Neck Abscess

What is a neck abscess?

A neck abscess is a collection of pus from an infection in spaces between the structures of the neck. As the amount of pus increases, the soft tissue spaces expand and push against the structures in the neck, such as the throat, tongue, and, in extreme cases, the trachea (windpipe). Neck abscesses are sometimes called cervical abscesses or deep neck infections.

There are several types of neck abscesses that are found in children, including the following:

  • Retropharyngeal abscess. An abscess that forms behind the pharynx (back of the throat) often following an upper respiratory infection. In children, the lymph nodes in this area can become infected and break down, forming pus. Retropharyngeal abscesses are most common in young children, because these lymph nodes atrophy (get smaller) by the time a child reaches puberty.

  • Peritonsillar abscess (quinsy abscess). An abscess that forms in the tissue walls beside the tonsils (the lymph organs in the back of the throat). Peritonsillar abscesses are most common in adolescents and young adults and are rarely seen in young children.

  • Submandibular abscess (Ludwig's angina). An abscess beneath the tissues in the floor of the mouth. Pus collects under the tongue, pushing it upwards and toward the back of the throat, which can cause breathing and swallowing problems. Ludwig's angina is not common in young children but may occur in older adolescents, especially after a dental infection.

What causes a neck abscess?

A neck abscess occurs during or just after a bacterial or viral infection in the head or neck such as a cold, tonsillitis, sinus infection, or otitis media (ear infection). As an infection worsens, it can spread down into the deep tissue spaces in the neck or behind the throat. Pus collects and builds up in these spaces forming a mass. Sometimes, a neck abscess occurs following an inflammation or infection of a congenital (present at birth) neck mass such as a branchial cyst or thyroglossal duct cyst.

What are the symptoms of a neck abscess?

The following are the most common symptoms of a neck abscess. However, each child may experience symptoms differently. Symptoms may include:

  • Fever

  • Red, swollen, sore throat, sometimes just on one side

  • Bulge in the back of the throat

  • Tongue pushed back against throat

  • Neck pain and/or stiffness

  • Ear pain

  • Body aches

  • Chills

  • Difficulty swallowing, talking, and/or breathing

The symptoms of a neck abscess may resemble other neck masses or medical problems. Always consult your child's physician for a diagnosis.

How is a neck abscess diagnosed?

Generally, diagnosis is made by physical examination. In addition to a complete medical history and physical examination, diagnostic procedures for a neck abscess may include the following:

  • Throat culture. A procedure that involves taking a swab of the back of the throat and monitoring it in the laboratory to determine the type of organism causing an infection.

  • Blood tests. To measure the body's response to infection

  • Biopsy. A procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope.

  • X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Treatment of a neck abscess

Specific treatment of a neck abscess will be determined by your child's physician based on:

  • Your child's age, overall health, and medical history

  • Extent of the condition

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Treatment may include:

  • Antibiotic medications (to treat the infection). Often, antibiotics must be given intravenously (in the vein) and hospitalization may be required.

  • Drainage of the abscess using a needle. This procedure may require hospitalization.

Your child's physician will give specific instructions to help your child's symptoms, which may include gargling and pain-relieving medications.