Retropharyngeal and parapharyngeal infections in children: A retrospective analysis.

Objectives: To describe presentations, management and outcomes of retropharyngeal and parapharyngeal infections in children presenting to a tertiary care pediatric emergency department.

Methods: A retrospective chart review of children with deep neck infections such as retropharyngeal or parapharyngeal infection from January 2008 to December 2018 was conducted at a pediatric hospital.

Results: There were 176 retropharyngeal, 18 parapharyngeal and 6 with both retropharyngeal and parapharyngeal infections treated during the 10-year study period. Males were 60% of the cohort and the mean age was 4.3 (SD: 3.2) years. No significant differences in age or sex ratio or presentations were seen in children with retropharyngeal infections compared with parapharyngeal infections. All received parenteral antibiotics; 42% (84/200) of children underwent surgery and four of them had more than one surgical drainage. Age <12 months and the diagnosis of parapharyngeal infections were associated with significantly higher rates of surgical treatment. Children under 12 months of age were sicker at presentation and had a high complication rate of 23% compared with 1% in the older children (p = 0.002). Seven children had co-existence of Kawasaki disease with deep neck infections.

Conclusions: Early diagnosis of retropharyngeal and parapharyngeal infections especially in infants under a year of age is important as they are more likely to have complications and need surgical management. Most paediatric patients with retropharyngeal and parapharyngeal infections have a phlegmon or very small abscesses and are treated non-operatively with parenteral antibiotics.