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Aim: After the relaxation of COVID‐19 mitigation measures, we observed a dramatic increase in pyogenic infections. Based on this observation, we retrospectively analysed all cases of invasive bacterial infections of brain, lung and complicated ear–nose–throat (ENT) infections, in the period from 1 August to 31 March from the years 2018–2019 to 2022–2023. Methods: The study was conducted in two Paediatric Emergency Departments, at IRCCS 'Burlo Garofolo' of Trieste and at Treviso Hospital. Electronic medical records were searched for all cases with a definitive diagnosis at discharge of mastoiditis, suppurative cervical lymphadenitis, retropharyngeal, parapharyngeal and peritonsillar abscess (ENT group), bacterial brain abscesses, epidural empyema, subdural empyema (central nervous system group), thoracic empyema and necrotising pneumonia (lung group). Results: In 2022–2023, we observed an increase in infections compared to the previous years. Total number of cases were 22, 29, 8, 27 and 63 in 2018–2019, 2019–2020, 2020–2021, 2021–2022 and 2022–2023, respectively. The greater increase occurred in thoracic empyema, with a peak incidence of +120% in 2022–2023 in respect of 2021–2022. Conclusion: We reported an important increase in paediatric bacterial complicated infections in two North East Italian regions, possibly correlated with the relaxation of COVID‐19 social distancing measures. [ABSTRACT FROM AUTHOR]

Purpose: Head and neck emergencies in children are frequent cause of visits to the hospital. Imaging plays a critical role in the management of these patients. This review article aims to familiarize radiologists with the common clinical presentations encountered, imaging characteristics of nontraumatic pediatric head and neck emergencies, and improve their ability to recognize associated complications as well as be aware of common mimics. Methods: We researched our database for commonly encountered nontraumatic head and neck emergencies in children. A literature search was done to compare and complete the list of conditions to be discussed in this review. Results: The review was organized according to anatomical location of the emergent condition. Relevant anatomy has been discussed along with clinical presentation, imaging characteristics and complications. We have presented common mimics with each set of disorders. Key imaging characteristics have been delineated using radiology images. Conclusion: Familiarity with the known complications of head and neck emergencies allows the radiologist to actively search for such findings, encourage early institution of appropriate therapy, and improve outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Most paediatric upper respiratory infections are virally mediated and result in self-limiting reactive lymphadenopathy. In children younger than 5 years, retropharyngeal lymph nodes may give rise to deep neck space infections in this potential space. Retropharyngeal infections are rare after 5 years because lymph nodes undergo atrophy. Methods: We present a series of 6 cases of paediatric retropharyngeal abscesses (RPA) complicated by mediastinitis, managed at a tertiary hospital over a 4-year period. Results: All our cases presented with fever, difficulty feeding, and neck swelling. The age range was 11 weeks–11 months, and all tested negative for human immunodeficiency virus. The diagnosis and complications were confirmed on computed tomography (CT) scan. The CT scans consistently revealed RPA with varying degrees of deep neck space and mediastinal extension. All children were promptly taken to theatre for source control. Two were extubated successfully immediately after surgery, and the other 4 were extubated in the paediatric intensive care unit, with the longest duration of intubation being 3 days. Methicillin-sensitive Staphylococcus aureus (MSSA) was cultured in all 6 cases. Conclusion: Management of these cases may be challenging, and young children with RPA require close care and airway monitoring. CT or magnetic resonance imaging is essential to delineate the extent of infection. Surgical drainage should be performed when there is a large abscess, a complication occurs, or an inadequate response in 24–48 h to medical management. [ABSTRACT FROM AUTHOR]

Objective: To compare ultrasonography-guided drainage versus conventional surgical incision and drainage in deep neck space abscesses. Methods: The study was pre-registered on the National Institute of Health Research Prospective Register of Systematic Reviews (CRD42023466809) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Medline, Embase and Central databases were searched. Primary outcomes were length of hospital stay and recurrence. Heterogeneity and bias risk were assessed, and a fixed-effects model was applied. Results: Of 646 screened articles, 7 studies enrolling 384 participants were included. Ultrasonography-guided drainage was associated with a significantly shorter hospital stay (mean difference = −2.31, p < 0.00001), but no statistically significant difference was noted in recurrence rate compared to incision and drainage (odds ratio = 2.02, p = 0.21). Ultrasonography-guided drainage appeared to be associated with cost savings and better cosmetic outcomes. Conclusion: Ultrasonography-guided drainage was associated with a shorter hospital stay, making it a viable and perhaps more cost-effective alternative. More randomised trials with adequate outcomes reporting are recommended to optimise the available evidence. [ABSTRACT FROM AUTHOR]

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BACKGROUND. Deep neck infections have significant morbidity and mortality. The most common complications are mediastinitis and sepsis. Acute mediastinitis continues to be a serious condition with a high mortality rate. The common primary sources of infection are of odontogenic etiology, pharyngo-laryngeal infections, cancers and iatrogenic. Most esophageal perforations are iatrogenic (50-75%) and most occur during endoscopic procedures. MATERIAL AND METHODS. We present the case of a 60-year-old patient who developed a deep neck infection two weeks after undergoing a biopsy for a mass located in the thoracic segment of the esophagus. RESULTS. The therapeutic management consisted of placing a tracheostomy tube, performing a lateral cervical incision to permit drainage of the abscess, lavage, and drainage of the superior mediastinum along with aggressive antibiotherapy. The postoperative evolution was favorable, with the CT scan showing no remaining colections and blood samples almost returning to normal values. CONCLUSIONS. Clinical evaluation, appropriate imaging, and aggressive active management are vital to successful outcomes for deep neck infections (DNIs). The origins of DNIs are usually evident from clinical and radiological examination. However, efforts should be made to identify the source of infection and this should be treated at the same time or electively.

