Retropharyngeal abscess (ICD-10 code J39.0) in childhood begins to develop after the appearance of an infection in the body. At first, it may manifest itself in the form of rhinitis and not present much discomfort. Then it affects the surrounding lymph nodes and enters with them into the pharyngeal space, where it causes an abscess.
Reasons
Abscess can develop in children against the background of the following infectious diseases:
- ARVI;
- measles;
- scarlet fever;
- diphtheria;
- flu.
In adults, a retropharyngeal abscess is most often formed on the background of a nasopharyngeal injury, for example, when a bone is pierced into the nasopharynx, during an examination of the internal organs through the mouth, or during a burn. Also, this condition can be caused in adults by a complication of tonsillitis. The causes of retropharyngeal abscess of the throat in adults may be tuberculosis or syphilis. This is due to a violation of the microflora of the nasopharynx and the body as a whole.
According to statistics, patients with chronic infectious diseases suffer from pharyngeal abscess more often than with a simple course of the disease. Reduced immunity, diabetes, a tumor or HIV can also cause this pathology.
Symptoms
Abscess symptoms are listed below:
- acute manifestations of sore throat;
- increase in body temperature to 39-40 °C;
- violation of the general condition.
Against the background of other infectious diseases present in the patient, the symptoms of a retropharyngeal abscess in adults are manifested by a sharp deterioration in he alth.
Children develop inexplicable feelings of restlessness, leading to sleep problems and impaired appetite.
In newborns, this disease can cause sleep disturbance.
The very first symptom of a retropharyngeal abscess in adults is the appearance of a sore throat, which is aggravated by swallowing water or food. This pain is sometimes so severe that patients are forced to abstain from frequent meals. There is a change in voice, most often it becomes hoarse. If the abscess is located in the upper or lower part of the nasopharynx, then the patient has nasal congestion.
If the abscess is large, the patient may experience choking attacks. These attacks appear most often while standing, since in this state the pus begins to flow down and begins to interfere with the passage of air. With an abscess, swelling of the lymph nodes is revealed. If the pharyngeal abscess in children caused swelling of the surrounding tissues, then swelling of the neck may occur.
Location
Retropharyngeal abscess can be classified according towhere it is located, into the following views:
- Epipharyngeal type of abscess is suppuration of tissue, which is localized above the palatine arch. This type of abscess is characterized by unilateral pain in the throat, pain in the chewing muscles and lymph nodes on the side of the abscess.
- Mesopharyngeal appearance of an abscess. This abscess is located between the root of the tongue and the edge of the palatine arch.
- Hipopharyngeal appearance of an abscess. This abscess is located below the root zone of the tongue.
- Mixed type of abscess - occupying the pharyngeal space and other several anatomical zones.
Shapes of flow
Retropharyngeal abscess is classified according to the form of the flow into the following types:
- Initial form. At this stage, there is swelling and redness. This form is recommended to be treated with medication.
- Sharp shape. Most often it develops as a result of suppuration of the lymph nodes during infection with streptococci and staphylococci. This form is treated surgically.
- Chronic. This stage develops after inadequate treatment of the acute form of the disease. This form is treated surgically.
Complications
Complications of a retropharyngeal abscess occur due to the spread of infection. This movement through the upper respiratory tract is especially dangerous.
If the infection has spread and settled on the bronchi, then this is the cause of bronchopneumonia.
During the spread of infection, there is a violation of the lungs, which causes the developmentthey have pneumonia.
The infection can also spread into the cranial cavity, leading to the development of a brain abscess or meningitis.
Suffocation is a serious complication. It occurs due to the overlap of the airways due to the presence of severe edema of the larynx at the site of rupture of the abscess. During the manifestation of such attacks, the work of the heart can be reflexively disrupted, up to cardiac arrest.
A serious complication is the rupture of an abscess, as at this time there is a runoff of pus along the walls of the pharynx. It can affect large vessels, which can cause bleeding or blood clots. This pus can leak into the mediastinum, where it can cause the development of purulent mediastinitis, which is the cause of sepsis.
Diagnosis
Diagnosis of retropharyngeal abscess is carried out by an otolaryngologist (ENT) by questioning the patient and a comprehensive clinical examination. The purpose of the survey is to study the nature and duration of complaints, and on the basis of this - to clarify the underlying disease, to find out what caused the formation of an abscess. For diagnosis in children, information about the nature of the first symptoms and the general state of immunity is specified from the parents.
After that, the doctor proceeds to a comprehensive clinical study, which consists of examining the patient in order to identify specific signs of an inflammatory process of an infectious nature, such as redness of the pharyngeal mucosa, soreness of the site during palpation,swollen lymph nodes.
