Ordinarily a retropharyngeal abscess is easily diagnosed, an incision made from within the mouth, the pus evacuated, and an uninterrupted recovery results. Parapharyngeal abscess is the second most common deep neck abscess after peritonsillar abscess. Trismus, drooling, dysphagia, and odynophagia also are. The parapharyngeal, the submandibular, and themasticator spaces were statistically. Introduction deep neck abscess, including parapharyngeal and. Clinical characteristics for conservative therapy of. Anatomical complexity and etiology med j malaysia vol 62 no 5 december 2007 415 medial displacement of the lateral pharyngeal wall and tonsil is a hallmark of a parapharyngeal space infection. Discussion in contrast to the retropharyngeal space, parapharyngeal space abscesses in the pediatric population are unusual.
Parapharyngeal and retropharyngeal abscesses are lifethreatening infections, with a much lower incidence since the advent of antibiotics. Acute retropharyngeal and parapharyngeal abscess is a rare but serious disease in children. A parapharyngeal abscess is a deep neck space abscess of the parapharyngeal space or pharyngomaxillary space, which is lateral to the superior pharyngeal constrictor muscle and medial to the masseter muscle. Hiv infection and tuberculosis are becoming more common causes in adults and children. Jul 01, 2015 deep neck infections include the parapharyngeal abscess, the retropharyngeal abscess and submandibular abscess. Deep neck infections parapharyngeal abscess, retropharyngeal. Because these nodes begin to disappear by age 4 to 5 years, retropharyngeal abscesses occur mainly in children age 1 to 8 years and are uncommon in adults. It is an inverted coneshaped potential space that extends from the hyoid bone to the base of the skull. Here, we report a case of a woman with parapharyngeal abscess caused by ggs. In view of the scarcity of literature on the subject of parapharyngeal abscess, this case seems worth reporting. It has clinical importance in otolaryngology due to parapharyngeal space tumours and parapharyngeal abscess developing in this area. A rare case of large schwannoma of the parapharyngeal space. The parapharyngeal space or lateral pharyngeal or pharyngomaxillary space is in the upper neck above the hyoid bone. Parapharyngeal abscess msd manual professional edition.
Sore throat is a common complaint in children and adolescents. Treatment of peripharyngeal abscesses by means of intraoral. Intravenous antibiotic therapy for deep neck abscesses. Rare condition, which can be a lifethreatening infection if not detected early.
Internal carotid artery pseudoaneurysm and ischemic stroke. A person of any age can develop a parapharyngeal abscess, but it is most commonly seen in children and adolescents 1. Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Article in hebrew abu elnaaj i1, krausz a, ardekian l, peled m.
All deep neck infections are considered emergencies because they have the potential. At the c3 level, there are 3 large lymph nodes with central necrosis arrows in the right parapharyngeal area, with slight tracheal deviation to the left. Parapharyngeal abscess secondary to lymphovenous malformation volume 3 issue 3 s khosla, n caton, tt zhang, c r davieshusband. Deep neck space infections dnsis include those located in either the retropharyngeal or parapharyngeal spaces. Parapharyngeal abscess radiology reference article. Head and neck abscesses in complicated acute otitis media. In treatment of deep neck infections intensive antibiotic therapy and surgical drainage are complementary to. Treatment of gas decreases the risk of acute rheumatic fever arf, suppurative complications and transmission of disease. The parapharyngeal space may be divided into two compartments on the basis of its relationship to the styloid process or, more precisely, to the tensorvascularstyloid fascia fig. Ct and ultrasound imaging of retropharyngeal abscesses in. Parapharyngeal space an overview sciencedirect topics. The optimal management of ppa caused by pta has been the subject of debate with respect to the surgical approach.
