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HEAD AND NECK SPACE INFECTIONS HEAD AND NECK SPACE INFECTIONS

HEAD AND NECK SPACE INFECTIONS - PowerPoint Presentation

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HEAD AND NECK SPACE INFECTIONS - PPT Presentation

Dr KCSUDEEP PERITONSILLAR ABSCESSQUINSY It is a collection of pus in the peritonsillar space which lies between capsule of tonsil and the superior constrictor muscle AETIOLOGY Usually follows acute tonsillitis or ID: 662073

space abscess posterior retropharyngeal abscess space retropharyngeal posterior side compartment pain tonsillar infection prevertebral fascia throat tonsil anterior due

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Slide1

HEAD AND NECK SPACE INFECTIONS

Dr. KCSUDEEPSlide2

PERITONSILLAR ABSCESS(QUINSY)

It is a collection of pus in the

peritonsillar

space which lies between capsule of tonsil and the superior constrictor muscle.

AETIOLOGY:

Usually follows acute tonsillitis or

denovo

without history of sore throat.

First

crypta

magna get infected and sealed off .

Which forms the

intratonsillar

abscess which then

brust

through

tonsillar

capsule causing

peritonsillitis

and then abscess.Slide3

CLINICAL FEATURES:

Peritonsillar abscess mostly affects adults and rarely children.

Usually it is unilateral.

Clinical features are divided into :

A)General:

they are due to

septicaemia .they include fever chills and rigors, general malaise , body aches, headache, nausea and constipation.B) Local:Severe pain in throat usually unilateral. Marked odynophagia.Patient is usually dehaydrated.Slide4

Muffled and thick speech, often called “ hot potato voice”Foul breath due to sepsis in oral cavity and poor hygiene.

Ipsilateral earache.( ref pain via CN IX which supplies both tonsil and ear.Trismus due to spasm of

pterygoid

muscles .Slide5

EXAMINATION:

1) Tonsil, pillars and soft palate on involved side are swollen and congested. Tonsil itself may not appear enlarged as it gets buried in the

oedematous

pillars.

2) Uvula is swollen and

oedematous

and pushed to opposite side.3)Bulging of soft palate and anterior pillar above tonsil.4)Mucopus may be seen covering the tonsillar region.5) Cervical

lymphadenopathy

. Involves

jugulodiagastric

nodes.

6)

Torticollis

– to the side of the abscessSlide6

SWAB CULTURE :GROWTH OF Strep pyogenes, Staph.

Aureus or anaerobic organisms. More often the growth is mixed, with both aerobic and anaerobic organism.

INVESTIGATIONSlide7

TREATMENT:

Hospitalisation

Intravenous fluids for dehydration.

IV Antibiotics covering both aerobic and anaerobic

Analgesics

Oral hygiene.

If frank abscess has formed incision and drainage should be done.Interval tonsillectomy: tonsils are removed 4-6 weeks following an attack.Abscess or hot tonsillectomy.Slide8
Slide9

COMPLICATIONS:

Parapharyngeal

abscess

Oedema

of larynx

Septicaemia

Pneumonitis or lung abscessJugular vein thrombosis.Spontaneous haemorrhage from carotid artery or jugular vein.Slide10

APPLIED ANATOMY:It lies behind the pharynx between the buccopharyngeal

fascia covering phayngeal constrictor muscles and prevertebral fascia.It extends from base of skull up to bifurcation of trachea.

This space is divided into two lateral compartment by fibrous

raphe

.

Retropharyngeal space infection can pass down behind

oesophagus into mediastinum.RETROPHARYNGEAL ABSCESSSlide11

PREVERTEBRAL SPACE:It lies between the vertebral bodies

posteriorly and prevertebral fascia anteriorly.

It extends from base of skull to coccyx.

Infection of this space usually comes from caries of spine.

Abscess of this space produces midline bulge.Slide12
Slide13

Aetiology

:Commonly seen in child below 3 yrs.It result from suppuration of retropharyngeal

lymphnodes

.

In adult it may result from penetrating injury of posterior pharyngeal wall or cervical

oesophagus

.ACUTE RETROPHARYNGEAL ABSCESSSlide14

CLINICAL FEATURES:

Dysphagia and difficulty in breathing are prominent symptoms.Stridor and croupy cough may be presentTorticollis.

Bulge in posterior pharyngeal wall usually seen on one side of midline.

X-ray soft tissue neck lateral view show widening of prevertebral shadow.Slide15
Slide16

Incision and drainage of abscess.

Systemic antibiotics.

Tracheostomy

.

