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Retropharyngeal and parapharyngeal infections in children: A retrospective analysis
Savithiri Ratnapalan1, Jeffrey Thevaranjan2, Niranjala Perera3
1University of Toronto, Canada; Hospital for Sick Children, Canada.
Insights
Early diagnosis of deep neck infections like retropharyngeal and parapharyngeal infections in infants is crucial. Infants under one year face higher complication risks and often require surgical intervention for these pediatric infections.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Emergency Medicine
Background:
- Deep neck infections (DNIs) in children, including retropharyngeal and parapharyngeal abscesses, require prompt evaluation and management.
- Understanding the specific characteristics, treatment pathways, and outcomes of these infections is vital for pediatric care.
Purpose of the Study:
- To delineate the clinical presentations, management strategies, and patient outcomes for retropharyngeal and parapharyngeal infections in a pediatric tertiary care setting.
- To identify factors associated with increased morbidity and the need for surgical intervention.
Main Methods:
- A 10-year retrospective chart review (January 2008-December 2018) of pediatric patients diagnosed with retropharyngeal or parapharyngeal infections.
- Data analysis included patient demographics, clinical presentation, treatment modalities (antibiotics, surgery), and complication rates.
Main Results:
- The study included 200 children with deep neck infections: 176 retropharyngeal, 18 parapharyngeal, and 6 with both. The mean age was 4.3 years, with 60% males.
- Parenteral antibiotics were administered to all patients; 42% required surgical drainage. Infants under 12 months had a significantly higher complication rate (23%) compared to older children (1%).
- Age under 12 months and parapharyngeal infection diagnosis were predictors for surgical treatment. Seven cases involved co-existing Kawasaki disease.
Conclusions:
- Early identification of retropharyngeal and parapharyngeal infections, particularly in infants, is critical due to higher complication risks and increased likelihood of surgical necessity.
- Most pediatric cases present as phlegmon or small abscesses, often managed successfully with parenteral antibiotics alone.
Objectives:
To describe presentations, management and outcomes of retropharyngeal and parapharyngeal infections in children presenting to a tertiary care pediatric emergency department.
Methods:
A retrospective chart review of children with deep neck infections such as retropharyngeal or parapharyngeal infection from January 2008 to December 2018 was conducted at a pediatric hospital.
Results:
There were 176 retropharyngeal, 18 parapharyngeal and 6 with both retropharyngeal and parapharyngeal infections treated during the 10-year study period. Males were 60% of the cohort and the mean age was 4.3 (SD: 3.2) years. No significant differences in age or sex ratio or presentations were seen in children with retropharyngeal infections compared with parapharyngeal infections. All received parenteral antibiotics; 42% (84/200) of children underwent surgery and four of them had more than one surgical drainage. Age <12 months and the diagnosis of parapharyngeal infections were associated with significantly higher rates of surgical treatment. Children under 12 months of age were sicker at presentation and had a high complication rate of 23% compared with 1% in the older children (p = 0.002). Seven children had co-existence of Kawasaki disease with deep neck infections.
Conclusions:
Early diagnosis of retropharyngeal and parapharyngeal infections especially in infants under a year of age is important as they are more likely to have complications and need surgical management. Most paediatric patients with retropharyngeal and parapharyngeal infections have a phlegmon or very small abscesses and are treated non-operatively with parenteral antibiotics.
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