Ct and ultrasound imaging of retropharyngeal abscesses in children charles m. Although many common suppurative processes about the head and neck such as localized suppuration of the lymph nodes give little concern and are rather easily cared for, the less common spreading lesions such as ludwigs angina, retropharyngeal abscess and other deep collections of the head and neck. We believe that early diagnosis and aggressive antibiotic treatment with early surgical drainage in cases associated with pus collection are the. Lateral pharyngeal space infection most often arises via contiguous spread of infection from a peritonsillar or retropharyngeal abscess. Pdf severe extensive deep neck abscess in an infant is uncommon. Jun 23, 2005 we report a parapharyngeal abscess in an adult patient that was drained transorally by performing ipsilateral tonsillectomy and aspirating the pus through the tonsillar bed. Retropharyngeal abscesses are deep neck space infections that can pose an immediate lifethreatening emergency, with potential for airway compromise and other catastrophic complications. Know the causes, symptoms, treatment, recovery, prognosis and complications of retropharyngeal abscess. To show the role of ultrasound us in distinguishing retropharyngeal abscess from adenitis in children. Most cases of pharyngitis are viral and selflimited. Many infections are caused by a combination of bacteria. We report a rare complication in the form of leftsided malignant middle cerebral artery mca infarction precipitated by left common carotid artery compression secondary to a multiloculated parapharyngeal abscess. Pharyngeal abscess a parapharyngeal abscess is a deep neck abscess. Numerous complications following impacted third molar extractions have been described previously.
All structured data from the file and property namespaces is available under the creative commons cc0 license. Surgical treatment of paraphyrngeal and retropharyngeal abscesses. Files are available under licenses specified on their description page. There are adjacent inflammatory processes that compromise the ipsilateral parapharyngeal space, retropharyngeal and prevertebral region reaching the level c4, probably determined by cellulitis. Retropharyngeal abscess fkc chu retropharyngeal abscess is a condition commonly seen in children but not so common in adult. Pediatric retropharyngeal abscess differential diagnoses. Group a streptococcus gas pharyngitis is the only commonly occurring infectious pharyngitis in which antimicrobial treatment is indicated. This approach is unusual as most previous studies report the aspiration of such abscesses through the lateral pharyngeal mucosa. Parapharyngeal abscess is a lifethreatening infection. Pdf lifethreatening parapharyngeal and retropharyngeal. Parapharyngeal abscess in children five year retrospective study. It occurs due to spread of infection form anatomical locations in the vicinity of the space. Surgical treatment of paraphyrngeal and retropharyngeal.
Among the responders, 8 of 10 abscesses were located in the retropharyngeal space alone, and 2 of 10 abscesses involved a combination of the retropharyngeal and parapharyngeal spaces. Retropharyngeal and parapharyngeal abscesses among children. Symptoms include fever, sore throat, odynophagia, and swelling in the neck down to the hyoid bone. Delay in treatment of parapharyngeal abscesses can. In small children, retropharyngeal abscesses usually occur after upper respiratory tract infections. Delay in diagnosis and treatment may lead to lifethreatening. To study the circumstances of diagnosis, predisposing factors, bacteriology and therapeutic management of parapharyngeal abscesses. Retropharyngeal and parapharyngeal abscesses among. Children find, read and cite all the research you need on researchgate. Schwannoma originating from the peripheral nerves is a rare lesion of the parapharyngeal space. Pdf acute retropharyngeal and parapharyngeal abscess is a rare but. The size of the abscess in the responders ranged from 1. Retropharyngeal abscess ear, nose, and throat disorders. Unlike in adults, these abscesses are difficult to diagnose in small children, and can rapidly develop into deep neck or mediastinal abscesses.
The parapharyngeal space blue is defined superiorly by the skull base, inferiorly by the hyoid bone. Anatomical complexity and etiology article pdf available in the medical journal of malaysia 625. Pdf parapharyngeal abscess two years after elective. Penetrating pharyngeal trauma is relatively common in children e. A retropharyngeal abscess forms when lymph nodes in the back of the throat become infected, break down, and form pus. Isolated tubercular parapharyngeal abscess masquerading as.
