Management of a Massive Retropharyngeal Abscess Through an External Cervical Approach: A Case Report

TL;DR

A 14-year-old boy with a large retropharyngeal abscess was successfully treated with surgery and antibiotics, leading to significant improvement.

Contribution

This case report presents a successful management approach for a massive retropharyngeal abscess using an external cervical surgical technique.

Findings

Surgical incision and drainage via a cervical approach effectively treated a large retropharyngeal abscess.

Combination of intravenous antibiotics, corticosteroids, and surgical intervention led to marked clinical improvement.

The patient showed rapid recovery and was able to tolerate a soft diet post-treatment.

Abstract

Retropharyngeal abscess appears to be decreasing in incidence in older children. It can be caused by local trauma to the posterior pharynx. Contributing risk factors include poor oral hygiene, diabetes, immunocompromised states, and low socioeconomic status. Early diagnosis is essential, as it may lead to potentially life-threatening dyspnea that requires rapid airway management.

A 14-year-old boy was referred to our hospital with complaints of dyspnea, rapidly progressive dysphagia, and high-grade fever for four days. The patient reported a history of neck pain and stiffness over the past twenty days. Physical examination was remarkable for stridor, inspiratory wheezing, and mild lower neck swelling. A lateral neck radiograph was initially performed, followed by a neck CT with contrast conducted in the emergency department, which demonstrated a rim-enhancing retropharyngeal abscess measuring approximately 10.5 x 3.4 x 5.4 cm, extending from the C3 to T3 level, displacing the esophagus and trachea anteriorly with associated mild to moderate narrowing of the airway. A smaller abscess was also identified adjacent to the primary lesion, measuring approximately 5.3 x 1.3 x 0.8 cm, at the level of C5 to T2. The patient was admitted to the ICU under the care of the otorhinolaryngology department. The airway was maintained, and intravenous antibiotics and corticosteroids were initiated. Surgical incision and drainage of the abscess through a cervical approach were carried out. The wound was irrigated, and a 10-Fr closed-suction drain (BIOVAC™, Biometrix™ Critical Care Solutions, QMD - Quality Medical Devices, Slovakia) was inserted through the left anterior cervical incision, advanced 3 cm into the abscess cavity, and connected to continuous suction; the procedure was performed in conjunction with the thoracic surgery team. The patient was transferred to the ward, where he showed marked improvement in respiratory distress and was able to tolerate liquids, followed by a soft diet.

The administration of intravenous antibiotics and corticosteroid therapy, along with surgical incision and drainage of the retropharyngeal abscess, was effective in treating this patient’s condition and ended with marked clinical improvement.

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