Nonsurgical management of parapharyngeal space infections: A prospective study

Objective/Hypothesis: Parapharyngeal infections, which can potentially cause life-threatening complications, may, in certain cases, be treated conservatively with no need for surgical drainage. A review of the literature reveals that the most recommended treatment of parapharyngeal infection is surgical drainage combined with intravenous antibiotic therapy. Several retrospective reports recommend conservative treatment with no surgical drainage. Study Design: Prospective, nonrandomized. Methods: A prospective study was performed on all patients with an infection limited to the parapharyngeal space. Results: Twelve patients presented with clinical and radiological diagnosis of parapharyngeal infection during a 5-year period. Five patients showed obvious presence of pus in other spaces and therefore were excluded. Seven patients with no gross extension into other spaces and with no respiratory distress or septic shock were treated with intravenous amoxicillinclavulanic acid for 9 to 14 days (average period, 11 days). All patients except one were children. All were cured with conservative management, and no surgical drainage was needed. None had any complications. Conclusion: Our results confirm the effectiveness of nonsurgical treatment of infections limited to the parapharyngeal space, at least in the pediatric population.