A Case of Retropharyngeal Abscess with Trismus

A 10-year-old boy complaining of severe sore throat, left cervical pain, left cervical swelling and high fever was referred to our hospital. Local findings demonstrated swelling of the posterior wall on the left side of the pharynx and swelling of the neck with severe tenderness. The patient had trismus and the distance between upper and lower molar on opening was only ten millimeter. Fiberscopy demonstrated that there was no swelling or edema in the larynx (epiglottis and arytenoids). The patient did not demonstrate dyspnea. Computed tomography (CT) demonstrated a massive soft tissue swelling in the retropharyngeal space. We could easily diagnose his disease as retropharyngeal abscess. It was supposed that transoral intubation into the trachea would be difficult due to trismus. Therefore, we did not schedule surgery on his first examination. Appropriate intravenous administration of antibiotics was performed. Trismus was improved and difficulty in transoral intubation into the trachea was supposed to have decreased. Seven days after the first examination, surgery was successfully performed via transoral incision under general anesthesia. The patient was discharged on the 7th day after surgery without complications such as mediastinitis.We reviewed 50 cases of retropharyngeal abscess including our case reported in Japan since 1990. The incidence of retropharyngeal abscess in infants has decreased due to developments in antibiotic chemotherapy, however the incidence in adults has increased due to complications such as diabetes mellitus. The management of retropharyngeal abscess including surgical treatment was discussed. Although retropharyngeal abscess is rare, understanding of this disease and appropriate treatment are required.