FRCS (ORL-HNS) · SECTION 1 SBA

Deep neck infection

A child has fever, torticollis, drooling and a bulging posterior pharyngeal wall. CT shows a rim-enhancing retropharyngeal collection with airway narrowing. What is the best next step?

CHOOSE ONE ANSWER

Best of five

  1. A. Urgent airway-aware ENT management with IV antibiotics and drainage planning
  2. B. Outpatient oral antibiotics
  3. C. Blind needle aspiration in the emergency department
  4. D. Immediate oral feeding
  5. E. Physiotherapy for torticollis
ANSWER AND REASONING

A. Urgent airway-aware ENT management with IV antibiotics and drainage planning

A mature collection with airway compromise requires coordinated anaesthetic and surgical management. Attempts to examine or drain without airway control can rupture the abscess and cause aspiration.

Why every option is right or wrong

A. Urgent airway-aware ENT management with IV antibiotics and drainage planning: A mature collection with airway compromise requires coordinated anaesthetic and surgical management. Attempts to examine or drain without airway control can rupture the abscess and cause aspiration.

B. Outpatient oral antibiotics: Airway narrowing and a collection require admission.

C. Blind needle aspiration in the emergency department: This risks aspiration and vascular injury.

D. Immediate oral feeding: Drooling and airway risk make this unsafe.

E. Physiotherapy for torticollis: The neck posture is secondary to deep infection.

What if the scenario changed?

If imaging showed only cellulitis without a collection and the airway was stable, close inpatient medical management might succeed.

EDUCATIONAL USE

Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.

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