Life-threatening parapharyngeal and retropharyngeal abscess in an infant

Abstract

Severe extensive deep neck abscess in an infant is uncommon. We share the case of a previously well 4-month old infant who was referred for a 4-day history of fever, lethargy and left lateral neck swelling. Contrast-enhanced CT scan revealed a large 5.3×8 cm collection involving the left parapharyngeal and retropharyngeal space, causing significant airway narrowing. 40 mL of frank pus was drained via intraoral incision and drainage with the aid of endoscope, and undesirable complications from an external approach were averted. The infant was extubated 48 hours postsurgery and was discharged home well after completion of 1 week of intravenous antibiotics. The child was discharged well from our follow-up at 1 month review. We discuss the pathophysiology of deep neck space abscesses, its incidence in the paediatric population and the various management options.

Challenges in Diagnosis and Management of Infantile Deep Neck Abscess: A Case Report and Literature Review

“…The patient was immediately intubated, and a contrast CT scan revealed a massive left parapharyngeal and retropharyngeal abscess causing airway narrowing. The patient was treated with an emergency surgical intraoral incision and drainage with endoscopic assistance, and antibiotics (IV cefotaxime and metronidazole) were administered for one week, with complete recovery [ 19 ].…”

Extensive Parapharyngeal Abscess in a 4-Month-Old Infant

“…The main symptoms include fever, dysphagia, odynophagia, sore throat, swelling of the soft tissues of the neck, hypersalivation, restriction of oral intake, torticollis and/or trismus, and dyspnea. 1,2,5,7-9…”

Retropharyngeal abscess in a 2‐month‐old boy presenting with intermittent stridor

“…These symptoms need attention, particularly in non‐verbal infants. There are reports of infants who presented with severe respiratory distress owing to retropharyngeal abscesses 4 . Although physical findings may include swelling of the posterior pharyngeal wall, this has only been observed in <50% of infant cases whose pharyngeal space is narrow 1 .…”