This document summarizes different types of deep neck space infections including peritonsillar abscess, parapharyngeal abscess, retropharyngeal abscess, and Ludwig's angina. It describes the etiology, clinical features, examination findings, complications, and treatment for each type of infection. Key information provided includes the most common causative bacteria for each infection, symptoms like pain, swelling and difficulty swallowing, examination findings of swollen areas, and treatments involving antibiotics, incision and drainage, or tracheostomy if the airway is compromised.

1. Deep neck space infection

2. PERITONSILLAR ABSCESS (QUINSY)
• Collection of pus in peritonsillar space (b/w capsule of tonsil &
superior constrictor muscle)

3. Etiology
• Following a/c tonsillitis (h/o sorethroat)
Infection of tonsillar crypts (cypta magna* )
↓
Occluded (sealed off)
↓
Intratonsillar abscess formation
↓
Bursts through tonsillar capsule
↓
Peritonsillitis
↓
abscess

4. Bacteriology
• Grp A beta hemolytic Streptococcus pyogenes most common
organism
• S aureus
• Anaerobic organisms
• Mixed (aerobic & anaerobic)

5. CFs
• Adults *
• u/l*
• General
• septicemia
• Fever ,chills ,rigors , general malaise ,body aches ,nausea & constipation
• Local
• Severe sore throat
• Odynophagia (cant even swallow his own salivadehydrated)
• Drooling of saliva
• Muffled & thick speech (hot potato voice)
• Poor oral hygiene Foul breath
• Ipsilateral ear ache  via CN IX
• Trismus  spasm of medial pterygoid

6. Examination
• Tonsils pillars & soft palate on the involved side } congested & swollen
• Swollen uvula pushed to one side
• Bulging of soft palate & anterior pillar above the tonsil
• Mucus may be seen covering soft palate
• Cervical ln+
• Torticollis

7. Conservative peritonsillitis
• Hospitalization
• Iv fluid }dehydration
• IV Abx
• Analgesics
• Oral hygiene

8. I & D  abscess
• Incision and drainage of abscess
• If not responding to maximum dose of IV Abx
• Interval tonsillectomy
• Tonsillectomy 4-6 weeks following an attack of quinsy.
• Abscess or hot tonsillectomy
• 'hot'tonsillectomy instead of incision and drainage

9. Complications
• Aspiration of pus } pneumonitis/lung abscess
• Jugular vein thrombosis
• Spontaneous hemorrhage from jugular vein /carotid a
• Septicemia
• Edema of larynx
• Parapharyngeal abscess

10. Parapharyngeal space

15. PARAPHARYNGEAL ABSCESS
(Abscess of pharyngomaxillary or lateral
pharyngeal space).
• Para pharyngeal space
Medial: Buccopharyngeal fascia covering the constrictor
muscles.
Posterior: Prevertebral fascia covering prevertebral muscles
and transverse processes of cervical vertebrae.
Lateral: Medial pterygoid muscle, mandible and deep surface
of parotid gland.

18. • Styloid process and the muscles attached to it divide the
parapharyngeal space into anterior and posterior compartments..

19. Lateral
parapharyngeal
space
anterior
posterior
Anterior compartment is
related to tonsillar fossa medially and medial pterygoid muscle
laterally
Posterior compartment is related to posterior part of lateral
pharyngeal wall medially and parotid gland laterally. Through
the posterior compartment pass the carotid artery, jugular
vein, IXth, Xth, XIth, XIIth cranial nerves and sympathetic trunk.

20. Cause of parapharyngeal abscess
• Tonsillectomy or tonsillitis  mc cause
• Infection or extraction of lower 3rd molar teeth

21. C/F parapharyngeal abscess
• 60 % develop it as a complication of tonsillitis
• 40 % from extraction of teeth (lower 3rd molar teeth)
• Medial displacement of tonsil
• Trismus d/t spasm of medial pterygoid
• Bulge behind posterior pillar of tonsil
• Swelling behind angle of jaw
• In the neck @ posterior part of middle third of SCM

22. Complication of parapharyngeal abscess
• Jugular vein thrombosis
• Carotid A rupture
• Lower cranial nerve palsy
• Horners syndrome

23. Acute retropharyngeal abscess

24. Retropharyngeal space is divided in to
compartment called space of gillet
Each lateral space contains
retropharyngeal lymph
nodes, which usually
disappear at
3–4 years of age

25. Lymph nodes in retropharyngeal space are called
glands of henle  disappears by 3-4 yrs

26. The space behind the prevertebral fascia and in
front of
the vertebral bodies is called prevertebral space.

27. • Retropharyngeal space
• Opens in to superior
mediastinum  posterior
mediastinum
• Prevertebral space
• Continues upto T1 to T3 where
prevertebral fascia fuses with
upper throracic vertebra

29. Acute retropharyngeal abscess
• d/t suppuration of LN in retropharyngeal space (glands of henle) ie in
space of gillette produces paramedian unilateral bulge in the
posterior pharyngeal wall
• LN regress by 5 years of age  therefore acute retropharyngeal
abscess is common in children

30. Rouviers node retropharyngeal node
Most superior node of lateral group of
reptopharyngeal LN

31. c/c retropharyngeal abscess
• Secondary to TB spine  abscess collects in prevertebral space
(danger space)central bulge
• Also arise d/t TB of LN of retropharyngeal space properparamedian
u/l bulge
• Rx
• I & D followed by full course of ATT

32. Retropharyngeal
abscess
• Widening of retropharyngeal
space (more than ¾ th of
diameter of cervical vertebra)
• Straightening of cervical spine
• Presence of gas shadow
Presence of gas shadow
Straightening of
cervical spine
Widening of
retropharyngeal
space

33. Ludwigs angina

34. • Ludwig's angina is infection of submandibular space.
• Rapidly progressive cellulitis
• Usually begins in submandibular space & spreads to involve
sublingual space

35. Mylohyoid divides into superior sublingual &
inferior subamxilary & submental space

37. • (a) sublingual compartment (above the mylohyoid)
• (b) submaxillary and submental compartment (below the
mylohyoid)

38. • Causes of ludwigs angina
• Dental infections
• Submandibular sialadenitis

39. Dental infections. Theyaccount for 80% of the cases. Roots of premolars
often lie above the attachment of mylohyoid and cause
sublingual space infection while roots of the molar teeth extend up to or
below the mylohyoid line and primarily cause submaxillary space infection

40. • Submandibular sialadenitis, injuries of oral mucosa and fractures of
the mandible account for other cases

41. Etiology
• Mixed infections involving both aerobes and anaerobes are common.
• Alpha haemolytic Streptococci, Staphylococci, and bacteroides groups are
common. RarelyH. influenzae, Esch. coli and Pseudomonas are seen.

42. • Rx
• Systemic Abx
• I&D only if not relieved by Abx
• Tracheostomy in case of endangered airway

43. Complications of ludwigs angina
• Aspiration & pneumonia
• Airway obstruction d/t laryngeal edema
• Spread of infection to parapharyngeal & retropharyngeal space

44. Vincents angina
• Ulceration of mucosa over mouth
tonsil pharynx
• Presence of abundant fusiform
bacilli
• Development of membrane
• Greyish black slough which bleed
whenremoved

45. Vincents angina is caused by
• Fusiform bacilli & borrelia vincentii