What is the role of surgery in the treatment of a retropharyngeal abscess (RPA)?

Updated: Jan 08, 2021
  • Author: Joseph H Kahn, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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See the list below:

  • Once the diagnosis of retropharyngeal abscess is suspected, consult an ENT, initiate fluid resuscitation (if indicated), initiate intravenous antibiotics, and carefully monitor the airway.

  • If any signs of respiratory distress are present, the patient may require airway management in the OR, with surgeon and anesthesiologist present.

  • Careful monitoring of airway status is essential and may require intensive care unit admission, even in the absence of respiratory distress in the ED.

  • The ENT physician decides whether to incise and drain the abscess in the operating room or whether a trial of medical therapy is indicated first.

  • Incision and drainage of retropharyngeal abscess in the ED may lead to aspiration and generally is not recommended.

  • 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]

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