Parapharyngeal abscess may cause lifethreatening complications. This retrospective study over a period of 7 years concerned 16 patients hospitalized in an ent and head and neck surgery department for parapharyngeal abscess. Grant, in pediatric respiratory medicine second edition, 2008. Parapharyngeal abscess in immunocompromised patients. Ct scan is the best imaging examination for diagnosis and followup of parapharyngeal abscess. Parapharyngeal abscess merck manuals professional edition. Retropharyngeal abscess rpa is an abscess located in the tissues in the back of the throat behind the posterior pharyngeal wall the retropharyngeal space. It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of the neck. Neck swelling from a retropharyngeal abscess caused by. The usefulness of abscess tonsillectomy followed by intraoral. Parapharyngeal abscess due to catscratch disease clinical. Retropharyngeal abscesses occur in the back of the throat. Lifethreatening parapharyngeal and retropharyngeal abscess in an infant. For an optimal understanding of deep space infections, knowledge of the anatomy of the fascial planes of the neck is necessary.
The parapharyngeal pharyngomaxillary space is lateral to the superior pharyngeal. L, abscedere, to go away a suppurative infection of tissues adjacent to the pharynx, usually a complication of acute pharyngitis or tonsillitis. In the absence of pneumatization, the mastoids bony walls are thick and. Middle cerebral artery infarction following common carotid. Presentation is variable, the first symptoms of a parapharyngeal abscess are similar to those of uncomplicated acute pharyngitis or tonsiliits fever, sore throat, nasal voice, dysphonia, cervical lymphadenopathy. The aetiology of the parapharyngeal abscess was odontogenic in two patients and remained unknown in the other seven. It is a serious medical condition, potentially fatal, and requires prompt diagnosis and treatment.
This program is a must read for anyone suffering from candida or ones like me who has ever taken antibiotics and is now experiencing any of the many problems that go along with intestinal flora imbalance. Staphylococcus aureus treatment was based on triple. Mycoplasma hominisassociated parapharyngeal abscess. Parapharyngeal abscess two years after elective tonsillectomy. Parapharyngeal abscesses the journal of laryngology. Treatment of the pseudoaneurysm has evolved in recent years from surgical ligation to endovascular techniques. Mycoplasma hominis most frequently causes diseases of the genitourinary tract.
Because rpas typically occur in deep tissue, they are difficult to diagnose by physical examination alone. Since a rigid curved laryngoscope creates a wide viewing. Deep neck infections include peritonsillar abscess, retropharyngeal abscess, and lateral pharyngeal space infection also known as pharyngomaxillary or parapharyngeal space infection. Parapharyngeal and peritonsillar infection following mandibular third molar extraction. In this case report, we describe an adult case of retropharyngeal abscess who presented to us with symptoms of sore throat and dysphagia for 1. The masticator and parotid spaces are located laterally, the pharyngeal mucosal space is. Management of parapharyngeal and retropharyngeal space infections. A 56yearold woman presented to the emergency department with complaints of sore throat and cervical swelling, and a diagnosis of parapharyngeal abscess was established.
We present five cases of parapharyngeal abscess resulting from tonsillitis and peritonsillar. Classic retropharyngeal abscess in children tends to spread from infected lymph nodes following upper respiratory tract infection such as pharyngitis, tonsillitis, sinusitis, cervical lymphadenitis or dental infections. Predominant anaerobic organisms isolated in peritonsillar, lateral pharyngeal, and retropharyngeal abscesses are prevotella, porphyromonas, fusobacterium and peptostreptococcus spp aerobic organisms. Extragenital infections are uncommon, with almost all occurring in immunosuppressed persons or those predisposed due to trauma or surgery. Paranasal sinuses ct before drainage into axial slice showing beginning of epiglottis at level of parapharyngeal abscess. Computed tomography shows a lesion that has a hypodense center with peripheral ring enhancement and irregular borders. The parapharyngeal space also termed the lateral pharyngeal space, is a potential space in the head and the neck. This space is divided by the styloid process into anterior and posterior compartments. The special traits of the presented case included the following. In some cases, however, where there is only a retropharyngeal adenitis, no pus may be obtained by the first incision, but may be obtained later.
