Retropharyngeal space infection

Introduction to posterior pharyngeal infection Infection of retropharyngeal space (infection of retropharyngeal space) is a purulent infection between the pharynx, the posterior wall of the esophagus and the anterior vertebral fascia. It occurs in infants and young children with thin and malnourished, mostly due to nasal, ear infection or cervical tuberculosis. Spread, clinical early respiratory-like infections, gradually forming a posterior pharyngeal abscess. Due to oppression of the abscess, edema of the throat, difficulty in breathing and swallowing, the vocal resonance cavity shrinks when the sound is made, and the child has a duck-like voice or crying. Physical examination revealed that the neck was stiff, and it was clinically appropriate to cut open drainage pus and systemic anti-infective treatment. basic knowledge The proportion of illness: 0.032% Susceptible population: infants who are born in thin and malnourished Mode of infection: non-infectious Complications: acute mediastinal inflammation meningitis sepsis and bacteremia

Causes of posterior pharyngeal space infection

Spread of infection (30%):

The most common cause is the infection of the nasal cavity, sinuses, adenoids and nasopharynx through the lymphatic system, causing acute suppurative lymphadenitis in the posterior pharyngeal space (one group of each of the posterior pharyngeal lymph nodes in the posterior pharyngeal line), which deteriorates into an abscess. Therefore, the disease can be complicated by acute infectious diseases such as measles, scarlet fever, and flu.

Ear infections (30%):

If otitis media spreads to the humerus, directly destroys the bone, or indirectly forms an epidural abscess, and then penetrates into the posterior pharyngeal space through the rupture hole of the skull base. The otogenic neck deep Bezold's abscess can also be used. Through the parapharyngeal space into the posterior pharyngeal space.

Foreign body (30%):

The posterior pharyngeal wall or the posterior wall of the esophagus is worn by trauma. Cervical tuberculosis or tuberculous retropharyngeal lymphadenitis spreads into a cold abscess, which is a chronic disease. Penetrated by parapharyngeal abscess.

Pathogenesis

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Prevention of posterior pharyngeal infection

Active treatment of maxillary third molar pericoronitis, periapical periodontitis and tonsillitis, posterior alveolar nerve block anesthesia, foramen ovale anesthesia, underarm-trigeminal-sympathetic nerve block to prevent infection. At the same time, active infection prevention should be applied to infected cases to avoid serious complications such as encephalitis and sepsis.

Post-pharyngeal space infection complications Complications Acute mediastinal meningitis sepsis and bacteremia

1. Respiratory obstruction, asphyxia is the main cause of death, often caused by spontaneous perforation or incision of the posterior pharyngeal abscess, pus into the respiratory tract, and sometimes caused by swollen pharyngeal or tracheal compression.

2. Infection spread

(1) mediastinal inflammation: infection can spread to the mediastinum can cause mediastinal inflammation, manifested as chest pain, severe breathing difficulties, high fever, X-ray film shows widening of mediastinal shadow.

(2) Other deep cervical interstitial infection: The pressure in the posterior pharyngeal abscess is too high, and the infection can spread to the throat space, the parotid space or the mandibular space.

(3) Meningitis: The infection spreads up into the brain and can cause meningitis.

(4) sepsis, bacteremia: bacterial toxins absorbed into the blood or pathogenic bacteria into the blood, can cause symptoms of systemic infection such as sepsis or bacteremia.

3. Bleeding and embolization lesions corrode the carotid artery, which can cause fatal bleeding; invasion of the jugular vein can cause jugular vein embolization.

Symptoms of posterior pharyngeal space infection Common symptoms, dysphagia, difficulty in swallowing, refractory breathing, closeness, loss of water, high fever, nausea, systemic failure

Clinical manifestation

(1) Symptoms of respiratory tract infection: The onset is more urgent. Early children have fever, crying, irritability and other symptoms of upper respiratory tract infection, and symptoms of systemic infection such as high fever appear several days later.

(2) Throat edema: It can occur early, gradually develop progressive dyspnea, wheezing and difficulty swallowing, and worsen after falling asleep. Children often refuse to eat due to difficulty swallowing.

(3) The duck is crying like this: At this time, the voice and crying of the child are special, the voice is ambiguous and the nasal sound is heard, and the crying sound is like a duck. This is due to the reduction of the pharyngeal cavity during vocalization, not hoarseness. This is a A noteworthy clinical phenomenon.

(4) neck pain, runny nose: children often complain of neck pain, there are hooligans, but usually no teeth close tight.

(5) symptoms of systemic failure: due to eating and breathing difficulties, children often have water loss, exhaustion and other performance.

2. Signs The neck has different degrees of rigidity, starting to lean back, and later leaning to the healthy side, in order to relieve pain and difficulty breathing.

Examination of posterior pharyngeal infection

Bacteriological examination, if the medical history is long, there is no significant lesion in the cervical spine, bacteriological examination should be done to further confirm the diagnosis.

1. Throat examination: It can only be a small extent of local swelling on the midline of the posterior pharyngeal wall (early caused by infection of the posterior pharyngeal lymph nodes) or obvious redness and swelling of the posterior pharyngeal wall. The affected side of the pharyngeal arch and soft palate can be pushed In front, such as abscess and throat, the affected side may have edema and edema, occasionally abscess position is low, need to be found by direct laryngoscopy, palpation, local soft, tenderness or fluctuation, obvious uplift Puncture and puff can obtain pus, but palpation may cause the puncture to rupture. It should not be easily tried. When puncture and puff, it should be prudent to prevent sudden abscess and suffocation. Therefore, first aid should be prepared before the examination. Take the supine position low, just in case.

2. X-ray examination: the soft tissue shadow of the anterior vertebral can be seen in the lateral radiograph.

Diagnosis and diagnosis of posterior pharyngeal space infection

The disease is rare in adults, often a cold abscess caused by tuberculous infection, symptoms and signs are directly in the throat, often pain, difficulty swallowing, difficulty breathing, wheezing, anorexia, nausea and so on.

According to the medical history, clinical manifestations and diagnosis of laryngoscopy are generally not difficult. X-ray examination can help to determine the size and extent of the abscess. Cervical vertebrae tuberculosis can show cervical bone destruction.

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