TREATMENT:Slide17

AETIOLOGY:

It is tubercular in nature and is the result of 1.Caries of cervical spine 2.TB infection of retropharyngeal

lymphnodes

secondary to TB of deep cervical nodes.

The former presents centrally behind the

prevertebral

fascia while the latter is limited to one side of midline as in true retropharyngeal abscessCHRONIC RETROPHARYNGEAL ABSCESSSlide18

CLINICAL FEATURES:

Discomfort in throat.

Dysphagia

but not marked.

Posterior pharyngeal wall shows a fluctuant swelling centrally or on one side of midline.

Neck may show TB

lymphnodes.Slide19

TREATMENT:

Incision and drainage: Can be done through a vertical incision along the anterior border of sternomastoid or along its posterior border.

Full course of

antitubercular

therapy should be given.Slide20

Also known as pharyngomaxillary or lateral pharyngeal space.

APPLIED ANATOMY: Parapharyngeal space is pyramidal in shape with its base at the base of skull and its apex at hyoid bone.

PARAPHARYNGEAL ABSCESSSlide21
Slide22

RELATIONS:

MEDIAL:

buccopharyngeal

fascia covering the constrictor muscles.

POSTERIOR:

prevertebral

fascia .LATERAL: medial pterygoid muscle, mandible and deep surface of parotid gland.Styloid process and muscles attached to it divide parapharyngeal space into anterior and posterior compartments.Slide23

Anterior compartment is related to

tonsillar fossa.Posterior compartment is related to post part of lat. Pharyngeal wall medially and parotid gland laterally.

Through post. Compartment pass the carotid artery, jugular vein, IX,X,XI,XII

th

cranial nerves and sympathetic trunk.Slide24

AETIOLOGY:

Infection of

parapahryngeal

space can occur from:

Pharynx

Teeth

EarOther spaces like infection of parotid, retropharyngeal and submaxillary spaces.External trauma.Slide25

It depends upon compartment involved.

Anterior compartment: Prolapse

of tonsil and

tonsillar

fossa

.Trismus due to spasm of medial pterygoid muscle.External swelling behind the angle of jaw. Marked odynophagia. CLINICAL FEATURES:Slide26

Posterior compartment:

Bulge of pharynx behind the posterior pillars.Paralysis of CN IX, X, XI,XII and sympathetic chain

Swelling of parotid region.

There is minimal

trismus

or

tonsillar prolapse.Fever , odynophagia, sore throat, torticollis and sign of toxaemia are common to both compartments.Slide27

Systemic antibiotics.

Drainage of abscess.

TREATMENT:Slide28

Acute edema of larynx with respiratory obstruction.

Thrombophlebitis

of jugular vein with

septcaemia

.

Spread of infection to retropharyngeal space.

Spread of infections to mediastinum along carotid space.

Mycotic

aneurysm of carotid

artey

.

Carotid blow out with massive

haemorrhage

.

COMPLICATIONS:Slide29

EAGLE’S SYNDROME (STALGIA)

Caused due to elongated styloid process or calcification of stylohyoid ligament.

Patient complains of pain in

tonsillar

fossa

and upper neck which radiates to the ipsilateral ear.It gets aggaravated on swallowing Diagnosis can be made by transoral palpation of the styloid process in the tonsillar fossa and by a radiograph such as anteroposteror

view with open mouth or lateral view of skull.Slide30
Slide31

Many persons may have elongated styloid process but remain asymptomatic and do not need treatmentSymptomatic

styloid process can be excised by transoral or cervical approach.Slide32

PBL

Case 34: A 25 year old farmer has been complaining of nasal obstruction, greenish nasal discharge and nasal deformity of one year duration.

On examination the nose was broad and contained a

lobulated

firm mass that may bleed on touch. Also, there was a hard swelling below the medial

canthus

of the right eye. One week ago, he noticed a change in his voice that was followed by respiratory distress. On examination there was marked stridor and laryngeal examination showed a subglottic laryngeal web.Slide33

A 25 year old male patient complained of sore throat fever and bilateral earache of 3 days duration.

He then developed very high fever 40 C, severe left earache, inability to open the mouth, drooling of saliva and a minimal difficulty in respiration. He underwent a minor surgical intervention with relief of all symptoms except the sore throat.Slide34

Case 65:

Following a meal a female patient aged 31 complained of severe pain in the right ear together with localized pain in the right side of the neck during swallowing. This pain was relieved by analgesics and local mouth gurgles containing a local anesthetic, but the pain reappeared after the effect of the drugs was over.