Retropharyngeal infections in children
- Ellen R Wald, MD
Ellen R Wald, MD
- Professor of Pediatrics
- University of Wisconsin School of Medicine and Public Health
- Section Editors
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Departments of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Suppurative infections of the neck are uncommon in children. However, they are potentially very serious. Suppurative cervical lymphadenitis is the most common superficial neck infection. Deep neck infections include peritonsillar abscess, retropharyngeal abscess, and lateral pharyngeal space infection (also known as pharyngomaxillary or parapharyngeal space infection). Lateral pharyngeal space infection most often arises via contiguous spread of infection from a peritonsillar or retropharyngeal abscess.
The clinical features, evaluation, and management of retropharyngeal cellulitis and abscess in children will be discussed here. Cervical lymphadenitis, peritonsillar cellulitis and abscess, and other deep neck space infections are discussed separately. (See "Cervical lymphadenitis in children: Etiology and clinical manifestations" and "Peritonsillar cellulitis and abscess" and "Deep neck space infections".)
ANATOMY AND PATHOGENESIS
The retropharyngeal space extends from the base of the skull to the posterior mediastinum (figure 1). The anterior boundary is the middle layer of the deep cervical fascia (abutting the posterior esophageal wall). The posterior boundary is the deep layer of the deep cervical fascia. These fascia fuse inferiorly at the level between the first and second thoracic vertebrae. The retropharyngeal space communicates with the lateral pharyngeal space. The lateral pharyngeal space is bounded laterally by the carotid sheath, which contains the carotid artery and jugular vein .
The retropharyngeal space contains two chains of lymph nodes that are prominent in the young child, but atrophy before puberty [2-4]. These lymph nodes drain the nasopharynx, adenoids, posterior paranasal sinuses, middle ear, and eustachian tube. Infections in these areas may lead to suppurative adenitis of the retropharyngeal lymph nodes [1,2,5,6]. Retropharyngeal abscess is associated with antecedent upper respiratory tract infection in approximately one-half of cases .
In approximately one-fourth of cases (usually in older children or adults), retropharyngeal infection is secondary to pharyngeal trauma (eg, penetrating foreign body, endoscopy, intubation attempt, dental procedures) [1,5,7-11]. It also may occur in association with pharyngitis, vertebral body osteomyelitis, and petrositis.
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- ANATOMY AND PATHOGENESIS
- EVALUATION AND DIAGNOSIS
- Physical examination
- Laboratory evaluation
- DIFFERENTIAL DIAGNOSIS
- Overview of strategy
- Supportive care
- Antimicrobial therapy
- - Empiric therapy
- - Response to therapy
- Surgical drainage
- Discharge instructions
- SUMMARY AND RECOMMENDATIONS
- Clinical features and diagnosis