Retropharyngeal and parapharyngeal abscess in children--epidemiology, clinical features and treatment
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Galia Grisaru-Soen1, Orna Komisar, Orna Aizenstein
1Pediatric Infectious Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. galiag@post.tau.ac.il
Insights
Pediatric retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs) often present with fever and neck pain. Many children with these deep neck infections can be successfully treated with antibiotics alone, avoiding surgery.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
- Pediatric Surgery
Background:
- Retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs) are serious deep neck infections in children.
- Prompt diagnosis and appropriate management are crucial to prevent severe complications.
Purpose of the Study:
- To describe the clinical presentation, diagnosis, management, and complications of pediatric RPAs and PPAs.
- To evaluate the effectiveness of surgical versus non-surgical treatment approaches.
Main Methods:
- Retrospective chart review of children under 18 diagnosed with RPA or PPA over an 11-year period at two tertiary pediatric hospitals.
- Data collected included demographics, symptoms, physical findings, imaging (CT scans), laboratory results, and treatment outcomes.
Main Results:
- 39 children (67% RPA, 33% PPA) were included; mean age was 4 years. Common symptoms were fever (70%) and neck pain (62%).
- CT scans were highly utilized (95%) for diagnosis. Intravenous antibiotics were administered to all patients. 17 patients underwent surgical drainage.
- No significant difference in hospital stay or complications was observed between surgical and non-surgical groups. No treatment failures occurred.
Conclusions:
- Pediatric RPAs commonly present with neck stiffness, fever, and lymphadenopathy, with rare respiratory distress.
- A significant proportion of children with RPAs and PPAs can be managed successfully with non-operative treatment, primarily antibiotics.
- CT scans are valuable for diagnosis and assessing infection extent, though accuracy can vary.
Objective:
To describe the clinical presentation, diagnosis, management and complications of children with retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs).
Methods:
A retrospective chart review was conducted at two tertiary care, pediatric hospitals in Israel. The medical records of all children <18 years who had been admitted with a diagnosis of RPA or PPA during an 11-year period (January 1997 to February 2008) were reviewed. Data on demographics, presenting symptoms, physical examination findings, imaging studies and interpretation, laboratory results, hospital course, medical treatment and surgical interventions were retrieved.
Results:
A total of 39 children were diagnosed as having RPA (n=26, 67%) or PPA (n=13, 33%). There was a predominance of boys (61.5%). The mean age of all the children at diagnosis was 4 years. The annual incidence increased over the 11-year period. The most common symptoms at presentation included fever (n=27, 70%) and neck pain (n=24, 62%). The physical examination revealed cervical lymphadenopathy in 30 children (77%), limitation of neck movements in 25 (64%), torticollis in 21 (54%), drooling in three (8%), and stridor in two (5%). Computerized tomographic (CT) scanning with contrast was performed in 37 patients (95%), of whom 17 underwent surgical drainage. Thirteen children were positively diagnosed as having an abscess by the finding of pus at surgery, of whom 12 had been found to have an abscess on their CT scan. All the patients received intravenous antibiotics. There was no significant difference in the duration of hospital stay between those who underwent surgery and those who were treated with antibiotics alone. There were no treatment failures and no complications in either of the two groups.
Conclusion:
Children with RPA most commonly present with restricted neck movements, fever and cervical lymphadenopathy, and rarely with respiratory distress or stridor. Many patients with RPA and PPA can be treated successfully without surgery. CT scans are helpful in diagnosing and assessing the extent of the infection, but they are not always accurate.
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