcus pyogenes and Streptococcus viridans
- Staphylococcus aureus (including MRSA)
- Respiratory anaerobes (including Prevotella, Fusobacterium, and Veillonella)
- Less common organisms are:
- Haemophilus species
- Acid-fast bacilli
- Klebsiella pneumoniae
- Escherichia coli
- Eikenella corrodens
- Mycobacterium tuberculosis
- Aspergillus and Candida species
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Basics
Description
- Deep tissue infection of the retropharyngeal space:
- Potential space bound anteriorly by buccopharyngeal fascia, posteriorly by alar fascia, superiorly by skull base, inferiorly by fusion of fascial layers at T2
- Space fused by raphe at midline with chains of lymph nodes extending down each side
- Alar fascia is poor barrier and allows retropharyngeal infections to spread into “danger” space and posterior mediastinum
- Primarily a disease of children, but increasing frequency in adults:
- Peak incidence at 3–5 yr when retropharyngeal nodes most prominent
- Prognosis is good when promptly diagnosed and aggressively managed with IV antibiotics and/or surgical drainage
- Complications due to mass effect, rupture, or spread are the major source of morbidity and include:
- Airway compromise (most common)
- Aspiration pneumonia due to rupture
- Sepsis
- Spontaneous perforation
- Necrotizing soft tissue infection
- Mediastinitis
- Thrombosis of the internal jugular vein
- Jugular vein suppurative thrombophlebitis (Lemierre syndrome)
- Erosion into carotid artery (primarily adults)
- Atlantoaxial dislocation from erosion of ligaments
- Cranial nerve palsies (typically IX–XII)
- Epidural abscess
- Recurrent abscess formation (1–5%)
Etiology
- Causes:
- Most often arises from infection of nasopharynx, paranasal sinuses, or middle ear
- Infection then spreads to lymph nodes between posterior pharyngeal wall and alar fascia
- Trauma, foreign bodies, and iatrogenic introduction of infection from instrumentation also common cause, especially in adults
- Diabetes and other immunosuppressed states may predispose to this infection
- Bacteriology: Predominately polymicrobial with anaerobes and aerobes
- Most common organisms are:
- Streptococcus pyogenes and Streptococcus viridans
- Staphylococcus aureus (including MRSA)
- Respiratory anaerobes (including Prevotella, Fusobacterium, and Veillonella)
- Less common organisms are:
- Haemophilus species
- Acid-fast bacilli
- Klebsiella pneumoniae
- Escherichia coli
- Eikenella corrodens
- Mycobacterium tuberculosis
- Aspergillus and Candida species
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