History and exam
Key diagnostic factors
common
spiking fever
Common finding with any abscess.
neck pain or torticollis
Caused by irritation of sternomastoid.
odynophagia
Attempts to swallow past the abscess are painful.
dysphagia
Attempts to swallow past the abscess are difficult.
neck swelling/mass/lymphadenopathy
There may also be other lymphadenopathy associated with the condition.
oropharyngeal swelling
Visible bulge seen in the posterior oropharynx on examination.
uncommon
drooling
Caused by odynophagia.
Other diagnostic factors
common
decreased oral intake
Caused by odynophagia.
anorexia
Caused by odynophagia.
malaise
Associated with systemic upset.
irritability
Fever and other symptoms in a child cause irritability.
uncommon
trismus
Caused by irritation of masseters (muscles that facilitate chewing).
Makes examination of the posterior pharyngeal wall difficult.
dysphonia
Swelling in the hypopharynx affects voice resonance above the vocal cords.
dyspnea
If the abscess is large enough to oppose the anterior pharyngeal wall, airway compromise occurs.
fatigue
Associated with airway compromise.
sleep apnea
A consequence of airway compromise.
stridor
If the abscess is large enough to oppose the anterior pharyngeal wall, airway compromise occurs.
tonsillar swelling
May indicate another cause or be the precursor of abscess formation.
increased respiration rate
Indicates airway compromise.
decreased oxygen saturations
Indicates airway compromise, but is usually a late finding and should not be relied on for diagnosis.
cyanosis
Sign of airway compromise.
tachypnea
Sign of airway compromise.
tracheal tug
Neck is stretched backward, while the physician grips the cricoid cartilage of the trachea while standing behind the patient, and feels whether the trachea is pulled down with each heartbeat.
Sign of airway compromise.
intercostal recession
Inward movement of intercostal muscles between the ribs as a result of reduced pressure in the chest cavity.
Sign of airway compromise.
Risk factors
strong
foreign body ingestion
There is a high risk in children with a history of swallowing foreign objects. The suspicion should be high especially if the object was sharp.
trauma to posterior pharyngeal wall
Penetrating trauma to the posterior pharyngeal wall is a known cause. Nonaccidental injury should be considered.[17]
dental caries/infection
Prior dental infection can predispose patients to the formation of an RPA.
diabetes mellitus
Up to one third of patients with deep neck abscess suffer from this condition.[4]
weak
male sex
adenotonsillectomy
There is an association between retropharyngeal or parapharyngeal abscess and adenotonsillectomy, although more research is needed in this area to define this association.[18]
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