DESCRIPTION

A relatively rare but potentially life-threatening infection occurring in the potential space between the posterior pharyngeal wall and prevertebral fascia

EPIDEMIOLOGY

• Winter-spring seasonality
• Children <5 years are at highest risk.
• 4.1 per 100,000 children <20 years old
• Male-to-female ratio 2:1

PATHOPHYSIOLOGY

• Most infections result from pharyngitis or supraglottitis and occur because of suppuration of the retropharyngeal lymph nodes, which lie in two paramedian 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.

ETIOLOGY

• Infectious: Cultures often 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.