Citation Information :
Chalkiadakis V, Stamataki S, Pantazopoulos T. A Delayed Diagnosis of a Retropharyngeal Abscess in a 38-day-old Neonate: A Case Report and Review of the Literature. Int J Otorhinolaryngol Clin 2021; 13 (3):129-132.
Objectives: Retropharyngeal abscess is very rare in neonates. Its clinical presentation, severity, and management may share different characteristics when compared to young children or adults. Precise physical examination can be difficult and imaging may be required. Management of this clinical entity includes both intravenous antibiotic therapy and surgical drainage. The aim of this case report is to evaluate clinical presentation and management of retropharyngeal abscesses in neonates.
Methods: We report the case of a delayed diagnosis of a retropharyngeal abscess in a 38-day-old neonate that was admitted to the emergency department of our hospital.
Results: Interestingly, our patient had not been diagnosed at the first examination due to insidious clinical symptoms. This reminds us the importance of accurate history and detailed clinical examination. His condition deteriorated gradually. Although surgical drainage of the abscess was performed as soon as it was diagnosed, postoperative complications were not avoided.
Conclusion: A retropharyngeal abscess remains a life-threating condition, with high mortality and morbidity. In neonates, diagnosis is challenging due to the variety of symptoms. Given the higher incidence of airway obstruction in these patients, early surgical intervention is usually essential. When complications are present, a multidisciplinary approach is required.
Elsherif AM, Park AH, Alder SC, et al. Indicators of a more complicated clinical course for pediatric patients with retropharyngeal abscess. Int J Pediatr Otorhinolaryngol 2010;74(2):198–201. DOI: 10.1016/j.ijporl.2009.11.010.
Coticchia JM, Getnick GS, Yun RD, et al. Age, site and time specific differences in pediatric deep neck abscesses. Arch Otolaryngol Head Neck Surg 2004;130(2):201–207. DOI: 10.1001/archotol.130.2.201.
Chang L, Chi H, Chiu NC, et al. Deep neck infections in different age groups of children. J Microbiol Immunol Infect 2010;43(1):47–52. DOI: 10.1016/S1684-1182(10)60007-2.
Grisaru-Soen G, Komisar O, Aizenstein O, et al. Retropharyngeal and parapharyngeal abscess in children-Epidemiology, clinical features and treatment. Int J Pediatr Otorhinolaryngol 2010;74(9):1016–1020. DOI: 10.1016/j.ijporl.2010.05.030.
Oh JH, Kim Y, Kim CH. Parapharyngeal abscess: comprehensive management protocol. ORL J Otorhinolaryngol Relat Spec 2007;69(1):37–42. DOI: 10.1159/000096715.
Metin O, Oz FN, Tanir G, et al. Deep neck infections in children: experience in a tertiary care center in Turkey. Turk J Pediatr 2014;56(3):272–279. PMID: 25341599.
Wong DKC, Brown C, Mills N, et al. To drain or not to drain–management of pediatric deep neck abscesses: a case control study. Int J Pediatr Otorhinolaryngol 2012;76(12):1810–1813. DOI: 10.1016/j.ijporl.2012.09.006.
Asmar B. Bacteriology of retropharyngeal abscess in children. Pediatr Infect Dis J 1990;9(8):595–597. PMID: 2235179.
Vieira F, Allen SM, Stocks RM, et al. Deep neck infection. Otolaryngol Clin North Am 2008;41(3):459–483. DOI: 10.1016/j.otc.2008.01.002.
Daya H, Lo S, Papsin BC, et al. Retropharyngeal and parapharyngeal infections in children: the Toronto experience. Int J Pediatr Otorhinolaryngol 2005;69(1):81–86. DOI: 10.1016/j.ijporl.2004.08.010.
Baldassari CM, Howell R, Amorn M, et al. Complications in pediatric deep neck space abscesses. Otolaryngol Head Neck Surg 2011;144(4):592–595. DOI: 10.1177/0194599810393882.
