Dysphagia in a diabetic patient

[Parapharyngeal abscess: perilaryngeal infrahyoid extension]

Parapharyngeal abscesses are located between the skull base and the hyoid bone. Their infrahyoid extension is usually following the retropharyngeal space, but also can be through the medial aspect of the parapharyngeal space. Thus, surrounding the visceral fascia, they might invade the perilaryngeal and perihypopharyngeal spaces. This results in more significant airway compromise. Computed tomography is essential while locating and evaluating the extension of these infections, specially with regards to the great vessels. We report on 8 parapharyngeal abscesses with perilaryngeal and/or perihypopharyngeal extension. We review their clinical and radiological features, based on computed tomography, as well as their medical and surgical treatment. When medical therapy fails, as they are usually medial to the great vessels, it is possible to perform aspiration and drainage transorally, avoiding the need for cervicotomy, in selected cases.

Is conservative treatment of deep neck space infections appropriate?

BACKGROUND

A 31-patient prospective series on deep neck infections, managed at Hospital Ramón y Cajal in Madrid, Spain, is presented.

METHODS

A prospective study was conducted from January 1994 to December 1997, including all parapharyngeal or retropharyngeal infections. Clinical and radiologic findings and length of stay in the hospital were registered. Medical treatment was instituted with broad-spectrum antibiotics, and surgery was reserved for those patients not responding to medical treatment.

RESULTS

Twenty-four patients (77.42%) had parapharyngeal, 3 (9.68%) retropharyngeal and 4 (12.90%) mixed infections. On the basis of clinical and CT findings, 19 cases (61.29%) were considered abscesses and 12 (38.71%) cellulitis. Medical treatment was successful in all but 3 cases (90.32%), with no major complications. All the patients were discharged from the hospital within 20 days after admission (mean, 8.09 days).

CONCLUSIONS

Despite the wide use of antibiotics, deep neck space infections are commonly seen. Although most reports are based on surgical treatment followed by antibiotics, medical treatment could be as successful as open surgical drainage in most cases.