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Surgical management of retropharyngeal space infections in children
1Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow, Kansas City, KS 66160, U.S.A.
Insights
This study found that a transoral approach is effective for pediatric deep neck space infections like retropharyngeal abscesses. Most children were successfully treated with one surgery, highlighting this minimally invasive method.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Infectious Diseases
Background:
- Deep neck space infections, particularly parapharyngeal and retropharyngeal abscesses, require effective perioperative management in pediatric patients.
- An increasing incidence of these infections was observed, correlating with a rise in group A beta-hemolytic streptococcal abscesses.
Purpose of the Study:
- To evaluate perioperative management strategies for pediatric patients undergoing surgical treatment for suppurative adenitis of the parapharyngeal and retropharyngeal spaces.
- To review changes in disease process and management over time and provide recommendations for optimal care.
Main Methods:
- Retrospective analysis of surgically treated pediatric patients from 1989 to 1998 at a tertiary care pediatric hospital.
- Review of patient demographics, symptoms, radiological findings (including computed tomography - CT), surgical approach, complications, medical therapy, and bacteriology.
- Correlation of CT findings with surgical observations.
Main Results:
- A significant increase in deep neck space infections was noted during the study period, linked to group A beta-hemolytic streptococcal infections.
- The majority of patients were boys aged 3-5 years. Most children (70/73) were treated via a transoral approach, with high success rates (68/73) after a single operation.
- Abscess wall irregularity was a more reliable indicator of pus than ring enhancement on CT scans.
Conclusions:
- This study represents one of the largest series of pediatric retropharyngeal abscesses reported.
- The transoral approach is supported for these abscesses, provided there is no lateral extension beyond the great vessels.
- Recommendations for optimal perioperative management are presented based on the findings.
Objective:
To study the perioperative management strategies in a large group of pediatric patients undergoing surgical therapy for suppurative adenitis of the parapharyngeal and retropharyngeal spaces.
Study Design:
Retrospective analysis of all patients treated surgically from January 1, 1989, to December 31, 1998, in a tertiary care pediatric hospital.
Methods:
Charts were reviewed for demographic data, duration and nature of symptoms, radiological workup, surgical approach, complications, duration of medical therapy and antibiotic choice, and bacteriological findings. Computed tomography (CT) results were correlated to surgical findings.
Results:
A dramatic increase in the incidence of deep neck space infection was seen during the study period; this increase was congruent with the increase in culture-positive group A beta-hemolytic streptococcal abscesses. More than two-thirds of the patients were boys with the peak incidence being in the 3- to 5-year-old group. The duration of symptoms before presentation was less than might be expected, especially in the younger age groups. Seventy of 73 children were treated with a transoral approach. Sixty-eight of 73 were successfully treated with one operative intervention. Irregularity of the abscess wall was found to be a stronger predictor of the presence of pus than the presence of ring enhancement.
Conclusions:
The current study represents the largest series of pediatric retropharyngeal abscesses in the modern medical literature. Changes in the disease process and in management from the first half of the century to today are reviewed, and recommendations for optimal management presented. The data in this series support a transoral approach to these abscesses unless there is extension lateral to the great vessels.
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