Retropharyngeal and parapharyngeal abscess are two types of two neck abscesses. A neck abscess is due to the accumulation of pus caused by an infection in the spaces between the structures of the neck. They are also called cervical abscesses or deep neck infections. Neck abscesses can include peritonsillar infections, retropharyngeal infections, submandibular infections, buccal infections, and parapharyngeal infections.
The key difference between retropharyngeal and parapharyngeal abscess is their location. Retropharyngeal abscess is the infection and accumulation of purulent discharge within the retropharyngeal space, while parapharyngeal abscess is the infection and accumulation of purulent discharge within the parapharyngeal space.
CONTENTS
1. Overview and Key Difference
2. What is Retropharyngeal Abscess
3. What is Parapharyngeal Abscess
4. Similarities – Retropharyngeal and Parapharyngeal Abscess
5. Retropharyngeal vs Parapharyngeal Abscess in Tabular Form
6. Summary – Retropharyngeal vs Parapharyngeal Abscess
7. FAQ – Retropharyngeal and Parapharyngeal Abscess
What is Retropharyngeal Abscess?
Retropharyngeal abscess forms behind the pharynx or back of the throat. Retropharyngeal abscess affects the retropharyngeal space, which is a midline deep compartment of the head and neck. This space primarily contains fatty areolar tissue and lymph nodes that drain the pharynx, nose, and middle ear. An abscess in this area often develops following an upper respiratory infection. In children, the lymph nodes in the abscess area can become infected and break down, which ultimately forms pus. Retropharyngeal abscesses are most common in young children.

Figure 01: Retropharyngeal Abscess
Retropharyngeal abscess is caused by a bacterial infection affecting the lymph node of the throat, such as tonsillitis, and infections involving antibiotic resistant bacteria like MRSA. The symptoms of this condition include trouble swallowing or experiencing pain, severe sore throat, difficulty in breathing, difficulty in speaking, noisy breathing, severe headache, stiff neck, coughing, and fever.
Retropharyngeal abscess can be diagnosed through physical examination, complete blood count, bacterial culture, X-ray, and CT scan. Furthermore, treatment options for retropharyngeal abscess involve clearing the infection through antibiotics and, in some cases, draining the abscess through respective surgery.
What is Parapharyngeal Abscess?
Parapharyngeal abscess is a deep neck abscess. It is the infection and accumulation of purulent discharge within the parapharyngeal space. This space is located lateral to the superior pharyngeal constrictor and medial to the pterygoid muscle. The infections in the parapharyngeal space normally originate in the tonsils or pharynx. However, pathogens spread from odontogenic sources and lymph nodes can also infect this space. The symptoms of this condition may include sore throat, fever, odynophagia, and swelling in the neck down to the hyoid bone.

Figure 02: Parapharyngeal Abscess
The diagnosis of parapharyngeal abscess is made through physical examinations and imaging tests like CT scan. Furthermore, treatment options for parapharyngeal abscess may include broad-spectrum antibiotics and surgical drainage.
Similarities Between Retropharyngeal and Parapharyngeal Abscess
- Retropharyngeal and parapharyngeal abscesses are two neck abscesses.
- Both conditions may cause similar symptoms, such as neck swelling and difficulty swallowing.
- Both conditions can be diagnosed through physical examinations and imaging tests.
- They can be treated with antibiotics and surgical drainage.
Difference Between Retropharyngeal and Parapharyngeal Abscess
Definition
- Retropharyngeal abscess is an abscess that forms in the retropharyngeal space.
- Parapharyngeal abscess is an abscess that forms in the parapharyngeal space.
Age of Onset
- Retropharyngeal abscess is seen in children.
- Parapharyngeal abscess is seen in adults.
Causes
- Retropharyngeal abscess is caused by a bacterial infection affecting the lymph node of the throat, such as tonsillitis and MRSA infections.
- Parapharyngeal abscess arises secondary to oropharyngeal infections that spread either by direct continuity or by lymphatic drainage.
Signs and Symptoms
- The signs and symptoms of retropharyngeal abscess are difficulty swallowing, pain when swallowing, fever, swelling in the lymph nodes, stiff neck, challenges breathing, noisy inhalation, and neck pain.
- The signs and symptoms of parapharyngeal abscess are fever, sore throat, odynophagia, swelling in the neck down to the hyoid bone, rigors, bacteremia, neurologic deficits, and massive hemorrhage.
Diagnosis
- Retropharyngeal abscesses can be diagnosed through physical examination, complete blood count, bacterial culture, X-ray, and CT scan.
- Parapharyngeal abscesses can be diagnosed by physical examinations and imaging tests such as CT scans.
Treatment
- The treatment options for retropharyngeal abscess are antibiotics such as ampicillin-sulbactam or clindamycin and, in some cases, draining the abscess through respective surgery.
- The treatment options for parapharyngeal abscess are broad-spectrum antibiotics such as ceftriaxone, ampicillin/sulbactam, clindamycin, and surgical drainage.
The following table summarizes the difference between retropharyngeal and parapharyngeal abscesses.
Summary – Retropharyngeal vs Parapharyngeal Abscess
Retropharyngeal and parapharyngeal abscess are two neck abscesses. Retropharyngeal abscess occurs behind the pharynx, while parapharyngeal abscess occurs lateral to the pharynx. Furthermore, retropharyngeal abscess results in infection and accumulation of purulent discharge within the retropharyngeal space, whereas parapharyngeal abscess results in infection and accumulation of purulent discharge within the parapharyngeal space. This summarizes the difference between retropharyngeal and parapharyngeal abscess.
FAQ: Retropharyngeal and Parapharyngeal Abscess
1. What is the most common causative agent of an abscess?
- A bacteria called Staphylococcus causes most abscesses in the human body. When bacteria enter the body, the immune system deploys white blood cells to fight the infection. This process causes inflammation, and the tissue nearby dies, which leads to abscess formation.
2. What is the most common cause of retropharyngeal abscess?
- The main cause of retropharyngeal abscess is usually a bacterial infection that has spread from the tonsils, sinuses, throat, adenoids, or nose. An injury to the back of the throat is caused by a sharp object, occasionally causing a retropharyngeal abscess.
3. What are the symptoms of a retropharyngeal abscess?
- The symptoms of retropharyngeal abscess are severe sore throat, swollen lymph nodes, difficulty in breathing, difficulty in speaking, breathing noisily, severe headache, stiff neck, and coughing.
4. What are the symptoms of parapharyngeal abscess?
- Most patients with a parapharyngeal abscess have a fever, sore throat, odynophagia, and swelling in the neck down to the hyoid bone. The other symptoms include rigors, bacteremia, neurologic deficits, and massive hemorrhage.
5. How are parapharyngeal abscesses treated?
- Treatment of pharyngeal abscesses involves the administration of broad-spectrum intravenous antibiotics, such as ceftriaxone, ampicillin/sulbactam, clindamycin with surgical incision, and drainage.
Reference:
1. “Parapharyngeal Abscess.” MSD Manual Professional Edition.
2. “Retropharyngeal Abscess: Causes, Symptoms & Treatment.” Cleveland Clinic.
Image Courtesy:
1. “LargeRetroAbsMark” By James Heilman, MD – Own work (CC BY-SA 4.0) via Commons Wikimedia
2. “B Lux fraktura c5-c6” By Doc. MUDr. Jan Šprindrich CSc (CC BY-SA 3.0) via Commons Wikimedia
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