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August 1991

Gilding the Lily-Reply

Author Affiliations

Children's Hospital Medical Center Pediatric Otolaryngology Elland and Bethesda Avenues Cincinnati, OH 45229-2899; University of Cincinnati College of Medicine 231 Bethesda Ave Cincinnati, OH 45267-0528

Am J Dis Child. 1991;145(8):849. doi:10.1001/archpedi.1991.02160080023013

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In Reply.—We certainly agree with Dr Faigel that in many situations there is abuse of advanced technology in the form of "overtesting."

This particular infant, however, was suspected of having retropharyngeal abscess (RPA) several days before otolaryngologic consultation was obtained. A delay in treatment of an RPA leads to an increased risk that the infectious process may spread not only within the retropharyngeal space, but also to the parapharyngeal space, carotid sheath, and mediastinum. The surgical procedure for a complicated RPA is much different from that for an uncomplicated one. Most RPAs are incised and drained with a transoral approach. If there is spread of the abscess to the parapharyngeal space or within the retropharyngeal space below the hyoid bone, for example, an external neck approach is best.

As discussed in our article, a complete medical history, physical examination, and lateral neck roentgenography are the best tools for diag-nosing

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