Comparing transoral and transcervical approaches for retropharyngeal and parapharyngeal abscesses: Postoperative outcomes and complications

Retropharyngeal and parapharyngeal abscesses (RPA, PPA) are rare but potentially life-threatening deep neck infections. While both transoral and transcervical drainage are standard treatments, comparative data on their efficacy remain limited. This study evaluates patient characteristics and management strategies to clarify the relative effectiveness and risks of each approach. Retrospective cohort study. Tertiary academic medical center. Adults diagnosed with RPA or PPA from 2013 to 2023 were included. Patient demographics, comorbidities, abscess features, interventions, and outcomes were collected. Surgical approaches were compared using Fisher's exact test and ANOVA. Eighty-four patients (mean age 44.6 years; 45.2 % female) were identified, including 54 RPA (64.3 %) and 30 PPA (35.7 %). Surgical drainage was performed in 55 patients (65.5 %) overall, more often for PPA than RPA (25/30 [83.3 %] vs. 30/54 [55.6 %], p = 0.02). Among surgically treated patients, 18 (32.7 %) underwent transoral drainage and 37 (67.3 %) transcervical. Recurrence occurred in 11 patients: 1 after transoral drainage (5.6 %) and 10 after transcervical (27 %; p = 0.08), more often in PPA than RPA (6/30 [20.0 %] vs. 5/54 [9.3 %]). No recurrences occurred in the antibiotics-only group. Sepsis developed in 3 transoral (22.2 %) and 11 transcervical cases (29.7 %). Patients undergoing transcervical drainage more often had extensive disease and comorbidities ( p = 0.01). Overall mortality was 4.8 %, including 3 transcervical patients (8.1 %) with multiple complications. RPA and PPA in adults remain high-risk infections. In selected patients without extensive disease, antibiotics alone or transoral drainage are effective. Transcervical drainage provides exposure for complex disease but is associated with higher complication rates and mortality.