From the Research
Management for a 16-year-old male with retropharyngeal emphysema after fall trauma presenting with mild odynophagia should include close observation in a hospital setting, preferably in an intensive care unit for at least 24-48 hours. The patient's condition is considered stable given the mild symptoms, but close monitoring is crucial due to the potential for airway compromise or other complications. Initial assessment should include:
- A complete head and neck examination
- Vital signs monitoring
- Imaging studies such as a lateral neck X-ray and CT scan to evaluate the extent of the emphysema and rule out associated injuries 1, 2.
The patient should be kept nil by mouth initially, with intravenous fluids for hydration. Broad-spectrum antibiotics such as ampicillin-sulbactam (3g IV every 6 hours) or clindamycin (600mg IV every 8 hours) should be administered to prevent infection, as bacteria from the oral cavity may enter the retropharyngeal space. Analgesics like acetaminophen (650mg every 6 hours) or ibuprofen (600mg every 8 hours) can be given for pain management. The patient should be positioned with the head of the bed elevated to 30-45 degrees to reduce pressure on the airway. Most cases resolve spontaneously within 3-5 days as air is reabsorbed, but the patient requires close monitoring for signs of airway compromise, mediastinitis, or abscess formation 2. Surgical intervention is rarely needed unless there is significant airway compromise or infection develops. Once the patient's condition stabilizes and odynophagia improves, a gradual return to oral intake can be initiated. It's worth noting that while the provided studies offer insights into the management of retropharyngeal emphysema, the most recent and relevant study 1 supports a conservative approach with close monitoring.