Background: A case of retropharyngeal abscess complicated by both artery and nerve injury has rarely been reported. Methods: A 36‐year‐old woman suddenly presented with right eye visual loss, dilated pupil, reduced direct light reflex, ptosis and ocular motility disorder on the side of inflammation progression, and was diagnosed with retropharyngeal abscess due to Fusobacterium necrophorum. The patient was treated only with antibiotics and, no further surgery was necessary but tracheotomy. Four months later, MRA showed right ICA occlusion and left ICA stenosis. MRI revealed continuous spread of inflammation due to the abscess from the retropharyngeal to the intracranial space. Results: These severe complications would be attributed to an endothelial damage to the arterial wall and an ischemic neuropathy caused by inflammation and thrombogenesis due to Fusobacterium necrophorum. Conclusions: This case should provide a better understanding of the mechanism of vascular and cranial nerve injury due to retropharyngeal infections, and highlights the need for early antibiotic therapy and repeated vascular evaluation. [ABSTRACT FROM AUTHOR]

Objective: Effective management of retropharyngeal abscess (RPA) may predicate upon identification of key patient characteristics. We analyzed characteristics and outcomes of pediatric patients with RPA to identify prognostic factors associated with successful surgical intervention. Methods: A financial database was searched for pediatric otolaryngology patients with RPA from 2010 to 2021. Medical charts were reviewed for demographics, presenting history, physical examination, laboratory testing, imaging, surgical findings, and hospital course. Bivariate analyses were performed to identify potentially significant predictors of positive drainage. These variables were included in multivariate analysis of surgical outcomes. Results: Of 245 total patients, 159 patients (65%) received surgery and 86 patients (35%) received antibiotics only. Patients with restricted cervical motion, neck swelling, and computed tomography (CT) cross‐sectional area (CSA) >2 cm2 were more likely to receive surgery. Rim enhancement on CT imaging was associated with positive surgical drainage (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.16–5.74). However, no variables from clinical symptoms or physical exam were associated with positive drainage. Variables that approached significance were included in multivariate analysis, which revealed only rim enhancement predicted positive drainage (OR 2.57, 95% CI 1.13–5.83). The mean length of stay (LOS) was 2.6 versus 3.5 days (p < 0.001) for medical vs surgical treatment groups, respectively. Conclusion: Our study revealed a high success rate of medical management. Although patient characteristics and clinical features were not significant predictors of surgical outcomes, CT findings such as rim enhancement were strongly associated with positive surgical drainage. Level of Evidence: 2 Laryngoscope, 134:1955–1960, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Differences in management and outcomes of otolaryngologic diseases may reflect inequities driven by social determinants of health. This study aimed to investigate disparities in presentation and outcomes of retropharyngeal abscess (RPA) among 231 pediatric patients. Methods: Medical records were searched for pediatric patients with RPA from 2010 to 2021. Charts were reviewed for demographics, clinical features, and treatment decisions. Area deprivation index (ADI) scores for patient zip codes were determined. Chi‐square analysis independent samples t‐test, and regression analyses were used to investigate associations between variables. Results: Among patients presenting for RPA, Black patients were less likely to undergo surgical management than non‐Black patients (53.2% vs. 71.6%, p = 0.009). Black patients had a lower rate of treatment with antibiotics prior to hospital admission (19.4% vs. 54.4%, p < 0.001). Among patients who received surgery, Black patients had higher cross‐sectional abscess area on CT (6.4 ± 8.4 cm2 > vs. 3.8 ± 3.3 cm2, p = 0.014), longer length of stay (5.4 ± 3.3 days vs. 3.2 ± 1.5, p < 0.001), and longer time between admission and surgery (2.3 ± 2.1 vs. 0.83 ± 1.1, p < 0.001). Increased ADI was correlated with increased rate of trismus. Conclusions: Lower rates of pre‐admission antibiotics and larger abscess area on CT imaging among Black patients may suggest disparities in access to primary care, resulting in presentation to tertiary care at later stages of disease and higher rates of medical management trial prior to surgical intervention. Level of Evidence: 3 (retrospective cohort study) Laryngoscope, 134:1907–1912, 2024 [ABSTRACT FROM AUTHOR]

This article discusses a case study of a 60-year-old patient who developed a deep neck infection as a complication of esophageal cancer. The patient underwent a biopsy and later presented with symptoms of a deep neck infection. The article highlights the importance of clinical evaluation, imaging, and active management for successful outcomes in deep neck infections. It also discusses the symptoms, diagnosis, and treatment options for these infections, emphasizing the need for prompt surgical drainage. The article also mentions the risk factors, microbiology, and potential complications associated with deep neck infections. [Extracted from the article]

Abstract Background Deep neck space infections are uncommon in infants. Retropharyngeal abscess (RPA) is a deep space neck infection that can present with subtle signs and symptoms. Delay in diagnosis can lead to life-threatening complications. Here we describe life-threatening complication of retropharyngeal abscess. Case presentation We report a life-threatening complication of retropharyngeal abscess in 10-month old Asian infant weighing 8.2 kg. The patient presented with fever, right-sided neck swelling, hoarseness of voice, and respiratory distress. The clinical and radiological findings were suggestive of airway obstruction complicated by retropharyngeal abscess. The patient was urgently taken to the operating room and underwent (grade 3) intubation. After stabilization, the patient underwent endoscopic trans-oral incision and drainage, during which 5 cc pus was aspirated. Antibiotics were prescribed for 2 weeks following the procedure based on the sensitivity result of the pus culture. Conclusion In retropharyngeal abscess, a delay in diagnosis can result in life-threatening complications. This report highlights the importance of prompt recognition of a threatened airway and the management of retropharyngeal abscess by emergency physicians. If an emergency physician suspects RPA with airway obstructions, the airway should be immediately secured in a secure environment by otolaryngologist and an anesthesiologist.

Introduction: Retropharyngeal abscess is a fatal infection that is uncommon, yet serious, especially in young children below 5 years. Oropharyngeal infections, in particular, can cause it as a complication of upper respiratory infections. They can also lead to respiratory depression and acute upper airway blockage and other complications. Case presentation: The unusual case of large retropharyngeal abscess in a 2-year-old child, secondary to mumps infection who presented to us with impending airway compromise is reported. Discussion: Retropharyngeal abscess secondary to mumps is a rare occurrence.The child initially had a bilateral parotid enlargement with fever and upper respiratory tract infection, which was diagnosed clinically as mumps by primary care physician and later confirmed by IgM antibody testing. The child was initially treated conservatively as the symptoms were mild at the beginning, however, the child worsened progressively and presented o our institute with acute retropharyngeal abscess in stridor. Emergency tracheostomy and intraoral abscess drainage were done under general anesthesia followed by appropriate intravenous antibiotics therapy. Conclusion: A dramatic recovery was observed following the treatment approach. Although it is rare to see such a large RPA in this antibiotic era, it is imperative to maintain a high index of suspicion.

