Introduction

Retropharyngeal abscess is an uncommon entity and a rare complication of acute mastoiditis. Retropharyngeal space lies behind the pharynx between buccopharyngeal fascia which covers the constrictors muscle, and prevertebral fascia. The most common routes by which pus normally spread to retropharyngeal area from the mastoid abscess are via the sheath of the sternocleidomastoid or digastrics muscle.

Case Report

We describe a 45- years old man who presented with otalgia, facial weakness and dysphagia for three days. Clinical examinations showed pus discharge from post auricular region, mass in the external auditory meatus and nasal endoscopic findings of fullness in the nasopharyngeal area. Further examinations showed the seventh, ninth, tenth and twelveth cranial nerve palsies were evident. Radiological investigation revealed the presence of mastoid abscess and retropharyngeal abscess. These were treated with intraoral incision and drainage of the abscess as well as tracheostomy for airway protection and subsequently mastoidectomy for drainage of mastoid abscess.

Discussion

We believe that mastoiditis is the primary source of infection in this patient as infections from mastoid cavity may have spread via suppuration of the lymph nodes around the internal jugular vein and petrositis as shown by multiple cranial nerve palsies especially facial nerve and nerve within the carotid sheath.

Conclusion

Although rare, direct infections from mastoid abscess to the retropharyngeal area may occur especially those patients with upper aerodigestive symptoms and the possibility of spreading infections into the retropharyngeal space should be considered.

Keywords: Mastoiditis, retrophayrngeal abscess

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