What is the anatomy of the retropharyngeal space relevant to deep neck infections?

Updated: Apr 30, 2020
  • Author: Alan D Murray, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Retropharyngeal space

  • The retropharyngeal space is sometimes considered a third medial compartment within the parapharyngeal space because the 2 communicate laterally. This space lies between the visceral division of the middle layer of the deep cervical fascia around the pharyngeal constrictors and the alar division of the deep layer of deep cervical fascia posteriorly. It extends from the skull base to the tracheal bifurcation around T2 where the visceral and alar divisions fuse. It primarily contains retropharyngeal lymphatics.

  • Infection may enter this space directly, as with traumatic perforations of the posterior pharyngeal wall or esophagus, or indirectly, from the parapharyngeal space. More than 60% of retropharyngeal abscesses in children are caused by upper respiratory tract infections, whereas most infections in adults in this region are caused by trauma and foreign bodies. Other common sources of infection in the retropharyngeal space are the nose, adenoids, nasopharynx, and sinuses.

  • Infections of this space may drain into the prevertebral space and follow that space into the chest. Mediastinitis and empyema ensue. Abscess in this space may push forward, occluding the airway at the level of the pharynx. It may appear as anterior displacement of one or both sides of the posterior pharyngeal wall because of involvement of lymph nodes, which are distributed lateral to the midline fascial raphe.

  • Retropharyngeal lymph nodes tend to regress by about age 5 years, making infection in this space much more common in children than adults.

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