1) The document discusses different types of abscesses that can occur in the pharynx and neck region, including peritonsillar abscesses, parapharyngeal abscesses, and submandibular space abscesses (Ludwig's angina). 2) It describes the anatomy, etiology, clinical features, investigations, treatment, and complications of each type of abscess. Recurrent tonsillitis and dental infections are common causes. 3) Symptoms include pain, difficulty swallowing, trismus, and in severe cases, airway obstruction. Treatment involves antibiotics, analgesics, and sometimes surgical drainage or tracheostomy.

1. Abscesses of
Pharynx
Dr.T.Dinesh Singh
Professor
MRIMS

2. 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

3. Peritonsillar abscess

4. 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

5. 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

6. Clinical features

7. 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

8. Clinical features
 Lymph nodes – tender
enlarged discrete
 Untreated – abscess
may rupture – foul
smelling discharge
 DD – peritonsillitis
- Parapharyngeal
abscess
- Parapharyngeal
malignancy

9. Investigations & Treatment
 Throat swab for culture
sensitivity
 CBP
 DM & CT Scan
 Treatment – antibiotics &
analgesics
 Hospitalization
 Incision & Drainage
 Hot tonsillectomy &
Interval tonsillectomy.

10. CT Scan – peritonsillar abscess

12. 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

13. 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.

14. Parapharyngeal space

16. 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.

17. 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

19. 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

21. DD
 Peritonsillar abscess
 Cervical adenitis
 Masticator space infection
 Submandibular space infection

22. 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.

23. Complications
 2] Carotid artery rupture
- false aneurysm formation
- herald bleeds – before major bleed
- ICA – common involvement
 3] Laryngeal edema
 4] Mediastinitis

24. 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

25. Ludwig’s angina

26. Etiology
 Age - 20 to 50 yrs
 Dental caries – 2nd & 3rd molar
 Trauma of tongue & floor of mouth
 Lingual tonsillitis
 Post dental extraction
 Post radiotherapy

27. 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

28. Ludwig’s angina

29. 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.

30. 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

31. Ludwig’s angina

32. Complications
 Airway obstruction
 Aspiration pneumonia
 Lung abscess
 Tongue necrosis
 Spread to other spaces.