Buckley J, Harris AS, Addams-Williams J. Ten years of deep neck space abscesses. J Laryngol Otol 2019;133(4):324–328. DOI: 10.1017/S0022215119000458.
Brito TP, Hazboun IM, Fernandes FL, et al. Deep neck abscesses: study of 101 cases. Braz J Otorhinolaryngol 2017;83(3):341–348. DOI: 10.1016/j.bjorl.2016.04.004.
Kanazawa Y, Asai M, Adachi Y, et al. Retropharyngeal abscess in a neonate: a case report and literature review. Int J Pediatr Otorhinolaryngol 2012;7(3):115–118. DOI: 10.1016/j.pedex.2012.03.003.
Jain A, Singh I, Meher R, et al. Deep neck space abscesses in children below 5 years of age and their complications. Int J Pediatr Otorhinolaryngol 2018;109:40–43. DOI: 10.1016/j.ijporl.2018.03.022.
Corte FC, Firmino-Machado J, Moura CP, et al. Acute pediatric neck infections: outcomes in a seven-year series. Int J Pediatr Otorhinolaryngol 2017;99:128–134. DOI: 10.1016/j.ijporl.2017.05.020.
Shimizu Y, Hidaka H, Ozawa D, et al. Clinical and bacteriological differences of deep neck infection in pediatric and adult patients: review of 123 cases. Int J Pediatr Otorhinolaryngol 2017;99:95–99. DOI: 10.1016/j.ijporl.2017.05.028.
Gharib B, Mohammadpour M, Sharifzadeh M, et al. A 15-month old boy with respiratory distress and parapharyngeal abscess: a case report. Acta Med Iranica 2016;54(12):812–816. PMID: 28120594.
Abdel-Haq N, Quezada M, Asmar BL. Retropharyngeal abscess in children: the rising incidence of methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J 2012;31(7):696–699. DOI: 10.1097/INF.0b013e318256fff0.
Wang Y, Sing N, Mernagh J. Retropharyngeal abscess: its evolution and imaging assessment. OMICS J Radiol 2013;2:5. DOI: 10.4172/2167-7964.1000127.
Huang CM, Huang FL, Chien YL, et al. Deep neck infections in children. J Microbiol Immunol Infect 2015;15:843–849. DOI: 10.1016/j.jmii.2015.08.020.
Cheng J, Elden L. Children with deep space neck infections: our experience with 178 children. Otolaryngol Head Neck Surg 2013;148(6):1037–1042. DOI: 10.1177/0194599813482292.
Jenkins IA, Saunders M. Infections of the airway. Pediatr Anesth 2009;19:118–130. DOI: 10.1111/j.1460-9592.2009.02999.x.
Lalakea ML, Messner AH. Retropharyngeal abscess management in children: current practices. Otolaryngol Head Neck Surg 1999;121(4):398–405. DOI: 10.1016/S0194-5998(99)70228-7.
Hoffmann C, Pierrot S, Contencin P, et al. Retropharyngeal infections in children. Treatment strategies and outcomes. Int J Pediatr Otorhinolaryngol 2011;75(9):1099–1103. DOI: 10.1016/j.ijporl.2011.05.024.
Balasubramanian A, Redzwan Shah J, Gazali N, et al. Life-threating parapharyngeal and retropharyngeal abscess in an infant. BMJ Case Rep 2017;bcr2017221269. DOI: 10.1136/bcr-2017-221269.
Lawrence R, Batemann N. Controversies in the management of deep neck space infection in children: an evidence-based review. Clin Otolaryngol 2017;42(1):156–163. DOI: 10.1111/coa.12692.
Woods CR, Cash ED, Smith AM, et al. Retropharyngeal and parapharyngeal abscesses among children and adolescents in the United States: epidemiology and management trends, 2003-2012. J Pediatr Infect Dis Soc 2016;5(3):259–268. DOI: 10.1093/jpids/piv010.