Retropharyngeal abscess (RPA) is a rare, potentially fatal condition found more frequently in young children usually who were having a history of Upper respiratory infection. RPA is an acute suppurative infection of the retropharyngeal space. In view of scarce literature availability and atypical presentation in infants, it poses a definitive diagnostic dilemma to the clinicians. Here, we are reporting a three-month-old male infant presented with feeding difficulty, obstructive sleep apnea and intermittent inspiratory stridor. Child was managed in a pediatric ICU with a multidisciplinary approach which involved pediatrician, otorhinolaryngologist pediatric anesthesiologist, microbiologist, and radiologist. With the recent advances, early radio imaging have a vital role in diagnosing the condition and also helps in planning of surgery. Prompt diagnosis and surgical management with appropriate antimicrobial therapy for this condition is imperative to prevent complications such as airway obstruction and mediastinitis. Timely surgical intervention, preferably intraoral transpharyngeal approach, to drain the abscess is recommended. [ABSTRACT FROM AUTHOR]

Key Clinical Message: We describe a patient who lost her vision because of Lemierre's syndrome. Ophthalmologic complications of Lemierre's syndrome are rare, and very few cases have been reported. Clinicians need to recognize that it is a serious condition that can lead to blindness in some cases. Lemierre's syndrome is a systemic septic embolism resulting from thrombophlebitis of the internal jugular vein. We report a case of blindness caused by Lemierre's syndrome, despite prompt diagnosis and early treatment. A 36‐year‐old woman was transported to our hospital. She presented with fever, facial swelling, and right visual acuity deterioration. Contrast‐enhanced computed tomography revealed a retropharyngeal abscess and right internal jugular vein thrombosis. Blood culture revealed Fusobacterium necrophorum, suggesting Lemierre's syndrome. The patient had septic shock and disseminated intravascular coagulation. We diagnosed her visual impairment as orbital‐apex syndrome due to spread of inflammation. After 6 weeks of antimicrobial drug treatments, her general condition had improved, and the retropharyngeal abscess had disappeared. On Day 49 of her illness, she was transferred to a rehabilitation hospital, but her visual acuity was not restored. Clinicians should be aware that Lemierre's syndrome can, although rarely, cause blindness. [ABSTRACT FROM AUTHOR]

The concept of neck spaces has been widely described to assist radiologists in approaching pathology and establishing a differential diagnosis. One of these spaces, the retropharyngeal space (RPS), spans both the suprahyoid and infrahyoid neck, extending from the skull base to the superior mediastinum, and contains only fat and lymph nodes, thus limiting the number of possible differential diagnoses. Despite this, pathologies affecting this space can produce significant morbidity and the RPS is clinically difficult to assess by direct inspection or physical examination. Fortunately, imaging can readily examine the RPS and consequently plays a crucial role in not only determining the extent, but also the character, of any abnormality as well as any associated complications. In this pictorial review, we present a range of unusual conditions that can affect this space and provide some key imaging concepts to aid diagnosis and help guide patient management. [ABSTRACT FROM AUTHOR]

In this work, we describe the case of a 68-year-old female patient with an injury to the back wall of the pharynx by a foreign body and its atypical placement in the retropharyngeal space, causing a retropharyngeal abscess. The foreign body was extracted during a transorally direct pharyngolaryngoscopy under general anesthesia. The symptomatology, diagnosis, and therapy of retropharyngeal abscess are the topics of discussion. We emphasize the necessity of timely and thorough localization of the foreign body and its extraction.

Abstract Background Kawasaki disease (KD) is a systemic inflammatory condition primarily affecting young children. Although 90% of KD patients present with variable head and neck manifestations, especially cervical lymphadenopathy, peritonsillar, retropharyngeal and parapharyngeal involvement are uncommonly reported as initial manifestations of KD. Case report Eight-year-old girl with prolonged fever, clinical and a radiological picture suggestive of retropharyngeal abscess, unresponsive to three changes in the antibiotic regimen and surgical drainage. The disease progressed with the development of additional signs and symptoms as non-purulent conjunctivitis (with uveitis), mucosal involvement (strawberry tongue and cracked lips), edema of her hands and feet, and arthritis. A diagnosis of Kawasaki disease was reached with complete remission after Intravenous Immunoglobulin (IVIG) treatment. In addition, we present a literature review of similar cases reported in the last thirty years. Conclusion Kawasaki disease requires a high index of suspicion and awareness of unusual presentations. It should be kept in mind as one of the differential diagnosis of patients with febrile inflammation of the retropharyngeal and parapharyngeal spaces who do not respond to antibiotic treatment in the relevant clinical context.

Introduction: Paediatric undiffentiated sarcoma is an extremely rare and highly aggressive tumour which represent a major challenge for clinicians and pathologist1). There are limited research and case reports about undifferentiated sarcoma of nasopharynx in paediatric population. Case Report: We report a case of undifferentiated sarcoma initially displaying as retropharyngeal abscess. A 1 year 7 month old boy who presented to our department with respiratory distress due to retropharyngeal mass in which then confirmed as abscess by CECT neck. Patient underwent direct laryngoscopy + transoral incison and drainage twice with minimal pus drain. Conclusion: Incidental findings of undifferentiated sarcoma on histopathological examination abscess wall was reported. Hence patient was started on chemotherapy. [ABSTRACT FROM AUTHOR]

Key Clinical Message We describe a patient who lost her vision because of Lemierre's syndrome. Ophthalmologic complications of Lemierre's syndrome are rare, and very few cases have been reported. Clinicians need to recognize that it is a serious condition that can lead to blindness in some cases. Abstract Lemierre's syndrome is a systemic septic embolism resulting from thrombophlebitis of the internal jugular vein. We report a case of blindness caused by Lemierre's syndrome, despite prompt diagnosis and early treatment. A 36‐year‐old woman was transported to our hospital. She presented with fever, facial swelling, and right visual acuity deterioration. Contrast‐enhanced computed tomography revealed a retropharyngeal abscess and right internal jugular vein thrombosis. Blood culture revealed Fusobacterium necrophorum, suggesting Lemierre's syndrome. The patient had septic shock and disseminated intravascular coagulation. We diagnosed her visual impairment as orbital‐apex syndrome due to spread of inflammation. After 6 weeks of antimicrobial drug treatments, her general condition had improved, and the retropharyngeal abscess had disappeared. On Day 49 of her illness, she was transferred to a rehabilitation hospital, but her visual acuity was not restored. Clinicians should be aware that Lemierre's syndrome can, although rarely, cause blindness.

