A 5-year-old child with adenotonsillar hypertrophy undergoes adenotonsillectomy for obstructive sleep apnea. On the third postoperative day, the child presents with fever, neck stiffness, inability to protrude the tongue, and a 'hot potato' voice. Oral examination shows edematous, congested uvula. What is the most likely diagnosis?

• A Retropharyngeal abscess
• B Post-tonsillectomy hemorrhage
• C Parapharyngeal abscess ✓
• D Necrotizing fasciitis of the neck

Explanation

Parapharyngeal abscess is a known complication of tonsillectomy and can present with fever, neck stiffness, trismus, and systemic signs. The 'hot potato' voice and systemic symptoms distinguish it from hemorrhage. Retropharyngeal abscess typically occurs in younger children with URIs. Hemorrhage would present with active bleeding or hematemesis, not fever and stiffness. Necrotizing fasciitis would show crepitus and rapidly progressive soft tissue involvement.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.