At first the child may have severe nasal pharyngeal symptoms accompanied by fever. These symptoms subside but the fever remains above normal. Several days later the temperature rises to 103 °F and local and pressure-symptoms appear. In other cases, onset is sudden with immediate local and pressure-symptoms. The characteristic symptoms are due to pressure: dyspnea from partial larynx closure, difficulty swallowing from food obstruction, mouth-breathing from posterior nares closure causing a 'quack' sound. Head is thrown back to elevate the mass and relieve pressure. Child appears desperately ill; pharynx bulges on one side with varying protrusion amounts. In some cases, uvula is pushed aside and pharynx filled up. Severity of symptoms depends on size of protruding mass. The tumor soon fluctuates showing pus formation leading to a hectic fever (high irregular temperature with chills, sweats, pallor). If left untreated, abscess will rupture in 2-3 days or delayed for weeks. As soon as fluctuation is discovered, the abscess should be incised with a guarded bistoury. This prevents swallowed or inspired pus causing complications like aspiration pneumonia or asphyxia. Child should be firmly held by nurse with head back; physician uses tongue depressor immediately withdrawable. After lancing, nurse bends child's head forward to allow pus out of mouth. Some surgeons prefer the child lying on a table with head hanging backward over end. Post-treatment is simple as symptoms disappear once pus removed. Retropharyngeal abscess from Pott’s disease due to cervical vertebrae softening and pus accumulation behind pharynx, slow forming without much fever. Such abscesses are opened externally when pressure-symptoms demand relief. <Callout type="important" title="Critical Surgical Intervention">Immediate incision of fluctuating abscess is crucial to prevent complications like aspiration pneumonia or asphyxia.</Callout>
Key Takeaways
- Recognize early nasal pharyngeal and pressure symptoms of retropharyngeal abscess.
- Understand the importance of immediate surgical intervention to prevent complications such as aspiration pneumonia or asphyxia.
- Know how to properly position and hold a child during abscess incision.
Practical Tips
- Use a tongue depressor instead of mouth-gag for quick removal in case of emergency.
- Ensure the child's head is positioned correctly post-incision to allow pus drainage.
- Monitor fluctuation signs closely to determine when surgical intervention is necessary.
Warnings & Risks
- Failure to promptly incise an abscess can lead to severe complications including aspiration pneumonia or asphyxia.
- Improper positioning of the child during surgery may hinder effective pus drainage and increase risk of swallowing or inhaling pus.
Modern Application
While surgical techniques have advanced, understanding early symptoms and recognizing the need for immediate intervention remains crucial. Modern medical practices offer safer methods but historical knowledge provides a foundation for quick decision-making in emergency situations.
Frequently Asked Questions
Q: What are the initial symptoms of retropharyngeal abscess?
Initial symptoms include severe nasal pharyngeal issues and fever, which may subside temporarily before local and pressure symptoms appear.
Q: Why is immediate surgical intervention critical for a fluctuating abscess?
Immediate incision prevents complications such as aspiration pneumonia or asphyxia caused by swallowed or inhaled pus.
Q: What position should the child be held in during abscess lancing?
The nurse should firmly hold the child with head thrown back to facilitate proper positioning for surgical intervention.