Introduction Eggerthia catenaformis, a non-spore-forming anaerobic Gram-positive bacillus component of the human fecal microbiota has rarely been reported in human diseases. In almost every case described in current literature to date, dental diseases (abscesses, periodontitis, or caries), are the most common source of the infection which extends to the brain, cervical spaces, pulmonary parenchyma, the pleural cavity, the abdominal wall, and the abdominal cavity. Case report An 82-year-old male Caucasian patient was admitted to our Emergency Department (ED) with a painless, right submandibular mass, dyspnea, and inspiratory stridor. A CT scan of the head, neck, and chest with intravenous contrast material revealed a retrotonsillar fluid collection. Air bubbles and minimal fluid were present from the right sub-mandibular area to the lower mediastinum between the spine, the descending thoracic aorta, and the trachea. The patient underwent surgical treatment and a broad-spectrum antibiotic. The retropharyngeal fluid collection culture showed the presence of Eggerthia catenaformis. After a first period in the Intensive Care Unit, he was admitted to a Step-Down Unit (SDU) where he underwent respiratory weaning, motor rehabilitation, and gradual oral feeding resumption. At discharge, the patient maintained the tracheal cannula as he still had impaired swallowing of solid foods. Conclusions Here we report the first case of descending necrotizing mediastinitis in a patient with a retropharyngeal abscess, in the absence of dental diseases. [ABSTRACT FROM AUTHOR]

Background: Deep neck space infections are uncommon in infants. Retropharyngeal abscess (RPA) is a deep space neck infection that can present with subtle signs and symptoms. Delay in diagnosis can lead to life-threatening complications. Here we describe life-threatening complication of retropharyngeal abscess. Case presentation: We report a life-threatening complication of retropharyngeal abscess in 10-month old Asian infant weighing 8.2 kg. The patient presented with fever, right-sided neck swelling, hoarseness of voice, and respiratory distress. The clinical and radiological findings were suggestive of airway obstruction complicated by retropharyngeal abscess. The patient was urgently taken to the operating room and underwent (grade 3) intubation. After stabilization, the patient underwent endoscopic trans-oral incision and drainage, during which 5 cc pus was aspirated. Antibiotics were prescribed for 2 weeks following the procedure based on the sensitivity result of the pus culture. Conclusion: In retropharyngeal abscess, a delay in diagnosis can result in life-threatening complications. This report highlights the importance of prompt recognition of a threatened airway and the management of retropharyngeal abscess by emergency physicians. If an emergency physician suspects RPA with airway obstructions, the airway should be immediately secured in a secure environment by otolaryngologist and an anesthesiologist. [ABSTRACT FROM AUTHOR]

Abstract Objective Incomplete Kawasaki disease (IKD) initially presenting as retropharyngeal abnormality is very rare and is prone to misdiagnosis and missed diagnosis, often leading to poor prognosis. Most patients were misdiagnosed with retropharyngeal abscesses. Here, we describe and compare IKD patients initially presenting with retropharyngeal abnormalities, typical KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients. Methods We performed a retrospective case–control study comparing IKD patients initially presenting with retropharyngeal abnormalities to both KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients admitted to Shenzhen Children’s Hospital between January 2016 and December 2021. Results We evaluated data from 10 IKD patients initially presenting with retropharyngeal abnormalities (Group A), 20 typical KD patients (Group B) and 16 surgical drainage confirmed retropharyngeal abscess patients (Group C). Compared to Group B, we observed that Group A was older and had a more intense inflammatory response. On the day of admission, Groups A and C had similar early clinical presentations, and there were no significant differences in any major signs or symptoms. Close observation for the development of new KD signs and symptoms and unresponsiveness to empirical antibiotic therapy after 3 days is extremely important. The CRP (p = 0.011), AST (p = 0.002) and ALT (p = 0.013) levels were significantly higher and the WBC (P = 0.040) levels were significantly lower in Group A than in Group C. Neck radiological findings, such as the presence of ring enhancement (p = 0.001) and mass effects on the airway, are also useful tools for distinguishing these two diseases. Conclusion The careful observation of the signs and symptoms of this disease and the comprehensive analysis of the laboratory tests and neck radiological findings may help clinicians become aware of retropharyngeal abnormality as an atypical presentation of KD. Then, unnecessary treatments could be reduced, and the occurrence of serious complications can be avoided.

Megersa Kelbesa Olika,1 Gudeta Teku Ayano,2 Tajera Tageza Ilala2 1Department of Anesthesia, Institute of Health, College of Public Health and Medical Science, Jimma University, Jimma, Oromia, Ethiopia; 2Department of Anesthesia, Faculty of Medicine, College of Medicine and Health Science, Hawassa University, Hawassa, Sidama, EthiopiaCorrespondence: Tajera Tageza Ilala, Department of Anesthesia, Faculty of Medicine, College of Medicine and Health Science, Hawassa University, Hawassa, Sidama, Ethiopia, Email tajeratageza@gmail.comBackground: A retropharyngeal abscess is a bacterial infection of the back of the throat. It rarely results in deadly complications such as mediastinitis and thoracic empyema from deep neck infections involving soft tissues of the face, arising from oropharyngeal infections, particularly dental caries. Thus, complicating retropharyngeal abscess extending to mediastinitis poses an increased risk of high mortality rate as a result of its significant invasive potential and the fact that the recognition and diagnosis must be made early, as this is usually delayed. Complicating retropharyngeal abscess increases airway compromise and difficult airway management during anesthesia. We present a 40-year-old, male patient who transferred from another primary hospital to our institution’s surgical emergency outpatient department with a complaint of neck swelling of 10 days secondary to tooth extraction. He had a complaint of dull-itching pain, localized initially to the submandibular area and subsequently involving the oropharyngeal, neck, and descending to the chest and mediastinum. He was diagnosed with a complicated retropharyngeal abscess extending to the mediastinum (mediastinitis) and thoracic empyema as a complication of odontogenic infection in origin. Besides intravenous antimicrobial therapy, deep neck incision and drainage, and thoracotomy was done under general anesthesia. After adequate venous access and the patient positioned in head-up position, premedication was given. General anesthesia with an endotracheal tube was provided with a ready tracheostomy set. Inhalational induction was conducted and laryngoscopy was performed after the adequate depth of anesthesia was achieved. We experienced anticipated difficult intubation after induction. After multiple attempts, the tracheal tube was placed correctly by using a bougie. Halothane was used for maintenance anesthesia with intermediate-acting muscle relaxant under controlled ventilation.Conclusion: On top of a detailed review of the patient’s history, physical examination, laboratory investigations, and imaging profiles; early recognition of the airway compromise from the complicated retropharyngeal abscess, and proper readiness to manage potentially challenging airway compromise, and difficult airway management during the perioperative period.Keywords: anesthesia, anesthesia management, dental infections, incision and debridement, Ludwig angina, mediastinitis, mediastinal abscess, retropharyngeal abscess, airway management, retropharyngeal abscess

