Inkina A.V., Arevina V.E. Polysinusitis complicated by peripharyngeal abscess and meningitis in a child. Head and neck. Russian Journal. 2023;11(2):52–56 The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, drawings, photographs of patients.
DOI: https://doi.org/10.25792/HN.2023.11.2.52-56
Background. Deep infections of the fascial spaces of the neck with subsequent abscess formation represent a formidable disease entity with significant mortality rates due to multiple complications, which include airway obstruction, pharyngeal abscess rupture, empyema, mediastinitis, carotid artery erosion, jugular thrombophlebitis, and cavernous sinus thrombosis. Parapharyngeal abscesses require rapid diagnosis and early treatment, often including surgical drainage to achieve the best outcome. Retropharyngeal abscesses can spread at the level of the nasal, oral, or laryngeal part of the pharynx or involve multiple parts causing corresponding functional disorders (impaired breathing, impaired swallowing, nasality, torticollis).
Case description. Male patient M., 6 years old, was admitted to the hospital with complaints of fever up to 38 °C, neck pain, and eyelid edema. He became ill acutely, 5 days before admission, when rhinorrhea, sore throat, cough, and fever up to 40 °C appeared. There was a mild swelling of the upper eyelid on the right with mild hyperemia of the skin. Computed tomography of the head, neck and chest organs with intravenous contrast enhancement revealed an uneven soft tissue induration and swelling of the nasopharyngeal fornix with the presence of a low-density contrast-accumulating structure – an abscess of the deep cervical space and the external base of the skull, sized 23x14x15 mm, and bilateral polysegmental pneumonia. According to clinical and laboratory data: WBC 20.93*109/l, C-reactive protein 167 mg/l, procalcitonin 7.4 ng/ml, in the CSF analysis, cytosis 402 in 1 μl, neutrophils 27%, lymphocytes 73%. Emergency surgery was performed – videoendoscopic maxillary transethmoidal sphenoidotomy, opening of the nasopharyngeal abscess by transoral access under general anesthesia. The treatment resulted in positive dynamics in the form of the eyelid edema resolution, normalization of the body temperature, blood, and cerebrospinal fluid parameters, as well as resolution of bilateral pneumonia.
Conclusion. Parapharyngeal abscesses in children present a diagnostic problem. This observation shows that computed tomography with obligatory contrast enhancement is crucial for the diagnosis of parapharyngeal abscess, and that timely surgical treatment, supplemented by antibiotic therapy, is the main treatment strategy for such patients. Key words: parapharyngeal abscess, retropharyngeal abscess, abscess, retrovisceral space, retropharyngeal space, meningitis
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study