title: The effectiveness of conservative management for retropharyngeal abscesses greater than 2 cm.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago.
authors.forename: A
authors.initials: A
authors.lastname: Khudan
authors.affiliation: Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago.
authors.forename: G
authors.initials: G
authors.lastname: Jugmohansingh
authors.affiliation: Department of General Surgery, San Fernando General Hospital, Trinidad and Tobago.
authors.forename: S
authors.initials: S
authors.lastname: Islam
authors.affiliation: Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago.
authors.forename: S
authors.initials: S
authors.lastname: Medford
authors.affiliation: Department of Clinical Surgical Sciences, University of West Indies, St. Augustine, Trinidad and Tobago.
authors.forename: V
authors.initials: V
authors.lastname: Naraynsingh
keywords: Conservative management; Para-pharyngeal and peri-tonsillar abscesses; Retropharyngeal