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Acute retropharyngeal and parapharyngeal abscesses in children
Jihad N Zahraa1, Ahmad A Al-Boukai
1Department of Pediatrics, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. jzahraa@ksu.edu.sa
Insights
Acute retropharyngeal and parapharyngeal abscesses are rare but serious pediatric infections. Early clinical suspicion and prompt diagnosis are crucial, especially for parapharyngeal involvement, to prevent severe complications.
Area of Science:
- Pediatric infectious diseases
- Otolaryngology
- Head and neck surgery
Background:
- Acute retropharyngeal and parapharyngeal abscesses are uncommon but severe pediatric conditions.
- Deep neck infections in children require careful management due to potential airway compromise.
Purpose of the Study:
- To review the experience with acute retropharyngeal and parapharyngeal abscesses in children.
- To highlight unusual features and diagnostic challenges in pediatric deep neck infections.
Main Methods:
- Retrospective review of medical records of children under 12 years old.
- Inclusion criteria: diagnosis of deep neck infection over a 10-year period.
- Data analysis focused on clinical presentation, diagnosis, and management.
Main Results:
- Eight pediatric cases were analyzed, with most patients under 3 years old.
- Common symptoms included fever, neck swelling, and feeding difficulties; clinical suspicion was low.
- Computerized tomography (CT) scans and direct visualization were key diagnostic tools; four patients had combined abscesses.
Conclusions:
- A high index of suspicion is essential for diagnosing these rare, life-threatening infections in children.
- Parapharyngeal abscesses were frequently missed clinically, necessitating increased awareness.
- Traditional medicine practices were associated with severe complications in some cases.
Objective:
Acute retropharyngeal and parapharyngeal abscess is a rare but serious disease in children. We reviewed our experience highlighting some of the unusual features of our cases.
Methods:
Medical records of children less than 12-years-old who were admitted to King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, over a 10- year period with final diagnosis of deep neck infection, were reviewed.
Results:
Eight patient's records were reviewed. Seven were less than 3-years of age. The retropharyngeal abscess was suspected clinically in 3 cases only. The most common findings were fever, neck swelling and feeding problems. The duration of symptoms and signs were so variable. The most helpful diagnostic tests were direct visualization and computerized tomography scan of the cervical area. The combination of retropharyngeal and parapharyngeal abscess was encountered in 4 patients. Cefuroxime was the drug of choice in all patients. Five patients responded to conservative management with antibiotics alone. Two cases had unusual presentation, one with subacute neck swelling, and one with severe airway compromise one week after manipulation of the tonsils by traditional therapist.
Conclusion:
High index of suspicion is warranted in such rare and life threatening disease. Special attention should be directed to the parapharyngeal entity, which was not suspected clinically in any case. The use of traditional medicine could have serious consequences in some patients.