Emergency Management of Parapharyngeal and Retropharyngeal Abscess due to Right Submandible Abscess with Complications of Right Pulmonary Empyema: Case Report

Introduction: Parapharyngeal and retropharyngeal abscess are deep neck infection originating from various sources including the mouth, ear, nose, and throat, and cause a medical emergency upper airway obstruction Case Report: A 39 years old male patient came to the Emergency Room (ER) Hasan Sadikin Hospital was complaining of swelling of the right cheek and lower right jaw, fever, headache, tightness, neck pain, and limited mouth opening. Routine blood tests revealed leukocytosis, elevated SGOT, ALT, and urea. Radiological examination of AP-lateral Neck Soft Tissue, radiolucent images in multiple air densities, suspected parapharyngeal, submandibular and retropharyngeal abscess, and leftward sliding airways. The patient was referred to an ENT colleague because of the constriction and impaired respiration, and a tracheostomy was recommended. Tracheostomy performed by ENT followed by oral surgery for submandibular abscess drainage incision through and through to the submental and tooth extraction 18, 16, 25, 26, 28, 47 in general anesthesia. The patient was subjected to a thorax radiographic examination and re-swab sampling of bacteria because he was still short of breath on a ninth day and was found pleural effusion on chest X-ray, and cultures of Serratia marcescens and Acinobacter baumanii in samples that were sensitive to meropenem antibiotics. The patient was placed on a chest tube to drain the pleural fluid. Conclusion: Parapharyngeal and retropharyngeal abscess treatment is carried out comprehensively with the teeth as a source of infection, namely incision drainage, extraction of focal teeth infection, and tracheostomy in case of emergency upper airway obstruction. Nosocomial infections due to the use of tracheostomy are influenced by various factors, are improper installation of the tools, the level of air sterilization in the room, and the cleanliness of the air hoses.