Management of parapharyngeal and retropharyngeal space infections

Deep neck space infection is a relatively common condition with potentially catastrophic, life-threatening complications. A detailed understanding of the topography of the neck, relationships between compartments of the neck, and the propagation of infection is essential for accurate assessment and formulation of a propitious and timely treatment plan. This article focuses on approaches to the deepest spaces in the anterior neck-the parapharyngeal space and retropharyngeal space (RPS). Treatment starts with assessment and assurance of a safe, stable airway, broad spectrum intravenous antibiotics, and contrasted imaging to formulate a surgical plan. The parapharyngeal space and retropharyngeal space may be approached transorally or transcervically. Sound surgical principles, namely wide incision and dependent drainage, may prevent the further spread and associated morbidity.