Surgical management of retropharyngeal space infections in children

Objective. To study the perioperative management strategies in a large grou p of pediatric patients undergoing surgical therapy for suppurative adeniti s of the parapharyngeal and retropharyngeal spaces. Study Design. Retrospec tive analysis of all patients treated surgically from January 1, 1989, to D ecember 31, 1998, in a tertiary care pediatric hospital. Methods: Charts we re reviewed for demographic data, duration and nature of symptoms, radiolog ical workup, surgical approach, complications, duration of medical therapy and antibiotic choice, and bacteriological findings. Computed tomography (C T) results were correlated to surgical findings. Results. A dramatic increa se in the incidence of deep neck space infection was seen during the study period; this increase was congruent with the increase in culture-positive g roup A beta -hemolytic streptococcal abscesses. More than two-thirds of the patients were boys with the peak incidence being in the 3- to 5-year-old g roup. The duration of symptoms before presentation was less than might be e xpected, especially in the younger age groups. Seventy of 73 children were treated with a transoral approach. Sixty-eight of 73 were successfully trea ted with one operative intervention. Irregularity of the abscess wall was f ound to be a stronger predictor of the presence of pus than the presence of ring enhancement. Conclusions. The current study represents the largest se ries of pediatric retropharyngeal abscesses in the modern medical literatur e. Changes in the disease process and in management from the first half of the century to today are reviewed, and recommendations for optimal manageme nt presented. The data in this series support a transoral approach to these abscesses unless there is extension lateral to the great vessels.