RETROPHARYNGEAL ABSCESS

Applied Anatomy

1. Retropharyngeal Space

• Boundaries: Between Buccopharyngeal fascia (anterior) and Prevertebral fascia (posterior).
• Extent: Base of skull → Bifurcation of Trachea (mediastinum).
• Compartments: Divided into two lateral spaces (Spaces of Gillette) by a fibrous raphe.
• Contents: Retropharyngeal lymph nodes (Usually disappear by 3-4 years of age).

2. Prevertebral Space

• Location: Posterior to Retropharyngeal space (behind prevertebral fascia).
• Extent: Base of skull → Coccyx.
• Significance: Infection usually from Caries Spine (TB). Causes a Midline Bulge.

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I. Acute Retropharyngeal Abscess

Etiology

• Age: Children < 3 years (due to presence of LN).
• Cause: Suppuration of retropharyngeal nodes secondary to infection in adenoids, sinuses, or nose.
• In Adults: Penetrating injury (fish bone) or extension from mastoiditis (rare).

Clinical Features

• Dysphagia & Dyspnoea: Prominent due to obstruction.
• Stridor: Croupy cough.
• Torticollis: Neck stiff, head kept extended.
• Examination: Unilateral bulge in posterior pharyngeal wall.

Diagnosis (Imaging)

• X-ray Neck (Lateral): Widening of prevertebral shadow +/- Gas.
• CT Scan: Shows extent and possible spread to mediastinum.

Treatment

1. Incision & Drainage:
   • Usually done without anaesthesia (risk of rupture during intubation).
   • Position: Supine with Head Low (Rose's position).
   • Incision: Vertical, over most fluctuant area.
   • *Suction must be ready to prevent aspiration.
2. Systemic Antibiotics.
3. Tracheostomy: If mechanical obstruction causes laryngeal oedema.

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II. Chronic Retropharyngeal Abscess

Etiology

Always Tubercular in nature.

• Type A: Caries of Cervical Spine → Pus behind prevertebral fascia.
• Type B: TB of Retropharyngeal Nodes → Pus in retropharyngeal space.

Comparison: Acute vs. Chronic

Feature	Acute Abscess	Chronic (TB Spine)
Cause	Pyogenic (Staph/Strep).	Tuberculosis (Pott's Spine).
Onset	Rapid/Acute.	Insidious/Slow.
Position of Bulge	Unilateral (Lateral space).	Central / Midline.
Dysphagia	Severe.	Mild / Discomfort only.
Incision Approach	Intra-oral (Vertical incision).	External (Behind Sternocleidomastoid). *Do NOT open intra-orally (risk of secondary infection).

Treatment (Chronic)

1. Drainage: External approach (anterior or posterior border of Sternomastoid).
2. ATT: Full course of Antitubercular therapy.
📚 Ref: Diseases of Ear, Nose & Throat (Dhingra)