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A relatively rare but potentially life-threatening infection occurring in the potential space between the posterior pharyngeal wall and prevertebral fascia
Children <6 years of age are most at risk, with 50% of the cases occurring in those <48 months of age.
Most large children’s hospital centers report 1–5 cases per year.
- Most infections result from pharyngitis or supraglottitis and occur because of suppuration of the retropharyngeal lymph nodes, which lie in 2 paramedial chains and drain various nasopharyngeal structures and sinuses.
- These lymph gland chains disappear in childhood; thus, retropharyngeal abscesses are most common in infancy and early childhood.
- Cellulitis of the retropharyngeal area leads to formation of a phlegmon, which matures into an abscess.
- Other sources of infection in this space, often seen in older children and adolescents, include penetrating trauma of the posterior pharynx (e.g., foreign object aspiration, dental procedures, attempts at intubation).
- Extension of infection into this space can arise from vertebral body osteomyelitis or a dental abscess.
- Infectious: Cultures frequently reveal multiple organisms.
- The predominant organisms isolated include the following:
- Streptococcus (group A and others)
- Staphylococcus aureus
- Various anaerobic species (e.g., Bacteroides, Peptostreptococcus, Fusobacterium)
- Many of the isolates are β-lactamase producers.