Download - Abscesses of pharynx
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Abscesses of PharynxDr.T.Dinesh SinghProfessorMRIMS
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Peritonsillar Abscess [Quinsy] Definition – acute inflammation of the
peritonsillar space. Place – lies between superior constrictor
muscle & the tonsillar capsule. Etiology – Recurrent attacks of tonsillitis- Trauma or Foreign body- Dental infections & surrounding areas- Immunocompromised status
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Peritonsillar abscess
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Peritonsillar abscess Crypta magna gets
obstructed – intratonsillar abscess.
Supratonsillar space of soft palate, immediately above the superior pole of tonsil, internal pterygoids
Group A beta-haemolytic streptococcus
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Clinical features Symptoms – General – fever, chills & rigor, malaise,
body aches & toxic features Local –odynophagia [ severe ] Otalgia Neck pain Trismus – pterygoid muscle spasm Muffled speech – hot potato voice
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Clinical features
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Clinical features Signs –anterior pillar cannot be
distinguised – oedema of surrounding tissues
Tonsil – pushed medially & downwards Tonsil congested – follicles may be filled
and membrane may be seen Uvula congested & pushed medially Mouth opening is poor
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Clinical features Lymph nodes – tender
enlarged discrete Untreated – abscess
may rupture – foul smelling discharge
DD – peritonsillitis- Parapharyngeal
abscess- Parapharyngeal
malignancy
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Investigations & Treatment Throat swab for culture
sensitivity CBP DM & CT Scan Treatment –
antibiotics & analgesics Hospitalization Incision & Drainage Hot tonsillectomy &
Interval tonsillectomy.
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CT Scan – peritonsillar abscess
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Parapharyngeal abscess Synonyms – pharyngomaxillary space- Lateral pharyngeal space Anatomy – potential space lateral to
pharynx Inverted Pyramid or V shaped – base of
skull to level of hyoid bone Content – carotid sheath and
surroundings
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Boundaries Anterior – interpterygoid fascia &
pterygomandibular raphe Posterior – prevertebral division of deep layer &
posterior aspect of carotid sheath Medial – middle layer of deep cervical fascia
around the pharyngeal constrictor & the fascia of the tensor & levator muscles of the velum palatani & the styloglossus.
Lateral – superficial layer of deep cervical fascia – overlies the mandible, medial pterygoid & parotid.
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Parapharyngeal space
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Compartments & Contents Divided – styloid process Anterior – pre-styloid compartment –
fat, loose areolar tissue, lymph nodes, internal maxillary artery.
Posterior – post-styloid compartment – carotid artery, IJV, cervical sympathetic chain, cervical nerves IX, X, XI, XII.
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Clinical features Etiology - Dental infections, tonsillitis,
sialadenitis, lymph node suppuration Firm induration [ swelling ], erythema –
seen lateral and anterior to sterocleidomastoid muscle
Difficulty in flexing & turning neck Trismus – pterygoid muscle Dysphagia & dyspnea Bulge – lateral wall of pharynx
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Investigations & treatment CT Scan – neck – location and extent Needle aspiration Chest X-Ray & CT chest Dental evaluation Treatment – antibiotics & analgesics Airway protection Surgical drainage – incision at level of
hyoid across SCM muscle
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DD Peritonsillar abscess Cervical adenitis Masticator space infection Submandibular space infection
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Complications 1] IJV – thrombosis Shaking chills, spiking fever, prostration Tenderness at angle of mandible & along SCM
muscle Asso. Bacteremia, pulmonary emboli,
suppurative subclavian phlebitis, lateral sinus thrombosis, brain abscess, metastatic abscess
Treatment – prolonged antibiotics, surgical drainage, ligation of involved vein.
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Complications 2] Carotid artery rupture - false aneurysm formation - herald bleeds – before major bleed - ICA – common involvement 3] Laryngeal edema 4] Mediastinitis
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Submandibular space abscess [ LUDWIG’S ANGINA ] Inflammation of the submaxillary and
sublingual space Cellulitis without lymphatic involvement
– causing massive swelling of tongue & floor of mouth.
Fatal – respiratory obstruction
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Ludwig’s angina
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Etiology Age - 20 to 50 yrs Dental caries – 2nd & 3rd molar Trauma of tongue & floor of mouth Lingual tonsillitis Post dental extraction Post radiotherapy
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Clinical features Toxic – high fever & malaise Painful swelling – region below the
mandible Dysphagia, difficulty in mouth opening,
dysarthria, & dyspnea Trismus Absence of lymphadenitis Drooling of saliva & rare stridor
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Ludwig’s angina
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Clinical features Baruny edema of the floor of mouth &
tongue pushing tongue posteriorly Laryngeal edema – forces the patient to
sit up & lean forwards. DD – submental space infection- Submandibular sialadenitis- Plunging ranula- Tumors.
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Investigations & Treatment Dental X-Rays CT-Scan – extent of disease, extension
to other neck spaces, airway. Treatment – antibiotics & analgesics Surgical drainage – mylohyoid opened Tracheostomy Treat – underlying cause
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Ludwig’s angina
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Complications Airway obstruction Aspiration pneumonia Lung abscess Tongue necrosis Spread to other spaces.