A 16-month-old Yoruba girl was referred from a peripheral hospital to the ear, nose and throat (ENT) unit of our hospital with a one-week history of fever, a six-day history of cough and a five-day history of neck swelling. Her fever was high grade with bouts of cough, and she had no history of contact with a person with chronic cough, no associated weight loss and no posttussive vomiting. Her mother noticed neck swelling five days before presentation which was progressive and painful, with associated limited neck movement. The patient refused to eat, expectorated a thick tenacious secretion, and had episodes of irritability and excessive crying. The child had a previous history of left ear discharge which had resolved, and there was no history of hearing impairment or nasal symptoms. About three days prior to presentation, the child was noticed to be breathless, for which she was treated at a private hospital as a case of pneumonia and was placed on an antitussive and antibiotics. The patient's medical history and family and social history, as well as the review of systems, were not remarkable. An examination of the throat revealed poor oral hygiene; foul-smelling, thick, tenacious, straw-colored secretion from the oral cavity and oropharynx; and a bulging posterior pharyngeal wall. The patient's neck showed a diffuse swelling which was tender. The ear, nose, chest and abdominal examinations were essentially normal. An assessment of retropharyngeal abscess was made to rule out parapharyngeal abscess. Investigations revealed that the packed cell volume was 41%, and the electrolyte and urea examinations showed the following concentrations: sodium, 142 mM/L; potassium, 3.7 mM/L; urea 6.5 mM/L; and creatinine, 101 mM/L. X-rays of the soft neck tissue revealed widening of the prevertebral space containing areas of opacity and lucency extending from the base of the skull to the level of the seventh cervical spine (C7), which at the level of the second cervical vertebra (C2) was about 22 mm, with the laryngeal air column almost obliterated and anterior displacement of the airway and straightening of the cervical spine. There was lateral displacement of the trachea to the left from the anteroposterior view. The patient was resuscitated with intravenous fluid and antibiotics and was taken for examination under anesthesia and drainage of the abscess. The patient was placed in the anti-Trendelenburg position while under general anesthesia. Intubation was difficult but was finally achieved using a size 2.5 mm endotracheal tube inserted by an experienced anesthetist, and light packing with wet gauze was placed around the endotracheal tube. Anesthesia was induced with halothane in oxygen, and the trachea was secured with 1 mg/kg suxamethonium. Anesthesia was maintained with 66% nitrous oxide in oxygen and 0.5% to 1% halothane in oxygen, while muscle paralysis was induced with 0.1 mg/kg pancuronium. Analgesia was ensured with 2 μg/kg fentanyl. A Boyle-Davis mouth gag was introduced gently to expose the oral cavity and oropharynx, a cruciate incision was made using a size 11 surgical blade and a surgical probe was introduced to break down all loculi. About 30 to 40 mL of foul-smelling, purulent discharge was drained with the extrusion of a fish bone remnant from the abscess cavity. The culture revealed a growth of mixed organisms: Staphylococcus aureus, Klebsiella pneumoniae and anaerobic streptococci. Prior to extubation, residual neuromuscular block was antagonized with a combination of 0.04 mg/kg neostigmine and 0.02 mg/kg atropine. The patient was extubated but suddenly developed laryngeal spasm. Manual ventilation with a face mask was difficult as the patient's pulse oximetry was less than 80%. Anesthesia was deepened with halothane, and the patient's trachea was resecured with 1 mg/kg suxamethonium. The patient was ventilated manually with 100% oxygen in the improvised recovery room on account of poor respiratory function for about 8 to 10 hours, after which she was transferred to the postoperative ward, where her condition was satisfactory. The patient was maintained on intravenous antibiotics, analgesics and anti-inflammatory agents. The patient was discharged to home on the fifth day postoperatively.