Discussion
Retropharyngeal abscesses are uncommon but potentially lethal infections. An early diagnosis and the widespread use of antibiotics have led to a considerable reduction in the incidence of major
complications and mortality which were previously associated with this condition (1). A significant proportion of untreated cases used to dissect into the posterior mediastinum causing mediastinitis,
pleuritis, and pericarditis. Spontaneous rupture into the pharynx have resulted in aspiration pneumonia and empyema. Other reported complications include upper airway obstruction, sepsis, and major
vessel erosion. The patients may present with a sore throat, dysphagia, reduced oral intake with or without drooling, odynophagia, ‘hot potato’ or hyponasal speech, trismus, otalgia,
headache, neck pain, cervical rigidity, torticollis, malaise, fever, and partial or rarely total airway obstruction. An examination reveals a bulging of the posterior pharyngeal wall. It is important
to note that this does not necessarily occur in the midline, as the raphe of the superior constrictor muscle attaches to the prevertebral fascia here. The aetiology of retropharyngeal abscesses
differs in adult and paediatric populations (1). In children, the retropharyngeal space contains lymph nodes which drain the ears, nasopharynx, paranasal sinuses and the soft palate. Abscesses are
usually related to the spread of infection to these nodes, typically following an upper respiratory tract infection. Children under the age of six years are most likely to be affected. In contrast,
abscesses in adults are usually secondary to trauma (e.g. intubation and oesophagoscopy) and foreign bodies. The upper respiratory tract infections and idiopathic groups also account for a
significant proportion (2). Abscesses in adults have occurred following odontogenic infection and cervical vertebrae fracture, and have been observed in patients with tuberculosis, syphilis,
diabetes, malignancy and chronic alcoholism. The most commonly cultured organisms include Staphylococcus aureus, Group A Beta-haemolytic streptococcus, Klebsiella species, and anaerobes such as
Bacteroides. The antibiotic chosen for treatment must provide cover for both aerobes and anaerobes, and be adjusted according to the microbiological culture and the sensitivity data. The lateral soft
tissue neck plain film is a quick and reliable method of confirming the diagnosis (3). The characteristic features seen include a widening of the retropharyngeal space, loss of the normal cervical
lordosis, and the presence of air in the soft tissues. A CT scan provides further detailed information which may be useful to the surgeon. It can differentiate between cellulitis and abscesses in
most cases. It can accurately localise the level of the abscess, define its relationship to the surrounding vascular structures, and determine if other neck spaces are involved. The management of
this condition consists of ensuring airway safety, the administration of intravenous antibiotics, and surgical drainage. In most cases, trans-oral drainage can be done. For situations in which there
is the involvement of other deep neck spaces or a proximity to great vessels, external drainage is preferred.