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A 14-year-old boy with progressive dysphagia and high-grade fever was diagnosed with a large rim-enhancing retropharyngeal abscess and treated with ICU care, antibiotics, corticosteroids, and external cervical incision and drainage, resulting in marked clinical 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\nAlzayed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98740  \nOpen Access Case Report  \nManagement of a Massive Retropharyngeal  \nAbscess Through an External Cervical Approach: A Case Report  \nShikhah Alzayed 1, Ahmed AlOlaywi 1  \n1. Department of Otorhinolaryngology-Head and Neck Surgery, Aljouf Health Cluster, Aljouf, SAU Corresponding author: Shikhah Alzayed, [shmalzayed@gmail.com](shmalzayed@gmail.com)  \nAbstract  \nRetropharyngeal abscess appears to be decreasing in incidence in older children. It can be caused by local trauma to the posterior pharynx. Contributing risk factors include poor oral hygiene, diabetes, immunocompromised states, and low socioeconomic status. Early diagnosis is essential, as it may lead to potentially life-threatening dyspnea that requires rapid airway management.  \nA 14-year-old boy was referred to our hospital with complaints of dyspnea, rapidly progressive dysphagia, and high-grade fever for four days. The patient reported a history of neck pain and stiffness over the past twenty days. Physical examination was remarkable for stridor, inspiratory wheezing, and mild lower neck swelling. A lateral neck radiograph was initially performed, followed by a neck CT with contrast conducted in the emergency department, which demonstrated a rim-enhancing retropharyngeal abscess measuring approximately 10.5 x 3.4 x 5.4 cm, extending from the C3 to T3 level, displacing the esophagus and trachea anteriorly with associated mild to moderate narrowing of the airway. A smaller abscess was also identified adjacent to the primary lesion, measuring approximately 5.3 x 1.3 x 0.8 cm, at the level of C5 to T2. The patient was admitted to the ICU under the care of the otorhinolaryngology department. The airway was maintained, and intravenous antibiotics and corticosteroids were initiated. Surgical incision and drainage of the abscess through a cervical approach were carried out. The wound was irrigated, and a 10-Fr closedsuction drain (BIOVAC™, Biometrix™ Critical Care Solutions, QMD-Quality Medical Devices, Slovakia) was inserted through the left anterior cervical incision, advanced 3 cm into the abscess cavity, and connected to continuous suction; the procedure was performed in conjunction with the thoracic surgery team. The patient was transferred to the ward, where he showed marked improvement in respiratory distress and was able to tolerate liquids, followed by a soft diet.  \nThe administration of intravenous antibiotics and corticosteroid therapy, along with surgical incision and drainage of the retropharyngeal abscess, was effective in treating this patient’s condition and ended with marked clinical improvement.  \nCategories: Otolaryngology  \nKeywords: adolescent, corticosteroid therapy, deep neck space infections, external cervical approach, retropharyngeal abscess  \nIntroduction  \nDeep neck infections occur in potential spaces and fascial planes of the neck; the retropharyngeal abscess isone of the most common deep neck space infections [1] . Retropharyngeal abscesses are rare in adults; however, they are more frequent in younger children due to the abundance of retropharyngeal lymph nodes and immaturity of their immune system [2,3] . These abscesses can be triggered by oropharyngeal trauma or dental disease, although in younger children, upper respiratory tract infections commonly precede abscess formation. Patients presenting with retropharyngeal abscesses are typically febrile with symptoms of upper aerodigestive tract obstruction, including dysphagia, odynophagia, inability to tolerate oral secretions, neck stiffness, and respiratory distress [4] . Such abscesses need prompt diagnosis","cbCaip8dq2w8scEb","https://ap.wps.com/l/cbCaip8dq2w8scEb","pdf",557452,"English","# Abstract\n# Introduction\n# Case Presentation\n## Emergency assessment and imaging\n## ICU management and surgical drainage\n# How to cite this article","[{\"question\":\"What risk factors contribute to retropharyngeal abscess formation?\",\"answer\":\"The article lists poor oral hygiene, diabetes, immunocompromised states, and low socioeconomic status, and notes that local trauma to the posterior pharynx can also contribute.\"},{\"question\":\"Why is early diagnosis important in retropharyngeal abscess?\",\"answer\":\"Early diagnosis is essential because the condition may progress to life-threatening dyspnea, requiring rapid airway management.\"},{\"question\":\"How was the 14-year-old patient treated in this case report?\",\"answer\":\"He received ICU care with airway maintenance, intravenous antibiotics and corticosteroids, followed by surgical incision and drainage of the retropharyngeal abscess via an external cervical approach with placement of a suction drain.\"}]","Management of a Massive Retropharyngeal Abscess Through an External Cervical Approach - A Case Report | PDF",1790742780]