Retropharyngeal and pretracheal spaces

The retropharyngeal space includes the posterior part of the visceral compartment in which the esophagus, trachea, and thyroid gland are enclosed by the middle layers of deep cervical fasci, which extend into the superior mediastinum. This space may become infected as a result from direct extension of a pharyngeal space infection or through lymphatics from the nasopharynx. The onset of the infection is insidious, although dyspnea, dysphagia, nuchal rigidity, fever, and chills may be present. Bulging of the posterior pharyngeal wall may be present. Soft tissue radiography or computed tomography (CT) scan disclose widening of the retropharyngeal space. Hemorrhage, rupture into the airway, laryngeal spasm, bronchial erosion, and jugular vein thrombosis are the main complications. The pretracheal space that surrounds the trachea generally becomes involved following perforation of the anterior esophageal wall or from an extension of a retropharyngeal infection. Patients usually present with hoarseness, dyspnea, and difficulty in swallowing. Prompt surgical drainage is needed to prevent mediastinal extension.

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