Download - Abscesses in relation to pharynx
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ABSCESSES IN RELATION TO PHARYNX
DEPT OF OTORHINOLARYNGOLOGYJ J M M C
DAVANAGERE
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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
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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
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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
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PERITONSILLAR ABSCESS(QUINSY)
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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
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TREATMENT Hospitalization Intra-venous fluids Intra-venous antibiotics covering
both aerobic and anaerobic Analgesics Oral hygiene Incision and drainage
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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
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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
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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
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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
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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
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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
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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
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TREATMENT
Incision And Drainage Of Abscess external drainage
Systemic antibiotics analgesics
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COMPLICATION Acute laryngeal edema Thrombophlebitis of jugular vein Retropharyngeal abscess Mediastinitis Erosion of carotid artery