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Retropharyngeal Abscess

  1. Acute:
    1. Children
      Cause: Suppuration of retropharyngeal lymph nodes due to infection at its drainage sites:
      1. Adenoids
      2. Nasopharynx
      3. Posterior nasal sinuses or nasal cavity
    2. Adults:
      Causes: Penetrating injuries to the posterior pharyngeal wall or the cervical oesophagus
      Rarely acute mastoiditis
    3. Features:
      1. Dysphagia
      2. Fever
      3. Difficulty in breathing with stridor or croupy cough
      4. Torticollis
      5. Bulge in the posterior pharyngeal wall on one side of midline
    4. Treatment:
      1. I & D without general anesthesia
      2. Antibiotics
      3. Tracheostomy: If large causing mechanical obstruction to the airway
  2. Chronic:
    1. Causes:
      1. T.B. of the cervical spine
      2. T.B. of the retropharyngeal lymph nodes
      3. Secondary to tuberculosis of the deep cervical lymph nodes
    2. Features;                                                           
      1. Discomfort in the throat                             
      2. Pain                                                    
      3. Fever                                                
      4. Progressive neurological signs and symptoms due to spinal cord compression
      5. Neck may show tubercular lymph nodes
    3. X-ray:
      1. Pre vertebral soft tissue shadow is widened
      2. Bone destruction
      3. Loss normal curvature of the spine
    4. Treatment:
      1. External drainage:
        1. Drainage through cervical incision
        2. High abscess
          Vertical incision along the posterior border of sternocleidomastoid
        3. Low abscess:
          Vertical incision along the anterior border of sternocleidomastoid

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