Deep Neck Infections in Children (Peritonsillar, Retropharyngeal, and Parapharyngeal Abscesses)

Abstract

Deep neck infections are those that start as cellulitis and phlegmon and progress to abscess formation in the spaces surrounded by deep cervical fascia. Deep neck abscesses include peritonsillar, retropharyngeal and parapharyngeal abscesses. They usually occur as a result of upper airway infections in children. Deep neck abscesses are polymicrobial infections caused by aerobic and anaerobic bacteria together. Infections in that region extend rapidly and easily to other regions of neck and can cause life threatening complications by causing injury to the vital structures of neck such as larynx, great vessels and cranial nerves. The main pathology is the acute lymphadenitis followed by suppuration of the regional lymph nodes. The main symptoms in deep neck infections are pain in the neck, limited neck motion, fever, mass or swelling at neck, dysphagia and anorexia. The choice of imaging in diagnosis of deep neck infections is contrast enhanced computed tomography (CT). However, the limitations of CT in differentiation of abscess from cellulitis and phlegmon cause problem. Thus, it is recommended to evaluate the CT findings in association with clinical findings in decision of treatment. It is usually recommended to start with IV antibiotic therapy initially in uncomplicated deep neck abscess cases and to perform surgical drainage if there is no improvement in 24-48 hours. It is important to know the anatomy, causes, clinical findings, diagnosis and treatment of these infections with high morbidity and mortality in children.