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Ann Med Surg (Lond). 2016 Oct 10;11:62-65. eCollection 2016 Nov.

The effectiveness of conservative management for retropharyngeal abscesses greater than 2 cm.

Author information

1
Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago.
2
Department of General Surgery, San Fernando General Hospital, Trinidad and Tobago.
3
Department of Clinical Surgical Sciences, University of West Indies, St. Augustine, Trinidad and Tobago.

Abstract

OBJECTIVES:

Conservative management for retropharyngeal abscesses <2 cm is now a first line option. It is unclear if conservative management can be used to manage larger abscesses without increased morbidity and mortality.

STUDY DESIGN:

A prospective case series was performed from 2012 to 2015 by the Otolaryngology department of the San Fernando General Hospital involving pediatric patients who presented with retropharyngeal abscesses. All patients were initially treated with antibiotics alone.

METHODS:

Patients with clinical features and CT scan confirmation of a retropharyngeal abscess were included in the study. Those who improved clinically and biochemically within 48 h continued to be treated conservatively and those who deteriorated had surgical intervention.

RESULTS:

Sixteen patients fulfilled the inclusion criteria. Most patients were Afro Trinidadian males between the ages of two and five who were also found to be iron deficient. Drooling was a sensitive predictor for the presence of an abscess but did not indicate the need for drainage. Hoarseness was the clinical feature that prompted surgical intervention. Sixty three percent of patients had an abscess >2 cm of which 90% improved within 48 h. One patient required surgical drainage with no increase in morbidity or mortality.

CONCLUSION:

Conservative management of retropharyngeal abscesses >2 cm can be offered to patients during the first 48 h. If the patient demonstrates clinical and biochemical improvement, antibiotics alone can be continued. If the patient deteriorates, surgical drainage can be subsequently performed with no increase in morbidity and mortality.

KEYWORDS:

Conservative management; Para-pharyngeal and peri-tonsillar abscesses; Retropharyngeal

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