A retropharyngeal abscess (RPA) is a collection of pus in the lymph nodes at the back of the throat. It is a potentially life-threatening medical condition. RPA, once almost exclusively a disease of children, is observed with increasing frequency in adults. Retropharyngeal abscess generally affects children under age 5. Infected material (pus) builds up in the space around the tissues at the back of the throat. This can occur during or immediately following a throat infection. An abscess is usually caused by a bacterial infection that has spread from the tonsils, throat, sinuses, adenoids, nose, or middle ear. Many infections are caused by a combination of bacteria. An injury to the back of the throat from a sharp object, such as a fish bone, occasionally causes a retropharyngeal abscess.

The retropharyngeal space is posterior to the pharynx, bound by the buccopharyngeal fascia anteriorly, the prevertebral fascia posteriorly, and the carotid sheaths laterally. It extends superiorly to the base of the skull and inferiorly to the mediastinum. RPA can cause sepsis and airway compromise. The main symptoms are difficulty and pain when swallowing, a fever, and enlargement of the lymph nodes in the neck. The voice is muffled, and children may drool. The neck may be stiff, and children may hold their head at an angle. The abscess can block the airway, making breathing difficult and noisy, particularly when children inhale (called stridor). Children may lie on their back, tilt their head and neck back, and raise their chin to make breathing easier.

RPA is more common in males than in females, with generally reported male preponderance of 53-55%. Complications include bleeding around the abscess, rupture of the abscess into the airway (which can block the airway), and pneumonia. The voice box (larynx) may go into spasm and further tamper with breathing. Blood clots may form in the jugular veins of the neck. Infection may spread down into the chest. Sometimes widespread inflammation and infection of the bloodstream occurs, causing organs to malfunction (a condition called septic shock). Retropharyngeal abscesses often need to be drained surgically. Surgery is needed to drain the infected area. High-dose intravenous antibiotics are used to treat the infection. Intravenous administration of a semisynthetic penicillin (eg, nafcillin) is recommended.

Retropharyngeal Abscess Treatment and Prevention Tips

1. High-dose intravenous antibiotics are used to treat the infection.

2. Endotracheal intubation may be required if the patient has signs of upper airway obstruction.

3. Cricothyrotomy (surgical or needle) may be required in the patient with upper airway obstruction.

4. Intravenous fluids are required if the patient is dehydrated because of fever and difficulty swallowing.