Retropharyngeal and parapharyngeal abscesses in children - a 9.5-year retrospective single-center analysis followed by literature review.

Introduction: Deep neck infections are severe complications of the inflammatory processes in the upper respiratory tract. They can be divided into retropharyngeal, parapharyngeal, peritonsillar, and submandibular abscesses, depending on the affected region. Deep neck infections are considered acute bacterial complications with a progressive course and life-threatening nature, and that is why they require an immediate, broad-spectrum, intravenous antibiotic therapy. Aim: The aim of our retrospective analysis was to characterize the population of children affected by retro- and/or parapharyngeal abscesses, with special interest in clinical presentation, diagnostic tools, treatment, and potential further complications. Materials and methods: The study was based on patients hospitalized in the Department of Pediatric Otolaryngology, Medical University of Warsaw, from January 2016 through June 2025. The clinical database was searched for records according to the ICD-10 classification, namely J39.0 or J39.1. Then, data were collected and analyzed using Microsoft Excel. A literature on this topic was also performed. Results: We found 84 cases meeting our inclusion criteria. Clinical suspicion of an abscess/inflammatory infiltration was confirmed with contrast-enhanced CT in 82 patients. We identified 22 (31.88%) retropharyngeal and 16 (23.18%) parapharyngeal abscesses, while in 12 cases (17.4%), they coexisted. Nineteen patients (retropharyngeal [8.70%, n = 6], parapharyngeal [11.59%, n = 8], or coexisting abscesses [7.25%, n = 5]) had abscesses simultaneously in other locations: peri-tonsillar area (18.3%, n = 13) or neck abscess (8.45%, n = 6). In total, 36.21% of the CT-confirmed deep neck infections were intraoperatively classified as inflammatory infiltrations. Of the remaining 15 patients, 2 did not undergo a CT scan, and in 13, the CT scan showed pure peritonsillar abscess; all were excluded from further analysis. Finally, 69 patients were included in the final analysis. The most common complaints on admission were fever (72.46%, n = 50), restricted neck mobility (60.86%, n = 42), and neck pain (40.57%, n = 28). Other symptoms, such as trismus, dysphagia, sore throat, headache, or earache, were observed less frequently. As for the laboratory tests, 47 patients (68.11%) had elevated CRP level and 53 (76.81%) presented with elevated WBC count. PCT was measured in only 30 cases (43.47%), of which 16 (23.18%) had elevated PCT levels. Sixty-two patients underwent a drainage procedure with microbiological examination. Microbiological cultures were positive in 37 (53.62%) cases. The most frequently isolated species were Streptococcus pyogenes, Prevotella melaninogenica, Staphylococcus aureus, and Streptococcus mitis. All patients were treated with ceftriaxone in combination with clindamycin or metronidazole and recovered successfully. Four patients in our group (about 5.8%) developed further complications: 2 cases of sepsis, 1 with associated central venous thrombosis; 1 case of abscess recurrence, and 1 case with long-term complication: pseudoaneurysm of the internal carotid artery. Conclusions: Retropharyngeal and parapharyngeal abscesses are serious complications of upper respiratory tract infections in children. Restriction of the neck mobility should always raise suspicion for this condition. Early diagnosis with prompt contrast-enhanced CT imaging when clinically indicated, together with surgical drainage and broad-spectrum intravenous antibiotic therapy, is crucial to diminish the risk of further complications. However, life-threatening complications, such as sepsis and thrombosis, may occur.