830 views

Transoral Incision and Drainage of a Massive Retropharyngeal Abscess Involving the Danger Space

Retropharyngeal (RP) abscesses are uncommon yet serious sequala of pediatric head and neck
infections. The RP space extends from the skull-base to the carina and is located between the
buccopharyngeal fascia, alar fascia, and the carotid sheaths. Immediately deep to this, anterior
to the prevertebral fascia, is the “danger space,” allowing infection to spread into the thorax
and mediastinum. We present the use of a transoral incision, and suction assisted evacuation
for managing a massive RPA with danger space extension.
Our patient, a 19 months-old previously healthy female, presented with 10 days of progressive
congestion, cough, and fever. Evaluation demonstrated a toxic stridorous child. Chest
radiograph demonstrated significant superior mediastinal widening. Subsequent contrasted CT
imaging demonstrated a large, rim-enhancing, RP fluid collection extending from the neck to
the carina with tracheoesophageal compression and mediastinitis. The patient was taken
urgently the OR for drainage. Following bronchoscopy and intubation, a mouth gag was used to
expose the RP. Parasagittal incision was made with immediate expression of high volume
purulent material. Hemostat dissection was performed to disrupt loculations and extrinsic neck
compression was used to evacuate the abscess. To access the deepest components, an eight
French tracheal suction catheter was passed to assist with decompression of the mediastinal
components until no further material could be evacuated. Copious irrigation was performed
and the incision was left open. The patient was kept intubated for 48 hours, before uneventful
extubation.

Transoral Incision and Drainage of a Massive Retropharyngeal Abscess Involving the Danger Space
Retropharyngeal (RP) abscesses are uncommon yet serious sequala of pediatric head and neck infections. The RP space extends from the skull-base to the carina. Immediately deep to this, anterior to the prevertebral fascia, is the “danger space,” allowing infection to spread into the thorax and mediastinum. Possible complications of RP abscess are mass effect causing airway compromise, rupture of the abscess into the airway or mediastinum and spread of infection locally inferiorly to the mediastinum and pericardium, laterally to the neck or posteriorly to the spine. The local infection can spread systemically as well and result with sepsis. Airway protection followed by surgical incision and drainage are the first line of therapy, followed by systemic antibiotics.
None
Direct laryngoscopy and bronchoscopy, followed by endotracheal intubation. Preparation for a potential “difficult intubation”. Craw Davis Mouth gag 1% lidocaine with 1:100,000 epinephrin for local anesthesia Curved hemostat 8 Fr flexible catheter Copious irrigations with sterile saline
Chest Xray (AP and lateral) are often used to confirm the diagnosis, followed by neck and chest CT
Posterior pharyngeal wall Buccopharyngeal fascia Retropharyngeal space
N/A
Bleeding (neck and chest) Rupture of the abscess into the airway/ mediastinum
None
None
N/A

Review Transoral Incision and Drainage of a Massive Retropharyngeal Abscess Involving the Danger Space.

Your email address will not be published.

Related Videos

Sponsored Videos

Register today to continue watching

Sign up for our free membership to watch and submit videos today! If you are already a member please log in to access your account.

Sign Up Now

Already a member? Click here to log in

Register today to submit a video

Sign up for our free membership to watch and submit videos today! If you are already a member please log in to access your account.

Sign Up Now

Already a member? Click here to log in

Upgrade your membership to continue watching

Please upgrade to membership to continue watching more videos.

Upgrade Now

Renew your subscription to continue watching

Please renew your subscription to continue watching.

Renew Now

Create An Author

Create A User

Create A Term