A 5-year-old has fever, torticollis, limited neck extension and refusal to swallow. CT demonstrates a retropharyngeal collection with early airway narrowing. What is the key first management priority?
Deep-neck infection can distort the airway rapidly. The safe sequence is to secure an airway plan before sedation, imaging transfers or attempted drainage.
A. Force oral examination to obtain a swab: This can distress the child and destabilise the airway.
B. Oral antibiotics with next-day review: A collection with airway narrowing needs urgent management.
C. Controlled airway assessment with senior ENT, anaesthetic and paediatric involvement before drainage decisions: Deep-neck infection can distort the airway rapidly. The safe sequence is to secure an airway plan before sedation, imaging transfers or attempted drainage.
D. Immediate transoral aspiration without airway preparation: Unplanned intervention risks aspiration and loss of airway.
E. Discharge because oxygen saturation is normal: Saturation may remain normal until late deterioration.
If imaging showed cellulitis without a collection and the airway was stable, intravenous treatment and close reassessment may avoid drainage.
Draft Clinora educational material only; not official JCIE content or clinical advice.
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