RELATIVE INCIDENCE AND ALTERNATIVE APPROACHES FOR SURGICAL DRAINAGE OF DIFFERENT TYPES OF DEEP NECK ABSCESSES IN CHILDREN

Objectives: To determine the relative frequency of retropharyngeal abs cesses (RPAs) vs lateral pharyngeal abscesses (LPAs) and to analyze al ternative approaches for surgical drainage. Design: Retrospective char t review. Setting: Tertiary care children's hospital. Patients: Sevent y pediatric patients who were evaluated, admitted, and treated for pre sumed deep neck abscesses (RPAs and LPAs) between January 1, 1986, and December 31, 1996. Intervention: Intravenous antibiotic therapy and s urgical drainage. Main Outcome Measure: Clinical resolution of the abs cess. Results: Fifty-eight patients were evaluated with computed tomog raphic scan. Thirteen of these patients did not have surgical interven tion. Of 12 patients diagnosed as having an isolated RPA, all had intr aoral surgical drainage and 9 had evidence of pus at surgery. Twenty-o ne patients had an isolated LPA. Sixteen of these underwent intraoral drain age and 5 underwent external drainage. Purulence was found at su rgery in 14 and 2 patients, respectively. The remaining 12, patients h ad a combination of RPA and LPA. Eight patients underwent intraoral dr ainage, and 4 patients required both intraoral and external approaches . Purulence was found at surgery in 5 and 4 patients, respectively. Of the 12 patients who were not evaluated with computed tomographic scan , two thirds were treated prior to 1987. Six of these 12 patients unde rwent surgical drainage via an intraoral approach, and 4 of the 6 pati ents had pus. The remaining 6 improved without surgery. Conclusions: M ost deep neck abscesses in children are located in the retropharyngeal or in the:lateral pharyngeal space medial to the great vessels. There fore, most can be managed successfully with intraoral rather than exte rnal drainage. External approaches are better re served for those absc esses that are lateral to the great vessels or that involve multiple s paces. In this patient population, LPAs were more commonly seen than R PAs.