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縱隔洞膿瘍 및 側頸部膿瘍을 倂發한 急性咽喉膿瘍의 治驗例

Acute Retrop ryngeal Abscess followed by Mediastinal and Deep Cervical Abscess

김기헌,
소속 상세정보
김기헌 (  ) - 가톨릭대학 의학부 이비인후과교실

Abstract


Retropharyngeal abscess is not common but is important in understanding the fascial spaces of the head and neck. The retropharyngealspace extends from the, anterior face of the basi-occiput downward through the prevertebral space into the posterior mediastinum, laterally the retropharyngeal space is continuous with the parapharyngeal space.
In infants and young children, there are lymph nodes in the retropharyngeal space, which atrophy. Or regress by young adult life. Therefore, retropharyngeal abscess is seen almost exclusively in infants and young children. Their afferents drainn adjucent muscles and bones, the nasal cavities, accessory sinuses the nasal part of pharynx, middle or internal ears. and the auditory tubes, their efferents, pass to the superiorr deep cervical nodes.
A special type, chronic type of retropharyngeal abscess, the "cold abscess" , of tuberculosis (Pott´s disease), is seen at any age.
Case; Report
This 57-year-old moderate developed and nourished housewife Mrs. Lee who was referred to out patient department because of dyspnea, fever, dysphagia, redness and swelling on the right lateral neck, chest discomfort, and limitation of movement of the neck at April 27, 1965.
The above mentioned symptom and sign noted for 7 days, and it was aggrevated the more for 2 days.
After the admission, operation of lateral incision of the right deep cervical abscess and internal approach of the retropharyngeal abscess, was performed with the Trendelenburg´s position under ether general endotracheal anesthesia. A lot of amount of greenish yellow pus was evacuated and revealed hemolytic streptococcus, it´s very sensitive to terramycin, tetracylin and albamycin, but also moderate sensitive to the streptomycin, kanamycin and leukomycin.
After the operation, rubber drain which was inserted into the retropharyngeal space, was exchanged and irrigation with saline solution daily.
Lipiodol was injected. through the Nelaton catheter into the retropharyngeal space and it´s spread to the right cervical abscess cavity and to posterior mediastinal abscess cavity (Fig. 2, 3, 4 & 5).
In the X-ray for sinus cavity, both maxillary sinuses were revealed diffuse cloud and chest PA showed negative finding. She was treated as above mentioned procedure for 16 days and her general condition and local sign improved.
About five months after discharge, she was rechecked of her general and local condition with laboratory examination and X-ray study. Her general and local condition revealed no definite abnormality and also the lipiodol of the mediastinum disappeared.
Following Results Summarized:
1. Acute retropharyngeal abscess followed by contralateral. deep cervical abscess and mediastinal abscess.
2. The neck lateral view of X-ray, and chest lateral view after lipiodol inject-ion through retropharyngeal incised wound are most significant in the diagnostic view point of the acute retropharyngeal abscess.
3. It´s the most effective treatment of acute retropharyngeal abscess that internal approach was made with Trendelenburg´s posltlon under the general anesthesia and ´then, irrigation done with saline solution daily until healing ´up of the local wound.

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