Background: Kawasaki disease (KD) is a systemic inflammatory condition primarily affecting young children. Although 90% of KD patients present with variable head and neck manifestations, especially cervical lymphadenopathy, peritonsillar, retropharyngeal and parapharyngeal involvement are uncommonly reported as initial manifestations of KD. Case report: Eight-year-old girl with prolonged fever, clinical and a radiological picture suggestive of retropharyngeal abscess, unresponsive to three changes in the antibiotic regimen and surgical drainage. The disease progressed with the development of additional signs and symptoms as non-purulent conjunctivitis (with uveitis), mucosal involvement (strawberry tongue and cracked lips), edema of her hands and feet, and arthritis. A diagnosis of Kawasaki disease was reached with complete remission after Intravenous Immunoglobulin (IVIG) treatment. In addition, we present a literature review of similar cases reported in the last thirty years. Conclusion: Kawasaki disease requires a high index of suspicion and awareness of unusual presentations. It should be kept in mind as one of the differential diagnosis of patients with febrile inflammation of the retropharyngeal and parapharyngeal spaces who do not respond to antibiotic treatment in the relevant clinical context. [ABSTRACT FROM AUTHOR]

A peritonsillar abscess (PTA) is a localized collection of pus in the peritonsillar space, between the palatine tonsillar capsule and the superior pharyngeal constrictor muscle (G. Gupta & R. McDowell, 2022). It is the most commonly occurring abscess in the head and neck region. Patient presentation usually includes odynophagia, unilateral otalgia, trismus, and voice changes. Managing a pediatric patient may be challenging, as children may not be able to describe their history of illness and symptoms. The management of a PTA can also differ between pediatric and adult patients (S. Ahmed Ali et al., 2018). It is important for practitioners to consider all aspects when providing treatment. This article describes the encounter and individualized treatment plan of an 11-year-old nonverbal autistic child who presented with fever, decreased oral intake, and left neck swelling. It also provides a general overview of PTAs and procedural steps to perform drainage through needle aspiration and incision and drainage. [ABSTRACT FROM AUTHOR]

Retropharyngeal abscess is life-threatening with potential airway emergency. A 53-year-old lady with diabetes mellitus presented with diffuse painful neck swelling for a week and difficulty in breathing with stridor. Video laryngoscopy done in operating theatre showed edematous laryngeal inlets with bulging posterior pharyngeal wall. Patient was tested positive for COVID-19 infection. The management was taken with high precautions, careful planning with unconventional and multidisciplinary approach. Management included airway protection, antibiotic, surgical drainage and correction of hyperglycaemia besides the compliance to COVID-19 SOP. Prognosis is good if identified early, managed aggressively and complications are avoided albeit the comorbidity and COVID-19 infective status. [ABSTRACT FROM AUTHOR]

Acute calcific tendinitis (ACT) of the longus colli muscle (LCM) is an inflammatory response due to deposition of calcium hydroxyapatite crystals. It is typically correlated with whiplash and overuse injuries. A common presentation of this inflammatory response is acute but progressive neck pain. It is a rare but important cause of neck pain that should be considered on a differential diagnosis when distinguishing between life-threatening conditions and non–life-threatening causes of neck pain. A 51-year-old woman presented to the emergency department (ED) reporting a mild sore throat that progressed to acute neck pain and stiffness. She also reported fatigue, fever, myalgias, and nausea. In the ED, the patient was tachycardic, hypertensive, and mildly febrile with normal oxygen saturation. Examination revealed meningismus and was negative for lymphadenopathy, oropharyngeal findings, and neurologic deficits. Laboratory studies were significant for leukocytosis. Computed tomography (CT) neck was obtained and was notable for calcification of the superior left longus colli muscle with prevertebral and retropharyngeal space edema along the muscle body. ACT of the LCM is a benign, self-limited condition that can present with features overlapping emergent causes of acute neck pain. Correct diagnosis relies on characteristic radiographic findings on CT. Fortunately, patients may be discharged home with a short course of anti-inflammatories and corticosteroids with near-complete resolution of symptoms. Emergency physicians, therefore, can rule out life-threatening causes of neck pain, while also making a definitive diagnosis and initiating effective management for this pathology. [ABSTRACT FROM AUTHOR]

Objective: Anterior cervical discectomy and fusion is a common procedure performed by spine surgeons with rare complications and high treatment success. Late presentation of retropharyngeal abscess in patients with a history of anterior cervical discectomy and fusion is rare but can have devastating consequences. There is a paucity of data to guide medical and surgical management of retropharyngeal abscess in these patients. Methods: We discuss 7 patients who presented to our institution with a late retropharyngeal abscess after having a history of anterior cervical discectomy and fusion. A review and description of the current literature regarding treatment and outcomes is described. Results: Seven patients presented to our institution with a retropharyngeal abscess ranging from 10 months to 7 years after undergoing anterior cervical discectomy and fusion. All patients received at least a 6-week course of appropriate intravenous antibiotics. Only one patient had their initial ACDF instrumentation removed at the time of presentation for the abscess. Four out of the 7 patients were treated with irrigation and debridement in addition to intravenous antibiotics, whereas 3 patients were treated with no surgery and intravenous antibiotics alone. All patients were asymptomatic at final follow up. Conclusions: Late retropharyngeal abscess after anterior cervical discectomy and fusion is a rare complication. Surgical management should be considered along with long term antibiotics. Removal of implants may not be necessary for infection resolution. Antibiotic treatment alone may be indicated for patients who are not septic, do not have airway compromise, or and can be considered for poor surgical candidates. [ABSTRACT FROM AUTHOR]

Aim: The major clinical manifestations multisystem inflammatory syndrome in children (MIS‐C) are fever, gastrointestinal and cardiac. The aim of this study was to describe MIS‐C in a series of patients who presented primarily with cervical manifestations. Methods: We retrospectively reviewed medical records of all patients who met the Centers for Disease Control and Prevention and World Health Organization MIS‐C diagnostic criteria treated at Hadassah‐Hebrew University Medical Center between April 2020 and September 2021. Results: Of 37 children diagnosed with MIS‐C (median age: 10.2 years, range 1.5–18 years, 20 male) five, 13.5% (median age: 14.4 years, range 9.2–17.5 years) presented with cervical symptoms mimicking neck infections. One was hospitalised with a working diagnosis of retropharyngeal abscess, and four with acute cervical lymphadenitis that did not respond to early antibiotic treatment. All developed full MIS‐C phenotype. Conclusion: MIS‐C may present as cervical inflammation. An ill‐appearing child with symptoms and/or signs of cervical inflammation should be evaluated for clinical and laboratory features of MIS‐C, thereby facilitating prompt treatment of this potentially fatal disorder. [ABSTRACT FROM AUTHOR]

