Retropharyngeal abscess (RPA), is a deep tissue neck infection. It is a serious and occasionally life-threatening infection due to the anatomic location and the potential for obstruction of the upper airway. The retropharyngeal space is found posterior to the esophageal wall and anterior to the prevertebral fascia. Lymph nodes found in this space drain the nasopharynx, paranasal sinuses and middle ear. Often infections of these areas will lead to infection in the retropharyngeal space. Atrophy of these lymph nodes at or before puberty has been found as an explanation of the predominance of RPAs in young children. In fact, some believe that they atrophy after 4 years of age. Once almost exclusively a disease of children, is observed with increasing frequency in adults. Retropharyngeal abscess poses a diagnostic challenge for the ENT surgeon because of its infrequent occurrence and variable presentation.

Ten cases of adult retropharyngeal abscess were reviewed. The diagnostic criteria were radiological evidence of widening of pre-vertebral soft tissue shadow and presence of pus in the swelling.

Sore throat, fever, muffled speech, painful swallow and stiffness of the neck were common presenting symptoms. Lateral X-ray of the neck was diagnostic. Commonest organism isolated was Streptococcus pyogenes. Airway obstruction was the commonest complication.

Most of the patients had history of trauma prior to the development of RPA. Computed tomography (CT) scan of neck and thorax has an important role in planning the management in addition to lateral X-ray of the neck. Transoral surgical drainage in association with antibiotics is the treatment of choice in abscesses confined to the retropharyngeal space.

Tuberculosis is no longer the commonest cause of adult retropharyngeal abscess. Sore throat or dysphagia, disproportionate to clinical findings in the throat should arouse suspicion of RPA. Early intervention with antibiotics reduces the chances of the development of complications.

Kumar N. Adult Retropharyngeal Abscess: A Retrospective Case Series. Int J Otorhinolaryngol Clin 2015;7(2):100-103.