Retropharyngeal Abscess
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Retropharyngeal Space and Abscess
📍 Anatomy of the Retropharyngeal Space
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Location:
The retropharyngeal space is a potential space situated between:
- Buccopharyngeal fascia (middle layer of deep cervical fascia) anteriorly
- Alar fascia (part of the deep layer of deep cervical fascia) posteriorly
What is the other name for Retropharyngeal Space?
🧱 Boundaries of the Retropharyngeal Space
| Boundary | Anatomical Landmark |
|---|---|
| Superior | Base of the skull |
| Inferior | Level of T4 vertebra / Carina (bifurcation of trachea) where alar and buccopharyngeal fascia fuse |
| Anterior | Buccopharyngeal fascia covering pharyngeal constrictors |
| Posterior | Alar fascia |
| Lateral | Carotid sheath and its contents |
- The space is divided by a midline fibrous raphe into two lateral compartments called the spaces of Gillette.
🧬 Contents of the Retropharyngeal Space
- Retropharyngeal (Rouvière's) lymph nodes
- Fat and loose areolar tissue
- Pharyngeal plexus of veins and nerves
- Communicates anterolaterally with parapharyngeal spaces on both sides
🦠 Retropharyngeal Abscess
🧫 Etiology of Retropharyngeal Abscess
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In Children (< 3 years):
Suppuration of retropharyngeal lymph nodes secondary to infection in:
- Adenoids
- Nasopharynx
- Posterior nasal sinuses
- Nasal cavity
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In Adults:
- Penetrating injury of posterior pharyngeal wall or cervical esophagus
- Rarely, spread from acute mastoiditis through petrous bone
⚠️ Clinical Features of Retropharyngeal Abscess
- Dysphagia
- Breathing difficulty
- Stridor and croupy cough
- Torticollis
- Unilateral bulge in posterior pharyngeal wall
🩻 Radiological Diagnosis of Retropharyngeal Abscess
📸 X-ray (Lateral View of Neck – Soft Tissue)
- Widening of prevertebral shadow
- May show presence of air/gas in soft tissue
- Straightening of cervical spine
- Air-fluid level may be seen
What is the normal width of pre vertebral soft tissue shadow?
🧠 CT Scan (Contrast-Enhanced)
- Confirms extent of abscess
- Detects spread below hyoid
- Identifies associated parapharyngeal abscess
💉 Treatment of Retropharyngeal Abscess
- Incision and Drainage (I&D)
What is the site of incision for I&D in Retropharyngeal abscess?
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Antibiotics
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Tracheostomy
What are the indications of Tracheostomy in Retropharyngeal abscess?
⚠️ Complications of Retropharyngeal Abscess
- Hemorrhage
- Laryngeal spasm
- Bronchitis
- Septicemia
- Metastatic abscess
- Internal jugular vein thrombosis
- Carotid artery erosion
- Aspiration pneumonia
📝 All the topics and questions mentioned in this post are explained in detail in my ENT notes - built for exam success and clinical understanding. Get full access by purchasing the notes.