Endobuccal abscess puncture was practiced in 4 cases. A case of parapharyngeal abscess jama jama network. Internal carotid artery pseudoaneurysm is an uncommon complication of retropharyngeal and parapharyngeal abscess in children. Parapharyngeal definition of parapharyngeal by medical. Parapharyngeal and peritonsillar infection following.
Mastoid pneumatic cell tracts closure during aom plays major role in the pathogenesis of otogenic head and neck abscesses. Retropharyngeal abscess in children american academy of. Transtonsillar drainage of parapharyngeal abscess springerlink. Although these two infections have some differing symptoms,bothusuallycausefever,sorethroat,anddifficulty eating. The importance of the parapharyngeal space also lies in its relationship with the other spaces of the neck. Nov 15, 2007 patients were considered to be cured when cervical ct scan performed on d2145 was normal. Ct scan with contrast medium of the neck of a child with parapharyngeal abscess due to catscratch disease. In two cases, the abscesses in parapharyngeal space were drained by abscess tonsillectomy followed by intraoral incision of the tonsillar bed. Bezolds abcess presenting as parapharyngeal abcessc. There have been few reported pediatric cases of bilateral parapharyngeal space abscesses, and none of sequential.
We present the case of a previously well man who developed an m. Potential threat to airway should always be considered. Trismus, drooling, dysphagia, and odynophagia also are observed commonly. Retropharyngeal abscess is generally caused during throat infection as an after effect of throat infection. This case report presents a immunocompetent adult female with parapharyngeal tuberculosis masquerading as peritonsillar abscess and could only be diagnosed by gene xpert.
Management of the deep neck infection is governed by the general condition of the patient, the extent of disease and. Pdf the differential diagnoses of an abscess deep in the neck are retropharyngeal abscess and parapharyngeal abscess. A 2yearold japanese boy recently presented to our department with a chief complaint of neck swelling. Parapharyngeal abscess, odontogenic infection, pus drainage. All patients were treated by intravenous antibiotics and steroids for 57 days. Therefore, until now, the recommended treatment of parapharyngeal abscess has been early open surgical drainage. What is retropharyngeal abscesscausessymptomstreatment. Lateropharyngeal and retropharyngeal abscesses are potentially life threatening infections in children. A retropharyngeal abscess is usually caused by a bacterial infection that has spread from the tonsils, throat, sinuses, adenoids, or nose. The parapharyngeal pharyngomaxillary space is lateral to the superior pharyngeal constrictor and medial to.
Infection may spread to the jugular vein, where it may cause thrombophlebitis and septic emboli. Progression of the signs and symptoms is key as it pertains to inflammation and obstruction of the upper airways andor. The usefulness of abscess tonsillectomy followed by. Peritonsillar abscess and tonsillitis may result in parapharyngeal abscess. Pdf parapharyngeal abscess is a difficult diagnosis to make in the pediatric population. Deep neck infections include the parapharyngeal abscess, the retropharyngeal abscess and submandibular abscess. A clinical approach to tonsillitis, tonsillar hypertrophy. Parapharyngeal abscesses associated with peritonsillar and retropharyngeal abscess were all initially.
They occur at 1 of 2 primarily contiguous anatomical sites, the retropharyngeal or parapharyngeal space, and are often termed collectively as deep neck space abscesses. Parapharyngeal abscess definition of parapharyngeal abscess. A retropharyngeal abscess is medical situation where there is a pus abscess formation in the tissue located on the back of the patients throat. Microbiology and management of peritonsillar, retropharyngeal. Mri demonstrating the parapharyngeal space blue and the retropharyngeal space red. Deep neck space abscesses in the united states are more common among children than among adults 17 and may be increasing in incidence 5, 8, 9. We present three cases of ppa concomitant with pta in elderly patients. There were no treatment failures in either the antibioticonly group or the antibioticsplus.
Although rarely, it can cause pharyngitis, tonsillitis, and peritonsillar abscess. Parapharyngeal abscesses caused by group g streptococcus. Parapharyngeal abscess ppa may cause lifethreatening complications and peritonsillar abscess pta and tonsillitis frequently precede ppa. Neurologic sequelae most commonly consist of horners syndrome with cerebral ischemia being uncommon.
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