Retropharyngeal abscess
Introduction
Introduction to retropharyngeal abscess Retropharyngeal abscess (retropharyngealabscess), occurs in the posterior pharyngeal space, mostly due to post-pharyngeal lymph node infection caused by suppuration, divided into acute and chronic two types, acute are more common in children. Chronic is rare, many cervical tuberculosis formation abscess, also known as cold abscess. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: secondary mediastinal infection pneumonia traumatic asphyxia
Cause
Cause of posterior pharyngeal abscess
The posterior pharyngeal space is located behind the posterior pharyngeal wall, between the buccal pharyngeal fascia and the wing fascia, up to the mediastinum under the skull base, adjacent to the parapharyngeal space on both sides, which is a potential fascial space containing loose connective tissue, and is swallowed by the pharynx. The slit is divided into two parts. The infant's posterior pharyngeal space is rich in lymph nodes. These lymph nodes receive part of the lymphatic drainage in the posterior part of the nasal cavity, the nasopharynx, the eustachian tube and the middle ear. Therefore, the acute inflammation of the above part can be infected by the lymphatic route. Causes purulent lymphadenitis and abscess, the lymph nodes of the pharynx gradually disappears from 3 to 8 years old, so the disease mostly occurs in children under 3 years old, some cases may be infected by the posterior pharyngeal wall and infected, or spread by inflammation in the adjacent area. As a result, the pathogen is the same as the abscess around the tonsils.
Prevention
Post-pharyngeal abscess prevention
Post-pharyngeal abscess should be cautious and gentle when using finger touch. It should also be fully prepared for puncture or incision, such as suction device, direct laryngoscope, etc., so as to avoid sudden rupture of abscess, pus into the respiratory tract and even suffocation or even death.
Complication
Post-pharyngeal abscess complications Complications secondary mediastinal infection pneumonia traumatic asphyxia
Post-pharyngeal abscess in children is an acute condition. Delayed treatment or improper treatment can be life-threatening. The downward extension of the abscess can cause laryngeal obstruction or mediastinal infection. Spreading into the parapharyngeal space to the outside can erode the large blood vessels of the neck and cause fatal bleeding. Sudden rupture of the abscess can cause aspiration pneumonia or suffocation. Therefore, you should gently touch and check the pharynx. Once the abscess is broken, immediately take the head down and use the tongue depressor to open it so that it can be opened. The pus flows out or is aspirated with an aspirator.
Symptom
Symptoms of retropharyngeal abscess Common symptoms Cervical lymphadenopathy, difficulty breathing, sore throat, fever, chills, irritability, restlessness, diarrhea, abscess, suffocation
According to the history, symptoms, signs and puncture, the diagnosis of posterior pharyngeal abscess is not difficult. The lateral radiograph of the anterior pharynx and the soft tissue shadow of the anterior vertebrae can be seen on the lateral radiograph of the neck, or the water surface is displayed, which is helpful for diagnosis. .
Most of the sick children have upper respiratory tract infections, acute onset, fever, crying, irritability, refusal to eat due to sore throat, usually form an abscess 2 to 3 days after the onset of the disease, after the abscess formation, the posterior pharyngeal wall bulge In the pharyngeal cavity, there are different degrees of difficulty in swallowing and poor breathing. Infants crying like ducks, breast milk can be reversed into the nasal cavity or causing cough. Larger children can express ambiguity and snoring. Inspiratory wheezing and inspiratory dyspnea, and may appear purpura, dehydration, acidosis and systemic failure, such as abscess compression throat entrance or complicated laryngitis, sudden suffocation.
Check the head of the child to lean back slightly and lean toward the affected side to relieve pain and poor breathing, limited neck activity, swelling of the lower jaw and neck lymph nodes, tenderness, pharyngeal mucosal congestion, pharyngeal wall bulging, and more On one side, the touch is soft or fluctuating. The abscess is close to the ipsilateral pharyngeal arch and soft palate or it is pushed forward. The puncture can extract pus.
Examine
Examination of retropharyngeal abscess
The head of the child often leans forward and leans toward the affected side. The saliva overflows, the affected neck lymph nodes enlarge, and there is tenderness. Be careful when examining the pharynx in children with suspected post-pharyngeal abscess to prevent the sudden rupture of the abscess and cause a large amount of pus to flow into the respiratory tract. Sudden death occurs, so the head should be used in the low-level supine position, but the cervical tuberculosis should not be over-rear, and prepare the suction device just in case, check the side of the posterior pharyngeal bulge, mucosal congestion, when the abscess is large Push the affected pharyngeal arch and soft palate forward, the abscess is soft and fluctuating, but the operation must be gentle. The cold abscess caused by cervical tuberculosis can be located in the central part. There is no obvious hyperemia in the local mucosa. X-ray film of the cervical spine can show the soft tissue shadow of the anterior vertebral vertebral body. Sometimes the fluid level and cervical bone destruction signs are visible, and the erythrocyte sedimentation rate increases.
Diagnosis
Diagnosis and diagnosis of retropharyngeal abscess
Need to differentiate from tuberculous abscess: tuberculous pharyngeal abscess, "no fever" abscess caused by cervical tuberculosis or lymphatic tuberculosis in the posterior pharyngeal space, abscess caused by cervical tuberculosis in the anterior intervertebral space, can be broken later to form the posterior pharynx Cold abscess in the gap, the disease is more common in adults or older children, with a history of tuberculosis, slow onset, accompanied by chronic cough, low fever in the afternoon, night sweats, weight loss and other systemic symptoms. This abscess is bulging, mostly in the center of the posterior pharyngeal wall. The pus is thin, and the tubercle bacillus can be found. CT scan or X-ray film of the cervical spine can understand cervical lesions. In addition, the patient has no difficulty in stretching the tongue and opening the mouth. It can be differentiated from inflammation around the tonsils and purulent submandibular gland inflammation; no sound Deafness can be differentiated from acute laryngitis and laryngeal edema.
