Retropharyngeal Abscess: Patterns of Deep Neck Space Extension and Clinical Findings From 11 Adult Cases

Retropharyngeal abscess (RPA) in adults is rare but associated with significant morbidity due to rapid extension into deep neck spaces and the risk of life-threatening complications. Early diagnosis and intervention remain essential, yet management strategies continue to be debated. This study aims to analyze epidemiological, clinical, imaging, and management-related characteristics of adult RPA cases and identify factors associated with disease severity, spread, and outcomes.

A retrospective chart review was conducted at the Otolaryngology Department of a tertiary university hospital between January 2016 and October 2025. Adult patients with clinically and radiologically confirmed RPA were included. Data were collected on demographics, comorbidities, clinical presentation, microbiological findings, imaging results, airway status, management strategies, and outcomes, along with laboratory parameters including WBC and CRP levels.

Eleven adults (seven males, four females; mean age 53.5 ± 15.4 years) were included. Mean WBC was 16.5 ± 3.11 ×10³/µL and mean CRP was 191 ± 110 mg/L. The most common symptoms were odynophagia and fever. Nine patients (81.8%) demonstrated radiological extension into deep neck spaces, most frequently the parapharyngeal and prevertebral spaces. Surgical drainage was performed in 10 patients; eight underwent transoral drainage, two required combined approaches, and two required tracheostomy. Staphylococcus species were the most common isolates. Mean hospitalization was 14.2 days (range 4-42). All patients survived.

Adult RPA frequently presents with extensive spread beyond the retropharyngeal space, owing to the anatomical continuity of this compartment, which facilitates rapid extension to the parapharyngeal, prevertebral, and mediastinal regions. Contrast-enhanced CT is essential for defining disease extent. Prompt airway evaluation and early broad-spectrum antibiotic therapy combined with surgical drainage remains the cornerstone of management, contributing to favorable outcomes.