Treatment consists of parenteral penicillin and surgery. Patients have fever and systemic toxicity as well as neck pain, dysphagia, muffled voice, and respiratory stridor. Physical findings include erythema and bulging of the posterior wall of the pharynx. Although the bacterial agent of retropharyngeal infections is not determined in many patients, streptococci and other mouth flora predominate. Penicillin is the traditional antibiotic of choice, but agents that provide a broader spectrum of antibacterial coverage may be justified until culture data are available.
Surgical drainage is vital to prevent asphyxiation and extension of infection to the mediastinum.
Infections of the retropharyngeal space must be distinguished from infections of the prevertebral space. The prevertebral space lies posterior to the retropharyngeal space and is separated from it by the prevertebral fascia. Infection of the prevertebral space often originates from osteomyelitis of the cervical vertebrae. This infection is frequently caused by staphylococci and may lead to spinal cord damage unless treated by an approach that combines immobilization, antistaphylococcal antibiotics, and external drainage. The parapharyngeal space is demarcated by the parotid gland and internal pterygoid muscle laterally and by the superior constrictor muscle medially.