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
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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.Slide8Slide9
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.Slide12Slide13
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.Slide15Slide16
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 ABSCESSSlide21Slide22
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.Slide30Slide31
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.