Abscesses of

Pharynx
Dr.T.Dinesh Singh
Professor
MRIMS
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
Peritonsillar abscess
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
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
Clinical features
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
Clinical features
 Lymph nodes – tender
enlarged discrete
 Untreated – abscess
may rupture – foul
smelling discharge
 DD – peritonsillitis
- Parapharyngeal
abscess
- Parapharyngeal
malignancy
Investigations & Treatment
 Throat swab for culture
sensitivity
 CBP
 DM & CT Scan
 Treatment – antibiotics &
analgesics
 Hospitalization
 Incision & Drainage
 Hot tonsillectomy &
Interval tonsillectomy.
CT Scan – peritonsillar abscess
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
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.
Parapharyngeal space
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.
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
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
DD
 Peritonsillar
abscess
 Cervical adenitis
 Masticator space infection
 Submandibular space infection
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.
Complications
 2] Carotid artery rupture
- false aneurysm formation
- herald bleeds – before major bleed
- ICA – common involvement
 3] Laryngeal edema
 4] Mediastinitis
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
Ludwig’s angina
Etiology
 Age - 20 to 50 yrs
 Dental caries – 2nd & 3rd molar
 Trauma of tongue & floor of mouth
 Lingual tonsillitis
 Post dental extraction
 Post radiotherapy
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
Ludwig’s angina
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.
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
Ludwig’s angina
Complications
 Airway obstruction
 Aspiration pneumonia
 Lung abscess
 Tongue necrosis
 Spread to other spaces.