What is the treatment for a retropharyngeal abscess?

Treatment of Retropharyngeal Abscess

The treatment of retropharyngeal abscess requires prompt surgical drainage combined with parenteral antibiotic therapy to prevent life-threatening complications such as airway obstruction and mediastinitis. 1, 2

Diagnostic Considerations

• Retropharyngeal abscess should be suspected in patients presenting with dysphagia (100%), respiratory distress (80%), limited neck motion (80%), fever (60%), and neck pain (50%) 1
• Lateral neck radiographs showing widening of the prevertebral space are an important diagnostic tool, while CT or MRI scans provide more accurate anatomical localization and verification of the abscess 3
• Common etiological factors include:
  • Upper respiratory tract infections (70%)
  • Dental abscesses (20%)
  • Foreign body ingestion or trauma (10%) 1

Treatment Algorithm

1. Surgical Management

• Surgical drainage is the primary treatment for retropharyngeal abscesses 1, 2, 4
• Surgical approaches include:
  • Transoral approach (most common, 70% of cases)
  • External cervical/transcervical approach (20% of cases)
  • Combined transoral and transcervical approach (10% of cases)
  • MRI-guided transnasal approach (for abscesses close to the skull base) 2, 4
• Surgical intervention should be performed promptly to prevent complications 4

2. Antibiotic Therapy

• Parenteral broad-spectrum antibiotics should be administered concurrently with surgical drainage 1
• Recommended antibiotic regimen:
  • Combination therapy with coverage for Gram-positive, Gram-negative, and anaerobic bacteria 5
  • Common effective regimen: cefazolin sodium and metronidazole combination 1
  • Streptococcal species are the most commonly isolated pathogens 2, 3

3. Special Considerations

• Pediatric patients (especially under 5 years) are at higher risk and should be managed in facilities with appropriate pediatric medical, surgical, and intensive care capabilities 4
• For abscesses associated with systemic signs of infection or in immunocompromised patients, more aggressive antibiotic therapy may be required 5
• Respiratory status should be closely monitored as airway obstruction is a potential complication 4

Potential Complications

• Airway obstruction (may require tracheostomy in severe cases) 2, 4
• Mediastinitis 4
• Empyema 1
• Torticollis (rare complication requiring additional orthopedic management) 6
• Recurrence (uncommon with appropriate initial management) 3
• Spinal canal abscess (rare) 3

Treatment Outcomes

• With appropriate surgical drainage and antibiotic therapy, most patients recover completely 1, 2
• Average hospital stay is approximately 7 days (range: 7.1±5.3 days) 1
• Mortality is rare with prompt diagnosis and appropriate treatment 4

Follow-up Care

• Regular assessment of wound healing and resolution of symptoms 6
• Monitoring for potential complications, especially in cases with extensive abscesses 4
• Multidisciplinary approach may be necessary in complex cases, particularly those with orthopedic complications like torticollis 6