No abstract

Retropharyngeal abscess, once a relatively common entity in children, is uncommon today. From 1981 to 1991, we treated 20 cases. Abscesses secondary to upper respiratory infection in children were seen only in three (15%) cases. Trauma and foreign bodies were the most common etiologic factors in the adult subgroup. Streptococcus viridans and Klebsiella pneumoniae were the most common pathogens. The use of contrast-enhanced computed tomography has had a significant impact on the diagnostic work-up. The choice of initial antibiotic therapy is discussed. There were no deaths in this series.

Kawasaki disease is an acute, multisystem vasculitis of unknown cause usually seen in children younger than 5 years of age. The otolaryngologist is often consulted before the diagnosis is established because patients have multiple head and neck manifestations, including stomatitis, pharyngitis, and cervical adenopathy,' Involvement of deep cervical lymph nodes produces large, hypodense lesions on computed tomography (Cf) scan, which may lead to a misdiagnosis of deep neck abscess and subsequent unnecessary surgery. Kawasaki disease has surpassed acute rheumatic fever as the leading cause of acquired heart disease among young children in the United States, and diagnostic delays will only further increase the incidence of coronary artery sequelae.' We present an unusual case of Kawasaki disease mimicking retropharyngeal abscess and discuss the diagnostic and therapeutic implications for otolaryngologists involved in the care of such patients.

Post-rhinoplasty nasal obstruction is often related to narrowing in the region of the nasal valve. Correction of this obstruction can include inferior turbinectomy, septoplasty spreader grafts and nasal valvuloplasty. The authors have seen cases of severe valve stenosis related to infracture after osteotomy which did not respond to any of the aforementioned procedures. These patients were treated with revision osteotomy with outfracture. We discuss patient selection and surgical technique for revision osteotomy with outfracture as well as a cadaver dissection demonstrating the effects of infracture and outfracture on valve area. The clinical results, based on patient satisfaction and pre- and postoperative photographs, are presented. Revision osteotomy with outfracture should be included in the surgeon's armamentarium for the treatment of post-rhinoplasty nasal obstruction.