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Cervical fascia
Superficial
Deep
Middle Deep
Superficial
Alar layer
Prevertebral layer
Retropharyngeal Space
Retropharyngeal space is a deep neck space
extending along its entire length situated posterior to the pharynx and the oesophagus and anterior to the alar layer of deep cervical fascia
It extends from the skull base to T4 i.e. the level
spaces Superior : Base of the skull Inferior : Extends upto the superior mediastinum till the level of bifurcation of the trachea Each lateral space contains retropharyngeal lymph
fascia covering lateral aspect of the pharynx medially and fascia covering pterygoid muscles, mandible and parotid gland laterally
Danger space Between prevertebral fascia and alar
fascia
Retropharyngeal Abscess
Retropharyngeal abscess (RPA) is a collection of pus in the tissues in the back of the throat behind the posterior pharyngeal wall (the retropharyngeal space) Types: Acute Retropharyngeal Abscess Chronic Retropharyngeal Abscess
Aetiology
Children Below 3 years of age - Suppuration of retropharyngeal lymph nodes secondary to infection of the Adenoids Nasopharynx Posterior nasal sinuses Nasal cavity Adults Penetrating injury of posterior pharyngeal wall or cervical oesophagus Pus from acute mastoiditis tracks along the undersurface of petrous bone to present as retropharyngeal
Symptoms
Dysphagia and difficulty in breathing
head
Bulge in the posterior pharyngeal
Signs
Systemic Fever Toxic look of the child Local Paramedian bulge in the posterior pharyngeal wall Grossly inflamed mucosa Dribbling and pooling of saliva Larynx and trachea pushed forwards Trismus is often absent
Differential Diagnosis
Croup- Breathing difficulty and a "barking" cough
Investigations
1)Lateral neck radiographs
Widening of the prevertebral
shadow Displacement of larynx and trachea forwards Straightening of cervical spine due to prevertebral muscle spasm Air shadow in prevertebral space with or without fluid level 2) CT Scan or MRI
Treatment
1) Hospitalisation 2) I.V. fluids and antibiotics 3) Incision and drainage of the abscess Usually done without anaesthesia due to risk of rupture of abscess during intubation/difficulty due to displaced or inflamed larynx/ posterior pharyngeal bulge/ non compliant patient
Treatment
Child is kept supine with head low. Mouth is opened with a gag A vertical incision is given in the most fluctuant area of the abscess. Suction should always be available to prevent aspiration of pus.
4) Tracheostomy Indicated when a large abscess causes mechanical obstruction to the airway or leads to laryngeal oedema leading to stridor
Complications
Meningitis Haemorrhage Laryngeal spasm Bronchial erosion Septicaemia Metastatic abscess Jugular vein thrombosis
pneumonia Pericardial tamponade Mediastinitis Acute hemiplegia of childhood Spread into other spaces
Aetiology
Being tubercular in nature, it is a result of
Caries of the cervical spine presents centrally
lymph nodes secondary to tuberculosis of deep cervical nodes limited to one side of the midline as in true retropharyngeal abscess behind the buccopharyngeal fascia
Symptoms
Discomfort in the throat Dysphagia (though present is not marked) Fluctuant swelling centrally or on one side of the
be present
Cervical pain may radiate to the upper limbs
Plain radiograph, CT scan or MRI of cervical spine show Caries of the spine with collapse of the body of vertebrae Prevertebral widening may be seen Median bulge on the posterior pharyngeal wall Signs of cervical spine or lymph node tuberculosis and neurological radiculopathies may be present No signs of acute inflammation
Treatment
Incision and drainage of the abscess
It can be done through a vertical incision along the anterior border of sternocleidomastoid (for low abscess) or along its posterior border (for high abscess)
Full course of anti- tubercular therapy to be given
Complications
Pus from various spaces can extend caudally Danger space : extends from base of the skull to the diaphragm and lies between prevertebral fascia and alar fascia Prevertebral Space : extends from the base of the skull to the coccyx and lies between vertebrae on one side and prevertebral muscles and fascia on the other
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