Tohoku J. Exp. Med., 2007, 213(1)

Case Report

Retropharyngeal Abscess Complicated with Torticollis: Case Report and Review of the Literature

JUN HASEGAWA,¹ MASARU TATEDA,¹ HIROSHI HIDAKA,¹ SHUN SAGAI,¹ AYAKO NAKANOME,¹ KATSUNORI KATAGIRI,¹ MASAHIRO SEKI,² YUKIO KATORI³ and TOSHIMITSU KOBAYASHI³

¹Department of Otorhinolaryngology, Iwaki Kyoritsu General Hospital, Iwaki, Japan
²Department of Orthopaedics, Iwaki Kyoritsu General Hospital, Iwaki, Japan
³Department of Otorhinolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan

Retropharyngeal abscess commonly develops among infants and small children, and is associated with the severe inflammation of the retropharyngeal lymph nodes located in the retropharyngeal space. Retropharyngeal abscess causes cervical pain, swelling, contracture of the neck, and in rare cases inflammatory torticollis, all of which result from an inflammatory process that irritates the cervical muscles, nerves or vertebrae. Here we report a rare case of retropharyngeal abscess with a complication of torticollis. A 4-year-old girl suffered from severe retropharyngeal abscess spreading through the deep cervical fascia, as judged by magnetic resonance imaging of the neck. Blood analysis showed high degree of inflammatory reactions, and so the patient was transferred to our hospital ward. The inflammation caused spasms of the prevertebral muscles, eventually leading to torticollis. The surgical drainage was performed immediately under general anesthesia, and an anti-inflammation therapy with intravenously administered meropenem trihydrate and clindamycin was used together with traction therapy to relieve the symptoms of the patient. We must be careful about the existence of epidural abscess and infectious spondylitis when the retropharyngeal abscess causes torticollis. In conclusion, an anti-inflammation therapy using antibiotics, along with traction therapy, was effective to relieve the symptoms. In addition to repeated clinical examinations, cooperation with orthopedists and careful follow-up are necessary. We also discussed the relationship between acute torticollis and retropharyngeal abscess.

keywords —— retropharyngeal abscess; torticollis; danger space; deep neck fascia; traction therapy

© 2007 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2007, 213, 99-104

Correspondence: Jun Hasegawa, Department of Otorhinolaryngology, Iwaki Kyoritsu General Hospital, 16 Kuzehara, Uchigoh Mimayamachi, Iwaki 973-8555, Japan.

e-mail: junha@orl.med.tohoku.ac.jp