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Pseudomonas organism. He was nursed in paediatric intensive care unit and was administered oral glycerol and high doses of intravenous antibiotics against gram positive, gram negative and anaerobic organisms. HRCT temporal bone (Fig 1) revealed right sided mastoiditis with an abscess under the temporalis muscle. There was cerebritis, transverse sinus thrombosis with empyema along the inferior border of the tentorium cerebelli on the right side (Fig 2). Neurosurgical consultation warned of considerable risk in draining a small subdural empyema and recommended continuation of conservative therapy. After a week of antibiotic cover child was taken up for a tympanomastoid exploration under general anaesthesia. By a postaural approach the mastoid was exposed. There was an abscess pocket below the temporalis muscle that was fully evacuated and granulation tissue debrided. The surface of the mastoid did not reveal any erosion. Some pus was seen to be draining from the region of the mastoid emissary vein. A canula was inserted in the foramina and suction applied. Mastoidectomy was performed

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there being no signs of any acute inflammation. No spinal tenderness, neck swelling or lymphadenopathy were detected. Indirect laryngoscopy revealed pooling of saliva and mild oedema of the supraglottic larynx without any airway compromise. A clinical diagnosis of acute retropharyngeal abscess with possible extension to parapharyngeal space was made. Urgent X-ray of soft tissues of the neck showed loss of cervical lordosis and gross widening of prevertebral soft tissues (Fig 1). Investigations revealed Hb-11.6 gm% with mild leucocytosis. Blood urea was raised marginally possibly due to dehydration which later became normal. X-ray chest and cervical spine, other biochemical parameters, blood culture and ultrasonography of abdomen were normal. He tested negative for HIV. CT scans showed a well defined retropharyngeal abscess with ring enhancement on right side extending from the skull base to the level of the fourth cervical vertebrae (Fig 2). There was associated cellulitis of the parapharyngeal space. Initial antibiotic therapy consisted of intravenous cefotaxime, gentamycin-later discontinued due to raised blood urea, and metronidazole. After 24 hours of antibiotic therapy and rehydration the abscess was drained perorally under general anaesthesia administered by an experienced anaesthesiologist. Using tonsillectomy