(A916) Computed Tomography (CT) Sinus Image Guided Navigation for Drainage of Pediatric Retropharyngeal Abscess

Introduction: Management of retropharyngeal abscesses (RPAs) includes treatment with intravenous (IV) antibiotics and/or surgical drainage. Intraoperative identification of an abscess pocket can be challenging. We describe a case of using computed tomography (CT) sinus image-guided navigation for the targeted drainage of an RPA with extension to the skull base.

Methods: Case report of a patient who underwent treatment for RPA at an academic pediatric hospital.

Results: A 12 year old patient, otherwise healthy, presented with two weeks of fever and right sided neck pain. Upon arrival, patient had elevation in inflammatory markers (ESR/CRP) and white blood cell count. Initial CT neck revealed a multifocal right sided RPA, with largest collection measuring 1.8 cm, with extension to the skull base. After failed medical management, repeat imaging done with standard sinus image guidance protocol (Medtronic TM) revealed an increase in size of the multi-loculated RPA with the dominant collection now measuring 2.3 cm. Given the location near the skull base, the decision was made to utilize image guidance. The patient was prepped and placed in suspension as is done for standard tonsillectomy. Image guidance calibration was performed in the standard fashion. Metal from the mouth gag did not interfere with image guidance navigation. The image guided Frazier tip suction was then used to locate the fluid collection. Next, a 30 degree endoscope was used to visualize the location for needle entry, and following the same trajectory, we performed needle aspiration of purulence. A Schnidt dissector was then used open the inferior pocket. Once inside the inferior pocket, the Schnidt was aimed at the superior pocket, which was confirmed by the curved frontal sinus navigation tool. Both abscess pockets were then irrigated. Following drainage, patient demonstrated clinical and laboratory improvement and was discharged with oral antibiotics.

Conclusions: For RPAs with extension near the skull base, image guidance done in the standard sinus protocol can be a useful tool for targeted drainage by providing confirmation of entry into the abscess pockets.