Retropharyngeal Abscess

Retropharyngeal Space and Abscess

📍 Anatomy of the Retropharyngeal Space

• 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

• 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

• In Children (< 3 years):

  Suppuration of retropharyngeal lymph nodes secondary to infection in:

  • Adenoids
  • Nasopharynx
  • Posterior nasal sinuses
  • Nasal cavity

• 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

1. Incision and Drainage (I&D)

What is the site of incision for I&D in Retropharyngeal abscess?

1. Antibiotics

2. 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