Parapharyngeal Abscess: Comprehensive Management Protocol

Abstract

Parapharyngeal infections are rare, but they cause serious morbidity and mortality. Therefore, until now, the recommended treatment of parapharyngeal abscess has been early open surgical drainage. The purpose of this study is to review the clinical course and outcome of treatment in parapharyngeal abscess according to method of treatment. A prospective study was designed for parapharyngeal abscess in patients admitted for deep neck infection. During an 8-year period, from June 1994 to January 2003, 34 patients were enrolled. All had contrast-enhanced computed tomography (CT) imaging and confirmation of an abscess in the parapharyngeal space. All patients were treated with intravenous antibiotics. We treated 19 cases (conservative group) with antibiotics only or needle aspiration and 15 (surgical group) with intraoral or external drainage. The mean duration of hospitalization was 8.2 days in the conservative group and 11.6 days in the surgical group. There was no complication except mediastinitis in 1 case of the conservative group. Because of severe dyspnea, 5 patients required tracheotomy. Neck CT scan is a useful diagnostic tool to detect and establish the treatment plan of parapharyngeal abscess. Parapharyngeal abscess may, in some cases, respond to antibiotics, become localized to the parapharyngeal space and be treated conservatively with no need for early open surgical drainage.

Deep neck abscesses: the Singapore experience

“…Securing the airways with tracheostomy or intubation is also necessary when upper airway obstruction occurs, as it is the most likely cause of fatality in this patient group [18]. While the therapeutic application of needle aspiration has been used in patients with no difference in complication rates [19], early open surgical drainage remains the definitive treatment for deep neck abscesses. If the size of the abscess is small and there are no imminent complications, a trial of conservative management may be attempted.…”

Parapharyngeal and retropharyngeal infections in children: Argument for a trial of medical therapy and intraoral drainage for medical treatment failures

“…Traditionally, parapharyngeal abscesses were approached via transcervical incision, but more recent studies have shown that transoral approaches are safe and effective with abscesses limited to the parapharyngeal space and not spreading into other deep neck spaces, or lateral to the great vessels [2,12,13]. Oh and coworkers recommend that all patients undergo a preoperative CT scan to accurately localize the abscess and prevent injuring the neurovascular structures in the posterior compartment of the parapharyngeal space [12].…”

Retropharyngeal and longus capitis intramuscular abscesses in a four year old presenting as torticollis

“…9 A number of authors have suggested using surgery only when patients do not respond to medical treatment. 8,9 Conclusion: In summary, deep neck abscess may be missed in an atypical or subclinical presentation and require a high index of suspicion. Therefore, in case of acquired torticollis with low grade fever and normal oropharyngeal findings, the diagnosis of deep space neck infection such as RPA must be ruled out.…”

“…Measurement greater than 7mm at 2 nd cervical vertebra and 22mm (in adult) and 14mm (in children) at 6 th cervical vertebra are considered abnormal and strongly support the diagnosis of RPA. 8 Most of the time, a good lateral neck X-ray is enough to establish diagnosis but CT scan is superior as it can be used to evaluate the extension of an abscess thus helping in determining treatment regimen. Medical records of 24 children with RPA were reviewed and it is reported that CT scan had a 75% accuracy for correctly identifying the abscess.…”