81 Retropharyngeal and Parapharyngeal Infections in Children

Abstract

Abstract Background Retropharyngeal and parapharyngeal infections are uncommon but life-threatening deep neck space bacterial infections that need prompt diagnosis and treatment for good outcomes. The retropharyngeal space contains chains of lymph nodes in young children, that atrophy and involute usually by four to five years of age. As these retropharyngeal nodes drain the nasopharynx, adenoids, posterior paranasal sinuses, and middle ear, they can get infected and suppurate following upper respiratory infections. The retropharyngeal space communicates laterally with the parapharyngeal space. Objectives To describe the presentations, diagnosis and management of retropharyngeal and parapharyngeal infections in children presenting to a tertiary care pediatric emergency department. Design/Methods A retrospective analysis of all patients diagnosed with retropharyngeal and parapharyngeal infections from 2008 to 2018 was performed. Data on demographic information, presenting symptoms, management and outcomes were extracted and analysed. Results 200 children were identified with retropharyngeal or parapharyngeal abscess during the study period. The median age was 4.04 years (2.54, 5.62): 6.50% were under 1 year of age and 5.50% were between 10-16 years of age. Fever was present in 98.5 % (197) of children, 50% had feeding issues and 36.5% (73) had neck swelling at presentation. CT scans were performed in 74% (147) of children. There were 167 retropharyngeal infections, 19 parapharyngeal infections and 4 patients had both retropharyngeal and parapharyngeal infections. All patients were admitted and treated with parenteral antibiotics, the most common being intravenous Clindamycin (in 134), followed by a combination of Ceftriaxone and Clindamycin (in 44). One third of them (66) underwent surgical drainage. Conclusion About 12 % of retropharyngeal and parapharyngeal infections can occur in infants under a year of age or in adolescents. Most paediatric patients with retropharyngeal and parapharyngeal abscesses can be treated non-operatively with parenteral antibiotics and do not require surgery.