Table 32-2.

Clinical Features of Retropharyngeal, Parapharyngeal, and Peritonsillar Abscesses

	Usual Age	Sites of Origin	Location	Clinical Findings	Complications/Extension Site	Management
Retropharyngeal abscess	< 4 yr	Pharyngitis, dental infection, trauma	Between posterior pharynx and prevertebral fascia	Unilateral posterior pharyngeal bulging; neck hyperextension, drooling, respiratory distress	Spontaneous rupture and aspiration; contiguous spread to posterior mediastinum, parapharyngeal space	Antibiotics, drainage; artificial airway
Parapharyngeal abscess	> 8 yr, adolescents, adults	Tonsillitis, otitis media, mastoiditis, parotitis, dental manipulation	Anterior and posterior pharyngomaxillary space	Anterior compartment: swelling of the parotid area; trismus; tonsillar prolapse.	Carotid erosion; airway obstruction; intracranial, lung, contiguous spread to mediastinum; septicemia	Antibiotics, drainage; artificial airway
Parapharyngeal abscess	> 8 yr, adolescents, adults		Anterior and posterior pharyngomaxillary space	Posterior compartment: septicemia; minimal pain or trismus		Antibiotics, drainage; artificial airway
Peritonsillar abscess	Adolescents, adults	Tonsillitis	Tonsillar capsule, and space below superior constrictor muscle	Swelling of 1 tonsil, uvular displacement; trismus, muffled voice	Spontaneous rupture and aspiration; contiguous spread to parapharyngeal space	Antibiotics, drainage

From Brook I: Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg 62:1545-1550, 2004.