[Adult parapharyngeal and retropharyngeal abscesses:clinical features and their implications for treatment strategy].

ABSTRACT

Objective:To identify the clinical risk factors related to the increased likelihood of surgical drainage and medical therapy failure in parapharyngeal and retropharyngeal abscess. Method:The charts of 93 consecutive patients from January 2006 to April 2017 with parapharyngeal and retropharyngeal abscess were reviewed retrospectively. Logistic regression analysis was used to study the clinical risk factors.Result:A total of 97 adult patients, there were 34 cases in the immediate surgical drainage group and 32 cases in the delayed surgical drainage group and 31 cases treated with medical therapy alone. The rate of operation therapy was 68%,and the success rate of the medical therapy alone was 32%. All patients had successful resolution of their abscesses by medical therapy and(or) surgical drainage. The average length of stay(17.26d) in the surgical drainage group was longer than the medical therapy group(10.26 d), and the difference was statistically significant(P<0.001).The maximum dimension of abscess＞2.37cm is not only the risk factor of increasing likelihood of surgical drainage, but also that of medical therapy failure(P<0.001, P<=0.002).The factors affecting the hospitalization day were whether or not the operation was performed. There was no significant difference in operative rate between diabetic group and nondiabetic group(χ2=0.523,P>0.05).There were no correlation between diabetes mellitus and the multiple space abscesses(r=-0.032,P<=0.760).Conclusion:Although a majority of adult parapharyngeal and retropharyngeal abscesses were treated with surgical drainage and sufficient effective intravenous antibiotics,but not all patients need surgical treatment. The diameter of the abscess is a risk factor affecting the operation or not.For those with larger abscesses,the preoperative preparation should be actively prepared and the operation should be intervened as early as possible;for those with smaller abscess,the treatment can be cured alone, and the surgical incision and drainage should be avoided in order to reduce the complications and shorten the hospital days.