Introduction: Acute longus colli tendinitis is caused by calcium hydroxyapatite deposition in the tendon of the longus colli muscle with subsequent inflammation. The calcifications are commonly located at the superior oblique portion at the level of the C1–C2 vertebrae. The typical clinical presentation consists of acute neck pain, odynophagia, and painful limitation of neck range of motion. Objectives: We will describe this disease with three that cases presented to our institution and compare the findings on imaging studies. Methods: We retrospectively reviewed the clinical data, radiological features, and laboratory reports of three patients diagnosed with acute longus colli tendinitis. Computed tomography and plain radiographs were reviewed and compared by a single radiologist. A contemporary review of the literature was conducted using PubMed (Medline), Embase, and Cochrane library databases. Results: Computed tomography showed greater sensitivity for the detection of the pathognomonic calcification than plain radiographs and facilitated the exclusion of other more severe conditions by following a systematic interpretation composed of five key elements. Plain radiographs showed non-specific signs of prevertebral soft tissue swelling and a decreased cervical lordotic curve. However, no calcification was identified on plain radiographs. The literature review revealed 153 articles containing 372 cases. Surgical or invasive procedures were mentioned in 13.7% of publications and were performed in 28 patients. Conclusion: Acute longus colli tendinitis can mimic the clinical presentation of more severe conditions that the otolaryngologist may be required to evaluate, such as infectious, traumatic, and neoplastic diseases. Knowledge of this entity, with its pathognomonic imaging findings, can prevent misdirected medical therapy and unnecessary invasive procedures.

Jun Hirai,1,2 Tessei Kuruma,3 Daisuke Sakanashi,2 Yuji Kuge,4 Takaaki Kishino,4 Yuuichi Shibata,5 Nobuhiro Asai,1,2 Mao Hagihara,6 Hiroshige Mikamo1,2 1Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute, Aichi, 480-1195, Japan; 2Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute, Aichi, 480-1195, Japan; 3Department of Otolaryngology, Aichi Medical University Hospital, Nagakute, Aichi, 480-1195, Japan; 4Department of Emergency and Critical Care Medicine, Aichi Medical University Hospital, Nagakute, Aichi, 480-1195, Japan; 5Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi, 480-1195, Japan; 6Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University, Nagakute, Aichi, 480-1195, JapanCorrespondence: Jun Hirai, Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute, Aichi, 480-1195, Japan, Tel +81-561-62-3311, Fax +81-561-76-2673, Email hiraichimed@gmail.comAbstract: Although Dialister pneumosintes is a commensal microorganism of the oral cavity, it may sometimes cause severe systemic infections. We report a case of Lemierre syndrome (LS), which developed after D. pneumosintes infection, in a 73-year-old Japanese woman who was admitted to the hospital for throat pain, neck swelling, and fever for 3 days. She had a 3-month history of neglected dental caries, gingivitis, and periodontitis. Physical examination revealed right tonsillar erythema and swelling, and computed tomography (CT) showed peritonsillar and retropharyngeal abscesses. Ampicillin/sulbactam was promptly administered after collecting two sets of blood cultures. Surgical drainage for peritonsillar and retropharyngeal abscesses was also conducted on the second hospital day. Although only commensal oral microflora grew in the culture from the drained pus, Gram-negative bacilli were confirmed in the anaerobic blood cultures. Metronidazole was administered intravenously; however, the fever and neck swelling persisted. Repeat CT performed on the fifth hospital day revealed right internal jugular vein thrombosis, a known complication of tonsillitis and pharyngitis once the infection extends beyond the oropharynx. We diagnosed she had coexisting LS, and anticoagulant therapy was added to her treatment regimen. Her condition improved, and she was discharged after completing 3 weeks of antibiotics. Conventional methods failed to identify the isolated bacterium, and 16S rRNA sequencing ultimately identified it as D. pneumosintes. In a literature review of bacteremia due to D. pneumosintes, poor oral hygiene was considered a probable risk factor for invasive D. pneumosintes infection. We consider this to be the case in our patient who presented with dental caries, gingivitis, and periodontitis. In addition, all cases revealed that the 16S rRNA gene sequencing is useful for identifying this species. Although the diagnosis of LS by physical examination is difficult, physicians should always consider it as a potential complication of infections in the pharyngeal area.Keywords: Dialister pneumosintes, Lemierre syndrome, tonsillar abscess, retropharyngeal abscess, oral hygiene, anticoagulation

The purpose of the study was to investigate the influence of the COVID-19 pandemic on the incidence of deep neck infections (DNIs) in pediatric patients. In addition, it describes the clinical, laboratory, and microbiology presentation as well as the clinical outcomes. Retrospective cohort study. A single tertiary medical center. All patients ≤18 years with a diagnosis of DNI, between the years 2010–2022, were included in the study and the yearly incidence of DNI was calculated. Patients were divided according to their diagnosis of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs), and according to age; Group 1 (aged 0 to ≤4 years) and Group 2 (aged>4 to ≤18 years). A total of 46 cases of DNIs; 24 were RPAs and 22 were PPAs, age group 1 had 20 patients, and age group 2 had 26 patients. The overall DNI incidence during 2010 was 0.81 and declined in 2020 (COVID-19 pandemic period) to 0.33, followed by a surge in the incidence of 4.85 in 2022 (post-COVID-19 period). In age group 1 RPAs were more dominant (70 %) while PPAs were dominant (61.5 %) in group 2. (p = 0.034). A higher prevalence of positive cultures was seen in the RPA group compared to the PPA group (75 % vs 33 %, p = 0.025, respectively), and in age group 1 compared to age group 2 (77 % vs 30 %, p = 0.001, respectively). In conclusion, our study provides valuable insights about the disease and vulnerable communities. In addition, we showed a decrease during the COVID-19 pandemic followed by an increase in DNI incidence post-COVID-19 pandemic era. A larger comprehensive prospective study is warranted to gain a deeper understanding of these trends and their underlying causes. [ABSTRACT FROM AUTHOR]

