title: Retropharyngeal and parapharyngeal abscesses: Factors in medical management failure.
abstract: Retropharyngeal and parapharyngeal abscesses are the most common deep neck infections in the pediatric population. How best to treat these patients, be it intravenous antibiotics or immediate surgical incision and drainage, has long been debated. The purpose of this study was to evaluate patient and abscess characteristics associated with failure of medical treatment. We retrospectively examined 46 patients between 1999 and 2009 at Arnold Palmer Children's Hospital in Orlando. Patient charts were reviewed, and data collected included age, gender of the patient, size of the abscess, days of admission to the hospital, admission to the intensive care unit, and surgical intervention, if applicable. All patients first received 24 to 48 hours of IV antibiotics, at which point a clinical decision was made to proceed with surgery or continue conservative management. When comparing antibiotic treatment failure across age, gender, and abscess size, statistically significant correlation occurred only with the size of the abscess. Medical management was more likely to fail, and surgery needed, when abscesses were larger than 2 cm. Additionally, hospital stay was not statistically different between the medical and surgical groups. Our data demonstrate statistical significance for the ability to treat retro- and parapharyngeal abscesses 2 cm or less in diameter with IV antibiotics alone, without complications, and with a statistically similar average hospital stay compared with surgery. Abscesses larger than 2 cm may be managed medically, as well, but failure of antibiotic therapy alone is more likely, with surgical intervention more often required.
authors.affiliation: Florida State University College of Medicine, and Childrens Ear, Nose, Throat, and Allergy, Orlando, FL, USA.
authors.forename: James
authors.initials: J
authors.lastname: Kosko
authors.forename: Justin
authors.initials: J
authors.lastname: Casey
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000628:therapy; D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D010608:Pharyngeal Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D017703:Retropharyngeal Abscess / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents