Acute retropharyngeal and parapharyngeal abscesses in children

Objective: Acute retropharyngeal and parapharyngeal abscess is a rare but serious disease in children. We reviewed our experience highlighting some of the unusual features of our cases. Methods: Medical records of children less than 12-years-old who were admitted to King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, over a 10-year period with final diagnosis of deep neck infection, were reviewed. Results: Eight patient's records were reviewed. Seven were less than 3-years of age. The retropharyngeal abscess was suspected clinically in 3 cases only. The most common findings were fever, neck swelling and feeding problems. The duration of symptoms and signs were so variable. The most helpful diagnostic tests were direct visualization and computerized tomography scan of the cervical area. The combination of retropharyngeal and parapharyngeal abscess was encountered in 4 patients. Cefuroxime was the drug of choice in all patients. Five patients responded to conservative management with antibiotics alone. Two cases had unusual presentation, one with subacute neck swelling, and one with severe airway compromise one week after manipulation of the tonsils by traditional therapist. Conclusion: High index of suspicion is warranted in such rare and life threatening disease. Special attention should be directed to the parapharyngeal entity, which was not suspected clinically in any case. The use of traditional medicine could have serious consequences in some patients.