A retropharyngeal abscess is a deep neck infection, uncommon in adults but more prevalent in children. This report details a rare case of a huge retropharyngeal abscess in an adult female, effectively managed by an incision in the posterior oropharyngeal wall under local anesthesia. A 76-year-old woman with hypertension, diabetes, ischemic heart disease, and total thyroidectomy presented with sudden neck swelling, dyspnea, stridor, and dysphagia. Examination and imaging revealed a large retropharyngeal abscess. The abscess was drained through an incision in the posterior wall of the oropharynx using a local anesthetic, yielding immediate symptom relief. Cultures identified Streptococcus and Staphylococcus aureus , leading to adjusted antibiotics. The patient showed significant improvement, with resolution of respiratory distress and reduced inflammation. The retropharyngeal space, containing lymph nodes and connective tissue, extends from the skull base to the superior mediastinum, communicating with the carotid sheath and parapharyngeal space. Effective management of a critically ill, immunocompromised patient with a resistant retropharyngeal abscess was achieved using an intraoral approach and intravenous antibiotics. This method avoids general anesthesia and minimizes postoperative complications. CT scans are essential for assessing disease extent and planning surgery. Our case highlights the successful treatment of a large abscess with minimal risks. Drainage of retropharyngeal abscesses via the intraoral approach under local anesthesia can be considered a valuable method for high-risk patients who are not candidates for general anesthesia. Additionally, we presented a rare case of an exceptionally large retropharyngeal abscess. • We presented a rare case of an exceptionally large retropharyngeal abscess. • The intraoral approach under local anesthesia effectively managed a massive retropharyngeal abscess in a high-risk adult patient. • The procedure minimized postoperative complications and avoided the risks associated with general anesthesia. • Timely intervention led to immediate improvement in respiratory distress, voice, and inflammatory markers. • Cultures identified Streptococcus and Staphylococcus aureus , prompting adjusted antibiotics despite initial resistance. [ABSTRACT FROM AUTHOR]

Retropharyngeal abscess (RPA) represents a rare and life-threatening condition, particularly uncommon in the adult population. The simultaneous occurrence of RPA, and cervical spondylodiscitis is an exceedingly infrequent situation. we reported the case of a 67-year-old male who presented to our department with complaints of sore throat, restricted neck range of motion, as well as numbness and weakness in the right arm persisting for two weeks. Cervical computed tomography identified a retropharyngeal abscess measuring 15 cm in height around C3 to D3. Subsequent cervical magnetic resonance imaging disclosed revealed infectious spondylodiscitis at C5-C6-C7 and partially collected epiduritis from C5 to C7. The abscess was promptly drained by the transoral way. Following the procedures, the patient was discharged with a cervical collar and a prescribed course of antibiotics. Cervical retropharyngeal abscesses complicating spondylodiscitis is very rare. The clinical symptoms are variable and nonspecific. Given the potentially life-threatening nature of this condition, its management represents a real challenge. The management of such complex cases necessitates a multidisciplinary approach involving otolaryngologists, neurosurgeons, and infectious disease specialists to mitigate the risk of complications and prevent any potential delays in treatment. • Retropharyngeal abscesses (RPA) complicating spondylodiscitis is a rare potentially life-threatening in adults. • The recognition of RPA alongside CS presented a challenge, primarily stemming from the rarity of this syndrome. • MRI and CT scan are essential and complementary to establish the diagnosis. • The treatment approach is medico-surgical. • Therapeutic strategy must be developed as soon as such a lead is suspected. [ABSTRACT FROM AUTHOR]

This report presents a case of a 9-month-old male subject, with an initial presentation of a viral-like illness progressing rapidly to multiple deep neck abscesses involving the bilateral submandibular, parapharyngeal, retropharyngeal, and anterior mediastinal spaces subsequently confirmed with contrast-enhanced computed tomography of the neck. Additionally, the subject developed mucocutaneous signs of generalized erythematous rash, with red, fissured lips along with edema of the extremities. Initial lab parameters were suggestive of high inflammatory markers, low albumin, and deranged coagulation profile. Treatment with broad-spectrum intravenous antibiotics, albumin, and fresh frozen plasma infusions was commenced. Echocardiography revealed dilatation of the left main coronary artery with mild mitral valvular regurgitation. Based on the clinical criteria, a diagnosis of typical Kawasaki disease (KD) on day 5 of illness was made, and the subject received intravenous immunoglobulin (IVIg) and aspirin. The clinical course was complicated by IVIg resistance, for which a second dose of IVIg and pulse systemic corticosteroid therapy was required. Post defervescence, an isolated elevation of activated thromboplastin time, partially corrected with mixing studies and a positive circulating lupus anticoagulant was noted. The patient did not develop any bleeding or thromboembolic complications during his hospital stay. Surgical drainage of the neck abscesses did not yield any pus or fluid collection. After a stormy course of 31 days, the subject was discharged with an improving trend of inflammatory markers and no progression of coronary artery dilatation. Gradual resolution to baseline health was noted upon follow-up, 18 months postdischarge from the hospital. Despite being one of the most common cause of childhood acquired cardiac disease, KD still poses a significant diagnostic and treatment challenge to physicians. This requires physicians to be vigilant for timely diagnosis and appropriate management to prevent significant cardiac comorbidities and be aware of the possible complications that might arise during the treatment.

Diseases affecting the ear, nose, and throat are prevalent in intensive care settings and often require combined medical and surgical management. Upper airway occlusion can occur as a result of malignant tumor growth, allergic reactions, and bleeding events and may require close monitoring and interventions by intensivists, sometimes necessitating surgical management. With the increased prevalence of immunocompromised patients, aggressive infections of the head and neck likewise require prompt recognition and treatment. In addition, procedure-specific complications of major otolaryngologic procedures can be highly morbid, necessitating vigilant postoperative monitoring. For optimal outcomes, intensivists need a broad understanding of the pathophysiology and management of life-threatening otolaryngologic disease.

Objective: Incomplete Kawasaki disease (IKD) initially presenting as retropharyngeal abnormality is very rare and is prone to misdiagnosis and missed diagnosis, often leading to poor prognosis. Most patients were misdiagnosed with retropharyngeal abscesses. Here, we describe and compare IKD patients initially presenting with retropharyngeal abnormalities, typical KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients. Methods: We performed a retrospective case–control study comparing IKD patients initially presenting with retropharyngeal abnormalities to both KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients admitted to Shenzhen Children's Hospital between January 2016 and December 2021. Results: We evaluated data from 10 IKD patients initially presenting with retropharyngeal abnormalities (Group A), 20 typical KD patients (Group B) and 16 surgical drainage confirmed retropharyngeal abscess patients (Group C). Compared to Group B, we observed that Group A was older and had a more intense inflammatory response. On the day of admission, Groups A and C had similar early clinical presentations, and there were no significant differences in any major signs or symptoms. Close observation for the development of new KD signs and symptoms and unresponsiveness to empirical antibiotic therapy after 3 days is extremely important. The CRP (p = 0.011), AST (p = 0.002) and ALT (p = 0.013) levels were significantly higher and the WBC (P = 0.040) levels were significantly lower in Group A than in Group C. Neck radiological findings, such as the presence of ring enhancement (p = 0.001) and mass effects on the airway, are also useful tools for distinguishing these two diseases. Conclusion: The careful observation of the signs and symptoms of this disease and the comprehensive analysis of the laboratory tests and neck radiological findings may help clinicians become aware of retropharyngeal abnormality as an atypical presentation of KD. Then, unnecessary treatments could be reduced, and the occurrence of serious complications can be avoided. [ABSTRACT FROM AUTHOR]

