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PERITONSILLAR ABSCESS
PARAPHARYNGEAL ABSCESS
RETROPHARYNGEAL ABSCESS
BRIG(R) ANWAR UL HAQ
ENT SPECIALIST
CMH LAHORE MEDICAL COLLEGE
Peritonsillar abscess (Quinsy)
• Streptococcus pyogenous
• S. Aureus
• Anaerobes
Clinical features
• High grade fever with rigors
• Severe throat pain (unilateral)
• Odynophagia
• Muffled and thick speech (hot potato voice)
• Foul breath
• Trismus
• Earache (ipsilateral)
On Examination
• Swollen tonsil, pillars, soft palate
• Uvula swollen and pushed
• Bulging of soft palate above the tonsil
• Cervical lymphadenitis
• Torticollis
Treatment
• Needle drainage and antibiotics
• Incision and drainage and antibiotics
• Abscess tonsillectomy
• Interval tonsillectomy
Parapharyngeal abscess
• Parapharyngeal space
– Medial-constrictor muscles
– Post-prevertebral fascia
– Lateral-medial pterygoid
muscle,
– mandible
– Communictes with other spaces
• Retropharyngeal
• Submandibular
• Carotid space
Causes
• Pharynx
• Teeth
• Ear
• Other spaces
• External trauma
Clinical features
• Anterior compartment
– Prolapse of tonsil
– Trismus
– Ext swelling
• Post compartment
– Bulge
– Cranial nerve paralysis
– 9, 10, 11, 12
– Swelling of parotid
region
Treatment
• Systemic antibiotics
• Drainage of abscess
– Tracheostomy for trismus
– Horizontal incision below the angle
– Blunt dissection
Retropharyngeal abscess
• Acute
– In children
• Suppuration of lymph nodes
– In adults
• Penetrating trauma
• Chronic
– Tubercolous
• Lymph nodes
• Cervical spine
Clinical features
• Dysphagia
• Torticollis
• Bulge in post wall
• Stridor
Investigations
• X-Ray neck lateral
view
• C T scan
Treatment
• I & D
• Anti TB drugs

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