Head and Neck Space Infections1

7/28/2019 Head and Neck Space Infections1

1/34


2/34

PERITONSILLAR ABSCESS(QUINSY)

It is a collection of pus in the peritonsillar spacewhich lies between capsule of tonsil and thesuperior constrictor muscle.

AETIOLOGY:

Usually follows acute tonsillitis or denovo withouthistory of sore throat.

First crypta magna get infected and sealed off .

Which forms the intratonsillar abscess which thenbrust through tonsillar capsule causingperitonsillitis and then abscess.


3/34

CLINICAL FEATURES:

Peritonsillar abscess mostly affects adults and rarely children.

Usually it is unilateral.

Clinical features are divided into :

A)General:they are due to septicaemia .they include fever chills and rigors, generalmalaise , body aches, headache, nausea and constipation.

B) Local:

Severe pain in throat usually unilateral.

Marked odynophagia.

Patient is usually dehaydrated.


4/34

Muffled and thick speech, often called hot potato voice

Foul breath due to sepsis in oral cavity and poor hygiene.

Ipsilateral earache.( ref pain via CN IX which supplies bothtonsil and ear.

Trismus due to spasm of pterygoid muscles .


5/34

EXAMINATION:

1) Tonsil, pillars and soft palate on involved side are swollenand congested. Tonsil itself may not appear enlarged as itgets buried in the oedematous pillars.

2) Uvula is swollen and oedematous and pushed to opposite

side.

3)Bulging of soft palate and anterior pillar above tonsil.

4)Mucopus may be seen covering the tonsillar region.

5) Cervical lymphadenopathy. Involves jugulodiagastricnodes.

6)Torticollis

to the side of the abscess


6/34


7/34

TREATMENT: Hospitalisation Intravenous fluids for dehydration. IV Antibiotics covering both aerobic

and anaerobicAnalgesics Oral hygiene. If frank abscess has formed incision

and drainage should be done. Interval tonsillectomy: tonsils are

removed 4-6 weeks following anattack.

Abscess or hot tonsillectomy.


8/34


9/34

COMPLICATIONS:

Parapharyngeal abscess

Oedema of larynx

Septicaemia

Pneumonitis or lung abscess

Jugular vein thrombosis.

Spontaneous haemorrhage from carotid

artery or jugular vein.


10/34

APPLIED ANATOMY:

It lies behind the pharynx between thebuccopharyngeal fascia covering phayngeal constrictormuscles and prevertebral fascia.

It extends from base of skull up to bifurcation oftrachea.

This space is divided into two lateral compartment by

fibrous raphe. Retropharyngeal space infection can pass down

behind oesophagus into mediastinum.


11/34

PREVERTEBRAL SPACE:

It lies between the vertebral bodies posteriorly and

prevertebral fascia anteriorly.

It extends from base of skull to coccyx. Infection of this space usually comes from caries of spine.

Abscess of this space produces midline bulge.


12/34


13/34

Aetiology:

Commonly seen in child below 3 yrs.

It result from suppuration of retropharyngeallymphnodes.

In adult it may result from penetrating injury of

posterior pharyngeal wall or cervicaloesophagus.

ACUTE RETROPHARYNGEAL ABSCESS


14/34

CLINICAL FEATURES:

Dysphagia and difficulty in breathingare prominent symptoms.

Stridor and croupy cough may be

present Torticollis.

Bulge in posterior pharyngeal wall

usually seen on one side of midline. X-ray soft tissue neck lateral view

show widening of prevertebral

shadow.


15/34


16/34

Incision and drainage ofabscess.

Systemic antibiotics.

Tracheostomy.

TREATMENT

:


17/34

AETIOLOGY:

It is tubercular in nature and is the result of

1.Caries of cervical spine2.TB infection of retropharyngeal

lymphnodes secondary to TB of deep

cervical nodes.

The former presents centrally behind the

prevertebral fascia while the latter is limited to

one side of midline as in true retropharyngeal

abscess

CHRONIC RETROPHARYNGEAL ABSCESS


18/34

CLINICAL

FEATURES:

Discomfort in throat.

Dysphagia but not marked.

Posterior pharyngeal wall shows afluctuant swelling centrally or on one

side of midline.

Neck may show TB lymphnodes.


19/34

TREATMENT:

Incision and drainage:

Can be done through a vertical incision alongthe anterior border of sternomastoid or along

its posterior border.

Full course of antitubercular therapyshould be given.


20/34

Also known as pharyngomaxillary or

lateral pharyngeal space.

APPLIED ANATOMY:

Parapharyngeal space is pyramidal in

shape with its base at the base of skulland its apex at hyoid bone.

PARAPHARYNGEAL ABSCESS


21/34


22/34

MEDIAL: buccopharyngeal fascia covering the

constrictor muscles.

POSTERIOR: prevertebral fascia .

LATERAL: medial pterygoid muscle, mandible

and deep surface of parotid gland.

Styloid process and muscles attached to it divideparapharyngeal space into anterior and

posterior compartments.


23/34

Anterior compartment is related to tonsillar

fossa.

Posterior compartment is related to postpart of lat. Pharyngeal wall medially and

parotid gland laterally.

Through post. Compartment pass thecarotid artery, jugular vein, IX,X,XI,XII th

cranial nerves and sympathetic trunk.


24/34

Infection of parapahryngeal space can occur

from:

Pharynx

Teeth

Ear

Other spaces like infection of parotid,retropharyngeal and submaxillary spaces.

External trauma.


25/34


26/34

Posterior compartment:

Bulge of pharynx behind the posterior pillars.

Paralysis of CN IX, X, XI,XII and sympathetic

chain Swelling of parotid region.

There is minimal trismus or tonsillar

prolapse. Fever , odynophagia, sore throat, torticollis

and sign of toxaemia are common to bothcompartments.


27/34

Systemic antibiotics.

Drainage of abscess.

TREATMENT:


28/34

Acute edema of larynx with respiratoryobstruction.

Thrombophlebitis of jugular vein with

septcaemia.

Spread of infection to retropharyngeal space.

Spread of infections to mediastinum along

carotid space.

Mycotic aneurysm of carotid artey.

Carotid blow out with massive haemorrhage.

COMPLICATIONS:


29/34

Caused due to elongated styloid process or calcificationof stylohyoid ligament.

Patient complains of pain in tonsillar fossa and upper

neck which radiates to the ipsilateral ear.

It gets aggaravated on swallowing

Diagnosis can be made by transoral palpation of thestyloid process in the tonsillar fossa and by a radiographsuch as anteroposteror view with open mouth or lateralview of skull.


30/34


31/34

Many persons may have elongated styloidprocess but remain asymptomatic and do

not need treatment

Symptomatic styloid process can beexcised by transoral or cervical approach.


32/34

PBL

Case 34: A 25 year old farmer has been complaining ofnasal obstruction, greenish nasal discharge and nasaldeformity of one year duration.

On examination the nose was broad and contained alobulated firm mass that may bleed on touch. Also,there was a hard swelling below the medial canthus ofthe right eye.

One week ago, he noticed a change in his voice thatwas followed by respiratory distress.

On examination there was marked stridor andlaryngeal examination showed a subglottic laryngealweb.


33/34


34/34

Documents

Head and Neck Space Infections1