Transoral negative-pressure catheter drainage of a retropharyngeal and mediastinal abscess

PURPOSE

A retropharyngeal abscess (RPA) is an extremely rare entity in adults that has a tendency to spread vertically and cause a mediastinal abscess. Traditionally, immediate aggressive drainage is recommended via a transcervical or transthoracic approach for the treatment of a retropharyngeal abscess with mediastinal extension. Here, we present a case of a retropharyngeal and mediastinal abscess using a transoral negative-pressure catheter drainage approach.

PATIENTS AND METHODS

A 24-year-old woman was admitted with a 4-day history of severe sore throat and painful swallowing. Computed tomography identified a retropharyngeal abscess extending to the upper posterior mediastinum. We performed transoral negative-pressure catheter drainage.

RESULTS

The postoperative course was uneventful. The patient reported a rapid improvement in symptoms and had a good tolerance of the catheters in the nasal cavity. At 2 years postoperatively, physical examinations revealed no recurrence or surgical complications.

CONCLUSIONS

Transoral negative-pressure catheter drainage is a minimally invasive operation for the treatment of RPA in adults with or without a mediastinal abscess. This method could be recommended as an alternative approach in such cases.

Extracranial head and neck infections

This article outlines infections in the submandibular, lateral pharyngeal, retropharyngeal, danger, and prevertebral spaces, in conjunction with infections of the sinuses and mediastinum. By understanding the anatomy and pathophysiology, the reader will gain insight into the rationale for various therapeutic options.

Citrobacter freundiicausing pharyngitis and secondary retropharyngeal abscess with intrathoracic extension to the diaphragm: minimally invasive management of a rare case

Introduction:

Citrobacter freundiiis a rare but potentially aggressive cause of pharyngitis which may progress to retropharyngeal abscess with diaphragmatic extension.

Objective:

To raise awareness of: (1) citrobacter as a potential cause of head and neck infection, including retropharyngeal abscess; (2) a novel surgical approach to draining such an abscess; and (3) citrobacter's particular biological properties which may affect the clinical course.

Method:

Case report.

Results:

The abscess was drained via a minimally invasive posterior pharyngeal wall incision and placement of a suction catheter into the mediastinum through this incision. Residual intrathoracic collections were drained by the cardiothoracic team via percutaneous aspiration. The patient made a full recovery.

Conclusion:

Early recognition of citrobacter head and neck infections, an awareness of the peculiarities of the clinical course of such infections, and timely surgical intervention can prevent catastrophic outcomes. A minimally invasive approach to mediastinal collections can be considered as a viable alternative to open thoracotomy, which carries a high morbidity rate.

Severe soft tissue infections of the head and neck: a primer for critical care physicians

Patients with severe infections of the potential spaces of the head and neck are commonly managed in the ICU. These infections may present with devastating complications such as airway obstruction, jugular septic thrombophlebitis, lung abscess, upper airway abscess rupture with asphyxiation, mediastinitis, pericarditis, and septic shock. A thorough understanding of the anatomy and microbiology of these infections is essential for proper management of these patients. Retropharyngeal, danger, prevertebral, lateral pharyngeal, and submandibular space infections and their site-specific clinical manifestations, complications, and therapeutic interventions are discussed.

Life-threatening infections of the peripharyngeal and deep fascial spaces of the head and neck

This article reviews life-threatening infections of the head and neck. It discusses the anatomic boundaries, pathophysiologic processes, clinical manifestations, potential complications, and suggested therapies of infections of the submandibular, lateral pharyngeal, retropharyngeal, prevertebral, and danger spaces.