From the Guidelines
Retropharyngeal abscess is most common in young children, particularly those under 5 years of age. This age group is more susceptible to retropharyngeal abscess due to the presence of numerous and active retropharyngeal lymph nodes, which tend to regress and atrophy after age 5 1. The anatomical characteristics of children's retropharyngeal lymph nodes, which drain the nasopharynx, adenoids, and paranasal sinuses, make them prone to infection following upper respiratory tract infections. Some key points to consider in the management of retropharyngeal abscess include:
- The retropharyngeal space in young children contains loose areolar tissue that can easily become infected when bacteria spread from the lymph nodes
- Common causative organisms include group A streptococci, Staphylococcus aureus, and anaerobes
- Treatment typically involves prompt antibiotic therapy and surgical drainage for larger abscesses
- Early recognition is crucial as these infections can lead to serious complications including airway obstruction, mediastinitis, or sepsis if left untreated. It is essential to refer infants, children, and adolescents with complicated infections, such as retropharyngeal abscess, to a pediatric otolaryngologist or other specialists with appropriate education, training, and experience 1.
From the Research
Age Group Affected by Retropharyngeal Abscess
- Retropharyngeal abscess is most common in children, particularly those under the age of 5 years 2.
- The median age of patients with retropharyngeal abscess is 36 months, with 75% of patients being younger than 5 years 3.
- A study found that the mean age of children with retropharyngeal abscess was 4 years, with a predominance of boys (61.5%) 4.
- Another study reported that children whose abscess grew methicillin-resistant Staphylococcus aureus (MRSA) were younger, with a mean age of 11 months, compared to those without MRSA 5.
Clinical Presentation
- Common presenting symptoms of retropharyngeal abscess in children include fever, neck pain, and limited neck movement 4, 3.
- Other symptoms may include sore throat, neck mass, respiratory distress, and stridor, although these are less common 3.
- Physical examination findings may include cervical lymphadenopathy, limitation of neck movements, torticollis, and drooling 4.
Diagnosis and Treatment
- Imaging studies, such as computed tomography (CT) scans, are useful in diagnosing and assessing the extent of the infection 4, 3.
- Surgical drainage may be necessary in some cases, although many patients can be treated successfully with antibiotics alone 4, 3.
- The choice of treatment depends on the severity of the infection and the presence of complications, such as airway obstruction or mediastinitis 6, 2.