For visual examination of the mucosa of the posterior pharyngeal wall and the detection of abscesses of its lower and upper sections, pharyngoscopy is used. A general and biochemical blood test will help determine the severity of inflammation and, based on this, form an objective treatment.
Bacterioscopy and bacteriological examination will help to identify pathogenic microflora in the mucous membrane, the biomaterial for which will be a smear from the mucous membrane of the pharynx. To identify the presence and localization of an abscess, as well as the degree of spread of the purulent process, modern research methods are used, such as CT and MRI.
Autopsy
Autopsy of a retropharyngeal (retropharyngeal) abscess is performed in several ways.
- With a surgical knife. The tool should be wrapped with cotton wool or adhesive tape. At the same time, the cutting part remains free, approximately 0.05 - 0.06 cm. Incision is performed starting from the bottom, from the place where the mucosal bulge begins. The depth is 0.5 cm. You need to finish the incision at the most convex point of the abscess. To avoid the flow of pus into the larynx, it is necessary to tilt the patient's head down immediately after performing the dissection.
- Pointed scissors. Scissors are inserted into the highest point of suppuration. To avoid aspiration, a small incision should be made first. Then open the tool to widen the edges of the cut. Using this method, a test sample can be taken in parallel for the purpose of diagnosis and treatment.
- Pus can flow into the neck if the pharyngeal abscess is low. Then it is preferable to open the abscess with an external surgical cut. In this case, it is recommended to draw a line along the anterior edge of the Musculus sternocleidomastoideus (sternocleidomastoid muscle). If a large section is performed, there is a possibility of damage to the accessory nerve.
In case of purulent accumulations associated with the ear, in addition to opening, surgical treatment of the ear is performed.
Pharmacology
Drug treatment of pharyngeal abscess is the use of antibiotics. The following groups are currently in use:
- Cephalosporins ("Ceftriaxone", "Cefepime").
- Macrolides ("Erythromycin", "Clarithromycin").
- Lincosamides ("Lincomycin", "Clindamycin").
The mechanism of the work of cephalosporins blocks the renewal of the cellular structure of microbes, which completely destroys them. Depending on the representative, they can be administered intravenously or intramuscularly.
Cephalosporins are prescribed for children at any age. But their safety in children under 6 months of age has not been proven.
Macrolides block ribosomes in bacteria, which inhibits their growth. Macrolides are most commonly taken by mouth.
Lincosamides block the renewal of the protein structure in bacteria, which slows down their division and growth. Depending on the representative, lincosamides can be administered intravenously or intramuscularly. Some of these medicinescan reduce the bioavailability of ingested food.
Anti-inflammatory and antipyretic agents can be used in conjunction with antibiotics. But they should only be used as a last resort, as they can cause suppression of an already weakened immune system.
Folk treatment
Treatment with folk remedies is most often carried out in order to reduce the symptoms of a throat abscess and stop the development of inflammation. It is not possible to cure a pharyngeal abscess with folk remedies. This is due to the fact that this disease has an infectious nature of occurrence.
Folk remedies include gargling with the following solutions and decoctions:
- A solution of s alt and soda can significantly reduce the number of bacteria around the swallowing process. To prepare it, you need to take one tablespoon of s alt or soda and dissolve in a glass of warm water. Gargle with the resulting solution, repeat at least five times during the day. The number of rinses can be increased by diluting the solution with water.
- Infusion of herbs for rinsing the goal. The preparation of such an infusion begins with drying and grinding various herbs, then the resulting dust is poured with boiling water and allowed to brew for several hours. Rinsing is repeated several times a day.
- Taking Kalanchoe juice will locally remove inflammation and reduce the symptoms of abscess development by removing purulent plaque.
Forecast
Timely diagnosis and detection of retropharyngeal abscess will cure it without any problems. According to statistics, if complications are avoided, then the timely opening of an abscess in most cases allows you to completely get rid of it without the appearance of dangerous consequences. If the treatment was not taken immediately and as a result of this, complications appeared, then in this case the prognosis is quite negative, up to death.
Prevention
To prevent the development of a retropharyngeal abscess, the following measures should be taken:
- correct treatment of ENT diseases;
- early diagnosis in the presence of ENT diseases;
- timely removal of foreign bodies from the throat;
- timely treatment of any purulent accumulations in the throat;
- avoiding throat burns when eating hot foods.
During endoscopic examinations, avoid injury to the throat. If, nevertheless, this happened, then take measures for antibacterial treatment.
General additional measures to prevent retropharyngeal abscess:
- accustoming the throat to hot and cold drinks;
- normalization of the microflora of the throat;
- strengthening immunity;
- taking vitamins;
- balanced nutrition.
