Retropharyngeal abscesses in children revisited.

Retropharyngeal abscess appears in infancy and early childhood. Because of the advances in antibiotic therapy, the frequency of this disease has decreased considerably. If overlooked, however, the sequelae of retropharyngeal abscess can be disastrous. Of the typical signs and symptoms listed in presentation, the swelling of the posterior pharyngeal wall is referred to as an important diagnostic sign. This presentation will discuss the fallibility of this important sign in the evaluation of a retropharyngeal abscess in children. The size of the pediatric oral cavity and the presence of pooling secretions in the pharynx, due to retropharyngeal tissue swelling, make assessment of swelling of the posterior pharyngeal wall extremely difficult. Radiological assessment of retropharyngeal abscesses cannot differentiate between cellulitis and abscess formation. The presentation will discuss the radiological appearance of a retropharyngeal swelling and discuss the differentiation of abscess formation from cellulitis. The rationale for a therapeutic regime will be developed to validate the concept that with suggestive clinical signs, suggestive radiological diagnosis, and in spite of negative evidence of retropharyngeal swelling by oral examination, justification exists for an examination under anesthesia and incision and/or aspiration of the retropharyngeal abscess.