Main menu

Pages

Suppurations of the Pharynx | symtoms, signs, treatment

I. Peritonsillar Abscess (Quinsy)

Definition: Collection of pus between fibrous capsule of the tonsil, usually at its upper pole &
the superior constrictor muscle.

Etiology: 
  • Usually as a complication of acute tonsillitis
  • Organisms: usually mixed aerobic & anaerobic infection.
Incidence: Usually young adult
Pathology: Starts by infection in the depth of one of the crypts (usually crypta magna).

Symptoms: 
(as tonsillitis but more severe)
General: Fever, headache, malaise (if pus >> hectic fever).
Local: 
  • Sore throat, severe & unilateral.
  • Severe dysphagia & odynophagia.
  • Unilateral neck pain & referred otalgia. 
  • Foetor oris 
  • Drooling
Signs:
General: Fever, tachycardia, toxic facies.
Peritonsillar-Abscess-quinsy
Local
  • Trismus, torticollis – muffled voice
  • Asymmetrical edema and congestion of soft palate.
  • Swelling above & lateral to tonsil
  • Tonsil is displaced downwards & medially.
  • Uvula is edematous & pushed to other side.
  • Large , firm , tender jugulodigastric LN.
Treatment:
A) During stage of peritonsillar cellulitis
  1. Parentral antibiotics
  2. Antipyretics , analgesics , bed rest , adequate fluids,& mouth wash
B) During stage of peritonsillar abscess
  1. Indicated by: Hectic fever,throbbing pain, pitting edema on probing, and aspiration of pus.
  2. Treated by: Incision & drainage Parentral antibiotics
Site of incision:
  • Most bulging point
  • Mid point of a line from base of uvula to last upper molar tooth.
  • 1/2 cm lat. to point of crossing of a vertical line along anterior pillar with a horizontal line
  • along base of uvula.
Technique: use a guarded knife, Hilton method to open loculation usually under G.A

C) Tonsillectomy should be done 4-6 weeks later

Differential Diagnosis:
  • Neoplasm (carcinoma,lymphoma). - Acute leukaemia. – Aneurysm of ICA
  • Abscess related to upper molar tooth. -Parapharyngeal swelling.
Complications:
  • Laryngeal edema & stridor. 
  • Pyaemia & septicaemia 
  • Para pharyngeal abscess

II. Parapharyngeal Abscess

Definition: Collection of pus in para pharyngeal space.
Etiology:
  • Peritonsillar abscess 
  • Tonsillitis 
  • Petrositis & mastoiditis
Symptoms: 
like quinsy + unilateral neck swelling
Signs: Fever, tachycardia, torticollis

Becks triad: 

  1. Swelling in lateral Pharyngeal wall pushing a normal tonsil medially.
  2. Tender firm external swelling on lateral side of the neck.
  3. Trismus.
Investigations: C T of pharynx & neck.
Parapharyngeal-Abscess
Treatment: 
As quinsy:
Hospitalization + incision & drainage by external incision along anterior border of sternomastoid.

Differential Diagnosis: All para pharyngeal swellings (salivary gland tumors neurogenic tumors, carotid aneurysm)

Complications:
  • Laryngeal oedema & stridor.
  • Mediastinitis.
  • Thrombosis of IJV.
  • Erosion of carotid artery.

III. Retropharyngeal Abscess (R.P.A):

Collection of pus between buccopharyngeal fascia of the posterior pharyngeal wall & the
prevertebral fascia.

A) Acute R.P.A :

Etiology: Suppuration of retropharyngeal L.N (gland of Henle) following URT infection.
Incidence: Usually child, as gland atrophies later.
Pathology: Abscess occurs to one side of midline.
Symptoms:
  • Fever, headache, malaise.
  • Severe dysphagia.
  • Stridor due to laryngeal edema

Signs:
  • Fever, tachycardia, torticollis with flexed neck.
  • Swelling in the posterior pharyngeal wall to one side of midline with hyperaemia &
  • congestion
  • Large tender cervical lymph node.
Investigations:
  • Xray :widening of prevertebral space
  • CT
Treatment:
  1. Incision & drainage: trans oral route. Head down Trendelenberg position
  2. Tracheostomy if stridor.
  3. Parentral antibiotics.

B) Chronic R.P.A ( cold abscess , Pott’s disease )

Etiology: T.B of cervical spine.
Incidence: In adult , uncommon.
Pathology: Cold abscess.

Symptoms: General: TB toxemia night fever, night sweat loss of weight, loss of appetite.
Local: Sore throat & odynophagia.

Signs: 
General: Neurological signs, associated pulmonary T.B
Local: Bulge of midline of posterior pharyngeal wall and tenderness over cervical spine.

Investigation:
  • Xray: destroyed vertebral bodies, chest X ray.
  • Sputum analysis, tuberculin test, needle biopsy.
  • CT scan
Treatment:
  1. Anti tuberculous treatment.
  2. Incision & drainage along posterior border of sternomastoid.
  3. Orthopedic treatment.

IV. Ludwig’s angina

Definition: Suppuration in submandibular space.
Etiology: Dental causes in 90%, infection of lower tooth, or extraction of septic tooth.
Incidence: More in diabetics.

Symptoms:
  • General: Fever, headache, malaise.
  • Local: Severe pain with dysphagia, muffled voice , difficult respiration .

Signs:

General: Fever, tachycardia.
Local:
  • Massive indurated tender neck swelling below the mandible
  • Swollen floor of mouth with the tongue pushed upwards
Treatment: 
  1. Hospitalization, care of air way, toxaemia.
  2. Parenteral antibiotics, antipyretics, analgesics.
  3. Secure airway: tracheostomy.
  4. Drainage: a free incision decompression.

You are now in the first article

Comments

1 comment
Post a Comment
  1. This is another testimony on how Chief Dr Lucky cured my HIV disease. Do you need a cure for your HIV disease? Do you want to be cured from your cancer disease? Or you want to be free from any type of disease. Kindly visit his website https://chiefdrluckyherbaltherapy.wordpress.com/ . He just cured my HIV disease and I’m very grateful to him, he is the only herbalist that can cure you.  
    WhatsApp number : +2348132777335 
    Via Email : chiefdrlucky@gmail.com
    Thank you all for reading,
    God bless"

    ReplyDelete

Post a Comment

Please note that we will be notified by e-mail about your comment , So be careful .
Any medical questions will be answered .

Table of Contents