Retropharyngeal and parapharyngeal abscess: experience in a tertiary-care center in Seville during the last decade

Introduction: Retropharyngeal and parapharyngeal abscesses are rare but associated with significant morbidity and potential mortality. This study reviews our experience in the diagnosis and management of retro- and parapharyngeal abscesses and compares children treated conservatively with those undergoing surgical intervention. Material and methods: A retrospective analysis of children diagnosed with retro- and parapharyngeal abscess from 2000 to 2009 in our tertiary-care centre. Results: Thirty-one children were identified. There were 17 retropharyngeal abscesses and 11 parapharyngeal abscesses; 3 children suffered from both conditions. The mean annual frequency increased significantly from 1.4 cases/year during 2000-2004 to 4.8 cases/year during 2005-2009 (P=.006). Median age was 3 years (range 1-10). A total of 18 (58%) children had received pre-admission oral antibiotics (beta-lactams in 84%). Clinical findings at presentation were: fever (93%), cervical lymphadenopathy (93%), neck pain (90%), torticollis (74%), odynophagia (64%), trismus (32%), drooling (22%) and stridor (6%). Thirteen (42%) children underwent surgical intervention, of those, microbiological culture was positive in 8 children; S. pyogenes being the most commonly isolated organism (n = 4). All the patients received parenteral antibiotic therapy. There were no significant differences in the length of hospital stay, complication or recurrence rates between children treated conservatively compared to those undergoing surgical intervention. Conclusions: Retro- and parapharyngeal abscesses were increasingly observed during the 2(nd) part of the study period. The majority of children (58%) were treated conservatively with excellent clinical response. Indication for surgical intervention should be made based on the clinical presentation and response to antibiotic therapy. (C) 2010 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L. All rights reserved.