Surgical management of parapharyngeal space infections

Parapharyngeal space (PPS) infections often arise from pharyngeal or dental infections and, if left untreated, can result in serious complications such as mediastinitis, Lemierre syndrome, and death. The PPS is an inverted triangle spanning the skull base to the greater cornu of the hyoid, the inferior constrictor medially, and the ramus of the mandible laterally with many vital structures contained within. Treatment begins with assessing the airway, considering the need for computed tomography or magnetic resonance imaging with intravenous contrast and broad-spectrum antibiotics. With evidence that a PPS infections has resulted in an abscess or there is failure of conservative management with 24-48 hours of intravenous antibiotics or in severe cases, surgical drainage is performed. This is done via the traditional transcervical route or, if the abscess is medial to the great vessels, a transoral approach. Complications of surgery are rare, and resolution of symptoms with prompt antibiosis and surgical treatment prevents the possibility of infectious spread and its dangerous sequelae.