ABSCESSES IN RELATION TO PHARYNX

DEPT OF OTORHINOLARYNGOLOGYJ J M M C

DAVANAGERE

PERITONSILLAR ABSCESS(QUINSY)

Collection of pus in the peritonsillar space ( between capsule and superior constrictor muscle)

Etiology: acute tonsillitis which arise de-novo

without previous history of sore throat

Chronic tonsillitis

PERITONSILLAR ABSCESS(QUINSY)

Pathogenesis: one of the tonsillar crypts usually crypta magna gets infected and sealed off leading to intra tonsillar abscess which then bursts through tonsillar capsule peritonsillitis peritonsillar abscess

Organisms: streptococcus pyogenes, staph. Aureus, anaerobic organisms. Most often growth is mixed

CLINICAL FEATURES

Mostly affects adults, rarely children Mostly unilateral, rarely bilateral General symptoms: due to septicemia Fever up to 104 degree F Chills and rigor Malaise, body ache, head ache Local symptoms: Severe throat pain Painful swallowing Muffled and thick speech (hot potato voice) Foul breath Ear pain trismus

PERITONSILLAR ABSCESS(QUINSY)

EXAMINATION Tonsil, pillars and soft palate on the

involved side are congested and oedematous

Tonsil is pushed medially and downwards Uvula is oedematous and pushed to

opposite side Bulging of anterior pillar and soft palate

above the tonsil Muco pus over the tonsil Cervical lymphadenopathy torticollis

TREATMENT Hospitalization Intra-venous fluids Intra-venous antibiotics covering

both aerobic and anaerobic Analgesics Oral hygiene Incision and drainage

COMPLICATIONS Parapharyngeal abscess Laryngeal oedema Septicemia: endocarditis, nephritis,

brain abscess Pneumonitis or lung abscess Jugular venous thrombosis Spontaneous hemorrhage from

carotid artery or jugular vein

RETROPHARYNGEAL ABSCESS Acute retropharyngeal abscess Commonly seen in children below three

years Result of suppuration of retropharyngeal

lymph node ( node of rovenier) secondary to infection in adenoids, nasopharynx, paranasal sinuses or nasal cavity

In adults results from penetrating injury of posterior pharyngeal wall or cervical esophagus

RETROPHARYNGEAL ABSCESS

Clinical features dysphagia, difficulty in breathing, stridor, croupy cough, torticollis

On examination: bulge in the posterior pharyngeal wall usually seen on one side of midline

Radiography: soft tissue lateral view of neck widening of pre-vertebral shadow and sometimes presence of gas

Treatment: incision and drainage, systemic antibiotics, tracheostomy

RETROPHARYNGEAL ABSCESS

Chronic retropharyngeal abscess: it is tubercular in nature and is result of

1. Caries of cervical spine 2. Tubercular infection of retropharyngeal

lymph node secondary to tuberculosis of deep cervical nodes

Caries of cervical spine presents centrally behind the prevertebral fascia

Tuberculosis of retropharyngeal node is limited to one side of midline

RETROPHARYNGEAL ABSCESS Clinical features: discomfort in throat,

dysphagia, On examination: posterior pharyngeal

wall shows a fluctuant swelling centrally or on one side of midline. Neck may show tuberculous lymph nodes

X-ray lateral view neck is diagnostic for caries spine

Treatment: incision and drainage, anti tubercular therapy

PARAPHARYNGEAL ABSCESS Etiology: Pharynx: acute or chronic infection of

adenoids or tonsil, bursting of peritonsillar abscess

Teeth: dental abscess (lower last molar) Ear: bezold’s abscess, petrositis Infection of parotid, retropharyngeal

and submaxillary space Penetrating neck injury

PARAPHARYNGEAL ABSCESS Clinical features: External swelling behind the angle of jaw Prolapse of tonsil and tonsillar fossa Trismus Paralysis of cranial nerve 9, 10, 11, 12 Swelling of parotid region Fever Sore throat Odynophagia Signs of toxemia

TREATMENT

Incision And Drainage Of Abscess external drainage

Systemic antibiotics analgesics

COMPLICATION Acute laryngeal edema Thrombophlebitis of jugular vein Retropharyngeal abscess Mediastinitis Erosion of carotid artery