RETROPHARYNGEAL ABSCESS

From Big Medical Encyclopedia

RETROPHARYNGEAL ABSCESS (abscessus retropharyngealis; synonym: retropharyngeal abscess, abscess) — suppuration limf, nodes and cellulose of retropharyngeal space with formation of a purulent cavity. Occurs especially often at the weakened children aged up to 2 — 3 years, is more rare at adults.

Etiology and pathogeny

Origin 3. and. the infection is. Children of younger age have an infection limf, nodes with the subsequent development 3. and. occurs on limf, to ways at pathology of a nasal cavity, a nasopharynx, an acoustical pipe and a middle ear or is result of systemic infections — measles, scarlet fever, flu, adenoviral. At more advanced age caries of teeth, an injury of a back wall of a throat with the subsequent infection can be the cause. At adults 3 are observed. and. specific character — «cold» 3. and., who in most cases are congestive character at a tubercular or syphilitic spondylitis of upper cervical vertebrae (see. Natechnik ). Sometimes 3. and. can arise after a tonsilectomy of an adenotomy. On localization 3. and. can be located in upper, average and lower departments of a throat. Development and distribution 3. and. in various departments of a throat it is connected with features of a structure limf, beds in each its department.

Clinical picture

Fig. 1. Characteristic roundish protrusion of a mucous membrane of a back wall of a throat on the right at retropharyngeal abscess (faringoskopiya). Under abscess — the pallet.

Distinguish acute, subacute and hron, a current 3. and. The acute current is most often observed. At an acute current 3. and. and its localizations on average department of a throat an early and leading symptom is pain and the difficulty during the swallowing which is followed at children of early age by concern, crying, a sleep disorder, failure from suction of a breast. High temperature of a body _ to 38 — 39 ° is characteristic. At an arrangement of abscess in an upper part of a throat there is a difficulty of nasal breath which is followed by twang. At 3. and. a lower part of a throat there is a complicated breath, especially in horizontal position, at the expense of the expressed hypostasis of a mucous membrane covering an entrance to a throat. Breath becomes rattling and reminds a sound of the working saw. Sometimes the voice gets a hoarse shade — - shout of a duck. Constant symptom 3. and. — swelling, morbidity limf, nodes of zachelyustny area and side upper cervical at the expense of what forced position of the head appears (an inclination towards abscess). At faringoskopiya (see) the hyperemic asymmetrically located protrusion of a mucous membrane of a back wall of a throat (fig. 1) of a rounded or oval shape, quite often fluctuating is defined at a palpation. At 3. and. in an upper part of a throat such protrusion is visible at back rinoskopiya (see), at localization of abscess in a laryngopharynx — at indirect laringoskopiya (see). At children of younger and early age at impossibility of survey of abscess by means of mirrors it can be considered if one pallet to raise a soft palate, and another to crush language from top to bottom and kpered. A palpation of protrusion sharply painful, and at 3. and. an ear origin at a palpation pus in outside acoustical pass of the relevant party appears. Changes of blood: a leukocytosis (leukocytes to 16 000 and above), a deviation to the left, ROE it is accelerated (to 50 mm an hour). Current acute 3. and. usually 10 — 14 days.

Subacute, hidden, 3. and. proceeds is longer with the expressed intoxication and disturbance of the general state.

Fig. 2. The scheme of an arrangement of retropharyngeal abscess of a specific etiology (it is specified by an arrow) at destruction of a cervical vertebra.

Hron, current 3. and. it is observed more often at adults at a spondylitis of a tubercular, syphilitic etiology (fig. 2). proceeds it is long, symptoms are expressed unsharply.

The diagnosis

the Diagnosis at an acute current is easy, based on data of clinic, survey of a throat and it rentgenol, researches in a side projection (see. Retropharyngeal space , fig.). At subacute and hron, a current it is necessary to suspect specific congestive abscess. The diagnosis is specified by means of a X-ray analysis of cervical department of a backbone, reactions of the Tuberculine test, Wasserman, at a puncture of infiltrate with the subsequent bacterial. research of contents. In these cases it is clinically possible to note restriction of mobility of a backbone in the corresponding vertebras and their morbidity at effleurage on acanthas. At suspicion of a tumor the biopsy is carried out.

Treatment

Treatment depends from a wedge, currents. At acute 3. and. in a stage of infiltration (lack of pus at a .punktion) intramuscular introduction of antibiotics is shown. In the presence of pus opening of abscess is necessary.

Fig. 3. Diagrammatic representation of opening of retropharyngeal abscess: the scalpel wrapped by bandage under control of sight and at an otdavlivaniye of language the pallet make a puncture of abscess.

Technology of opening of abscess. Opening is made through a mouth, usually under anesthetic. Under control of sight and at an otdavlivaniye the pallet of language the scalpel wrapped by bandage (except the end which leave free), make a puncture on depth apprx. 0,5 cm in the place of the greatest protrusion of abscess (fig. 3). After that quickly incline the head of the child in order to avoid hit of pus in a throat and preventions of asphyxia down., it is reasonable to make during the opening simultaneous suction of pus by means of a suction machine, the tip to-rogo is held together with the pallet. After opening and suction of pus for full evacuation of pus from abscess of edge of a section part with an ear packer.

Hron, specific «cold» retropharyngeal abscesses of congestive character do not open in order to avoid consecutive infection, and against the background of antitubercular or anti-syphilitic treatment make repeated punctures with suction of pus and the subsequent administration of specific medicinal solutions. At otogenic retropharyngeal abscesses make at the same time opening of abscess and ear operation. Appoint high doses of antibiotics, sulfanamide drugs, the febrifugal and hyposensibilizing means, and carry out disintoxication therapy.

The forecast

the Forecast at timely carried out treatment favorable. At overdue diagnosis and untimely opening of abscess life-threatening complications can develop: back mediastinitis (see), thrombosis of an internal jugular vein, arrosive bleeding, pneumonia, at spontaneous opening — asphyxia. The forecast at «cold» 3. and. a specific etiology in many respects depends on a current of a basic disease.


Bibliography:

Andryushin Yu. N. and Andryushina K. M. Regional features of a structure of an intraorganic lymphatic bed of a throat of the person, Zhurn, ushn., Nov. and throats, Bol., No. 5, page 60, 1973;

the Multivolume guide to otorhinolaryngology, under the editorship of A. G. Likhachev, t of the 3rd page 348, M., 1963 (to download);

Janeska I. River and. Rankow R. M. Fatal mediastinitis following retropharyngeal abscess, Arch. Otolaryng., v. 93, p. 630, 1971.

I. B. Soldatov.

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