A Medico-Legal Dilemma in Emergency Airway Management in a Rapidly Progressive Parapharyngeal Space Abscess: A Case Report

Deep neck space infections are potentially life-threatening due to their rapid progression and risk of airway compromise. Emergency airway management in such cases may be further complicated by consent-related challenges. A 28-year-old previously healthy woman presented with dysphagia following recent hemodialysis with right-sided central venous catheterization. Her symptoms progressed to neck swelling, hoarseness, and respiratory distress. Fiber-optic examination suggested deep neck space involvement, and contrast-enhanced CT confirmed a right parapharyngeal space abscess. Despite initiation of intravenous antibiotics and planned drainage, the patient deteriorated rapidly with signs of impending airway compromise. Emergency tracheostomy and surgical drainage were planned. However, consent for tracheostomy was refused by the patient’s relatives despite detailed counselling. Following urgent multidisciplinary deliberation and in view of life-threatening airway obstruction, a decision was made to proceed with emergency airway management. Tracheostomy and drainage were successfully performed, resulting in stabilization and subsequent clinical recovery. This case highlights the importance of early recognition of airway compromise in deep neck infections, the need for timely and decisive airway management, and the ethical challenges encountered when life-saving interventions are refused.