Surgical implications of the retropharyngeal space

The retropharyngeal space involves the entire length of the posterior aspect of the neck, extending from the base of the skull to the level of T1, T2 in the superior mediastinum. This space lies between the buccopharyngeal fascia anteriorly and the prevertebral fascia posteriorly. This paper details the normal anatomy of the area, and describes important modalities in evaluation of the retropharyngeal space, including physical exam, special x-ray procedures, and surgical approach. The pathology found in the retropharyngeal space covers a broad spectrum of entities including infection, neoplasms, metabolic dysfunction, trauma, and lymphadenopathy. Certain conditions are age related and many are manifestations of associated conditions or sequelae of therapy for unrelated problems. An example of retroperitoneal pathology in the form of life-threatening (secondary to airway obstruction) hematoma is presented. This case history details the prudent evaluation of the problem and our surgical approach to management of retropharyngeal hematoma.