Navigated retropharyngeal abscess cleavage to avoid revision surgery – a case series

Introduction:

Surgical treatment of abscess-type inflammation in the upper retropharyngeal area requires a targeted approach, taking into account adjacent, sensitive, anatomical structures. In some cases, however, no reliable relief of the abscess cavern can take place in an initial procedure, since surrounding inflammatory tissue simulates an opening due to the exit of the pus. To avoid revision surgery, an already initial, navigation-based procedure is a possibility of sufficient intervention.

Material and methods:

We report on 3 cases of MRI-guided revision surgery in clinically and radiologically insufficient initial discharge of a 2-year-old and an 11-year-old girl as well as a 49-year-old woman. The surgical approach was transoral. Optical navigation was carried out via a Scopis® Hybrid Navigation® and a Brainlab® system.

Results:

Despite initial imaging and the attempt to undergo conventional transoral surgical discharge, persistent abscess remained in all 3 cases during follow-up MRI. In the navigated revision, 2 cases showed sufficient relief and in one case the safe exclusion of the radiological evidence. There were no intraoperative or postoperative complications. All 3 patients were released after completing the concomitant antibiotic therapy in good general condition.

Conclusion:

The navigation-based probing and targeted relief of abscessing inflammation of the upper retropharyngeal space is a safe and sufficient surgical technique. The need for revision surgery could be reduced by the already initial application.

Publication History

Publication Date:
18 April 2018 (online)