To discuss the varied presentations, diagnosis, and prompt management of retropharyngeal abscess for academic importance. A retrospective study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery in Belagavi district of Karnataka. Six cases of varied age group with diagnosis of retropharyngeal abscess were studied during two-year period from January 2019 to January 2021. Thorough assessment of all cases was done which included symptoms at the time of presentation, clinical examination findings, imaging studies and laboratory results, medical and surgical interventions. Six patients (4 males, 2 females) were diagnosed as having Retropharyngeal abscess. Youngest age of presentation was 2 month infant. The most common symptoms at presentation included fever and odynophagia seen in all six patients. The clinical examination revealed bulge in posterior pharyngeal wall in all cases, cervical lymphadenopathy in one case, drooling of saliva in three and stridor in one patient, diffuse neck swelling in two ptatients, and trismus in two patients. Contrast Enhanced Computerized Tomographic (CECT) scanning was performed in five patients and one patient underwent Magnetic Resonance Imaging (MRI). The abscess was surgically drained in all patients and received intravenous antibiotics after which there was significant improvement. Retropharyngeal space infection if left untreated, they carry the potential to cause life-threatening complications and death. Although with availability of broad-spectrum antibiotics, the mortality rate is low, appropriate and successful management requires a thorough understanding of the anatomy of the neck, knowledge of usual causative organisms and appropriate medical and surgical management. [ABSTRACT FROM AUTHOR]

Background A retropharyngeal abscess (RPA) is a deep neck infection that considers a medical emergency because of the possibility of serious complications including life-threatening upper airway obstruction, mediastinitis, and sepsis. Materials and Methods We present our experience in Benghazi Children's Hospital, describing the clinical presentations, diagnostic workup, management, and the outcome of four children presented during the time period between November 2017 and November 2021 as cases of RPA secondary to penetrating trauma to the posterior pharyngeal wall either due to ingestion of a foreign body or due to manipulation of tonsils by the traditional therapist. Results All cases presented with fever, poor feeding, and hyperextension of the neck. All were diagnosed by ultrasound and they needed surgical drainage of RPA, as they did not improve with medical treatment alone. Conclusion A high index of suspicion is necessary for the early diagnosis and treatment of RPA. Two of our cases were presented following the manipulation of tonsils by a traditional therapist, so we attempted to emphasize this life-threatening consequence after traditional therapy, as well as the unnecessary morbidity and mortality associated with this ongoing traditional treatment in our country. [ABSTRACT FROM AUTHOR]

Purpose: To characterize the clinical features and outcomes of pediatric patients with retropharyngeal (RPA) or parapharyngeal abscesses (PPA) managed only with medical treatment and showing the importance of early symptoms and imaging studies in the diagnosis of deep neck space infections (DNIs) in children. Methods: A retrospective analysis of all patients diagnosed with RPA and PPA between 2007 and 2017 was performed in Hospital Universitario Central de Asturias. Results: 30 children were identified, with 11 RPA and 19 PPA. 23 children (76.7%) were under 5 years old, and all were treated with intravenous amoxicillin/clavulanic acid and corticosteroids. Torticollis and fever were present in all patients. The mean length of hospital stay was 7.5 days. There were no complications associated. Conclusion: DNIs can be treated in a conservative way, reserving the surgical drainage for cases with a complication associated (airway compromise, lack of response to antibiotic therapy, immunocompromised patients). Treatment with intravenous antibiotics and corticosteroids is a safe option, reducing the duration of symptoms and the length of hospital stay. [ABSTRACT FROM AUTHOR]

Background: A retropharyngeal abscess is a bacterial infection of the back of the throat. It rarely results in deadly complications such as mediastinitis and thoracic empyema from deep neck infections involving soft tissues of the face, arising from oropharyngeal infections, particularly dental caries. Thus, complicating retropharyngeal abscess extending to mediastinitis poses an increased risk of high mortality rate as a result of its significant invasive potential and the fact that the recognition and diagnosis must be made early, as this is usually delayed. Complicating retropharyngeal abscess increases airway compromise and difficult airway management during anesthesia. We present a 40-year-old, male patient who transferred from another primary hospital to our institution's surgical emergency outpatient department with a complaint of neck swelling of 10 days secondary to tooth extraction. He had a complaint of dull-itching pain, localized initially to the submandibular area and subsequently involving the oropharyngeal, neck, and descending to the chest and mediastinum. He was diagnosed with a complicated retropharyngeal abscess extending to the mediastinum (mediastinitis) and thoracic empyema as a complication of odontogenic infection in origin. Besides intravenous antimicrobial therapy, deep neck incision and drainage, and thoracotomy was done under general anesthesia. After adequate venous access and the patient positioned in head-up position, premedication was given. General anesthesia with an endotracheal tube was provided with a ready tracheostomy set. Inhalational induction was conducted and laryngoscopy was performed after the adequate depth of anesthesia was achieved. We experienced anticipated difficult intubation after induction. After multiple attempts, the tracheal tube was placed correctly by using a bougie. Halothane was used for maintenance anesthesia with intermediate-acting muscle relaxant under controlled ventilation. Conclusion: On top of a detailed review of the patient's history, physical examination, laboratory investigations, and imaging profiles; early recognition of the airway compromise from the complicated retropharyngeal abscess, and proper readiness to manage potentially challenging airway compromise, and difficult airway management during the perioperative period. [ABSTRACT FROM AUTHOR]

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Retropharyngeal abscesses (RPAs) represent the group of deep space infections of the neck. Although RPA is a well-known condition, some aspects of it still may be challenging. Localization, symptoms, and etiology may confuse even the most experienced physicians. S. equi subspecies are zoonotic agents and cause multiple diseases in diverse animals. Infections in humans are rare. This report presents an extremely rare case of retropharyngeal abscess in a 12-year-old girl caused by an infection of Streptococcus equi subsp. equi. [ABSTRACT FROM AUTHOR]