What is the efficacy of nonsurgical treatment of retropharyngeal abscess (RPA)?

Updated: Jan 08, 2021
  • Author: Joseph H Kahn, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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A prospective study in South Korea compared intravenous antibiotics plus surgical drainage with intravenous antibiotics with or without needle drainage. One case of mediastinitis occurred in the nonsurgical group. The authors concluded that, in conjunction with neck CT scanning, selected cases of parapharyngeal abscesses may be treated conservatively without early open surgical drainage. [58]

An 11-year chart review of 162 pediatric patients with retropharyngeal abscess at St. Louis Children's Hospital revealed that 126 of the patients required surgery initially, and, of the 36 patients treated medically initially, 17 required surgery. [17]

Of 24 pediatric RPAs in children treated at Starship Pediatric Hospital in Auckland, Australia, between 1999 and 2005, 10 (41.7%) required surgery, while 14 (58.3%) did not require surgery. [59]

According to a systematic review, medical treatment of pediatric deep neck abscesses may be a safe alternative to surgical drainage of these lesions, but the investigators cautioned that further studies will be needed before a more solid conclusion can be drawn. [60]

A retrospective study by Kosko and Casey suggested that in pediatric patients with a retropharyngeal or parapharyngeal abscess, intravenous antibiotic therapy alone is more likely to fail, and surgery more likely to be required, when the abscess is larger than 2 cm in diameter. [61]

Li and Kiemeney reported an association between abscess size greater than 2.2 cm and the need for surgical intervention. [12]

Vinckenbosch et al reported that surgery is indicated if the abscess size is greater than 2 cm or if there are complications or worsening of symptoms during medical treatment. [33]

Wilkie et al reported that selected pediatric deep neck space infections can be managed medically but that that abscess size greater than 2.5 cm significantly predicts whether surgical intervention is required. [56]

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