In a retrospective review of 185 patients with deep neck infections 1 in the Taiwan University Hospital between 1997 and 2002, the parapharyngeal space was the most commonly involved space (39%). Odontogenic infections (53%) and upper airway infections (31%) were the two most common identified causes. Streptococcus viridans and Klebsiella pneumoniae were the most common organisms (34% each). Of the 142 patients with abscess, 103 patients (72.5%) underwent surgical drainages.
For a consecutive case series 2 a total of 178 children were included. They were treated for retropharyngeal or parapharyngeal infections.Median age was 34.5 months (2.9 years; range, 2-142 months); two-thirds were male. Increased surgical drainage was found in children age ≤ 15 months (p =0 .002) and for abscesses >2.2 cm (p = 0.0001). Risk factors associated with increased likelihood of medical therapy failure included age ≤ 51 months, intensive care unit admission, and CT findings consistent with abscess size >2.2 cm. Methicillin-resistant Staphylococcus aureus infections were found more often in younger children, with the highest incidence in those ≤ 15 months of age (p = 0.001). All children had resolution of infection.
A third retrospective chart review 3 included 54 children up to 15 years with a CT-confirmed diagnosis of retropharyngeal or parapharyngeal abscess. Antibiotic treatment alone was compared with antibiotics plus abscess drainage. Younger children within the group with smaller abscesses were more likely to need surgical drainage (p<0.05). Of 13 children requiring operative management, 10 underwent a period of antibiotic treatment and observation prior to surgery, 8 (80%) had fever beyond 48 h compared with 3 (23%) in the non-surgical group (p<0.01). A total of 27 children had an abscess > 25 mm diameter on CT scan, four (15%) of whom responded quickly to antibiotics and were managed non-operatively, while the rest underwent surgery.
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