![]() ![]() Patients with abscess secondary to skull base osteomyelitis require close imaging surveillance because of the difficulty of definitive control of the disease. Minimal morbidity, the absence of cervical or palatal scars and a short hospitalization time can be considered as important advantages in comparison to external approaches. The tensor veli palatini is thought to be responsible for eustachian tube function. In selected cases of abscess, transnasal endoscopic drainage may be an effective alternative to external approaches. The inferior laryngeal artery climbs the trachea to the back part of the larynx under cover of the inferior pharyngeal constrictor muscle. Velopharyngeal closure is accomplished through the contraction of several velopharyngeal muscles including the levator veli palatini, musculus uvulae, superior pharyngeal constrictor, palatopharyngeus, palatoglossus, and salpingopharyngeus. At follow-up MR, another abscess was detected in the left retro-parapharyngeal space. Twelve months after the first surgery, the patient reported an improvement of symptoms, except for persistent dysphonia related to vagal nerve palsy. The second patient, affected by skull base osteomyelitis secondary to malignant external otitis, after a first successful drainage, underwent a second endoscopic procedure for the reoccurrence of an abscess in the contralateral retroparapharyngeal space. Twenty-six months after surgery, he is symptom-free, with hemitongue atrophy due to denervation as the only residual sign. ![]() The first patient, with an abscess associated with chronic otitis media and presenting hypoglossal nerve palsy, quickly recovered from pharyngodinia, otalgia and trismus. The main surgical steps were incision of the posterior pharyngeal mucosal wall, widening of the incision, drainage of purulent collection and careful dissection and removal of the necrotic tissue. We report two cases of retro-parapharyngeal abscess with prevalent retronasopharyngeal extension in two men aged 60 and 82, both of whom underwent transnasal endoscopic drainage. Deep neck abscesses are life-threatening conditions, in early stages preferably treated by intravenous antibiotic therapy in advanced stages, surgical drainage is mandatory. ![]()
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