1. ABSCESSES IN RELATION
TO PHARYNX
DEPT OF OTORHINOLARYNGOLOGY
JJM M C
DAVANAGERE

2. PERITONSILLAR
ABSCESS(QUINSY)
 Collection of pus in the peritonsillar
space ( between capsule and superior
constrictor muscle)
 Etiology:
 acute tonsillitis which arise de-novo
without previous history of sore throat
 Chronic tonsillitis

3. PERITONSILLAR
ABSCESS(QUINSY)
 Pathogenesis: one of the tonsillar crypts
usually crypta magna gets infected and
sealed off leading to intra tonsillar
abscess which then bursts through
tonsillar capsule peritonsillitis
peritonsillar abscess
 Organisms: streptococcus pyogenes,
staph. Aureus, anaerobic organisms. Most
often growth is mixed

4. CLINICAL FEATURES
 Mostly affects adults, rarely children
 Mostly unilateral, rarely bilateral
 General symptoms : due to septicemia
 Fever up to 104 degree F
 Chills and rigor
 Malaise, body ache, head ache
 Local symptoms:
 Severe throat pain
 Painful swallowing
 Muffled and thick speech (hot potato voice)
 Foul breath
 Ear pain
 trismus

5. PERITONSILLAR
ABSCESS(QUINSY)

6. EXAMINATION
 Tonsil, pillars and soft palate on the involved
side are congested and oedematous
 Tonsil is pushed medially and downwards
 Uvula is oedematous and pushed to opposite
side
 Bulging of anterior pillar and soft palate above
the tonsil
 Muco pus over the tonsil
 Cervical lymphadenopathy
 torticollis

7. TREATMENT
 Hospitalization
 Intra-venous fluids
 Intra-venous antibiotics covering both
aerobic and anaerobic
 Analgesics
 Oral hygiene
 Incision and drainage

8. COMPLICATIONS
 Parapharyngeal abscess
 Laryngeal oedema
 Septicemia: endocarditis, nephritis,
brain abscess
 Pneumonitis or lung abscess
 Jugular venous thrombosis
 Spontaneous hemorrhage from carotid
artery or jugular vein

9. RETROPHARYNGEAL
ABSCESS
 Acute retropharyngeal abscess
 Commonly seen in children below three years
 Result of suppuration of retropharyngeal
lymph node ( node of rovenier) secondary to
infection in adenoids, nasopharynx,
paranasal sinuses or nasal cavity
 In adults results from penetrating injury of
posterior pharyngeal wall or cervical
esophagus

10. RETROPHARYNGEAL
ABSCESS
 Clinical features dysphagia, difficulty in
breathing, stridor, croupy cough, torticollis
 On examination: bulge in the posterior
pharyngeal wall usually seen on one side
of midline
 Radiography: soft tissue lateral view of
neck  widening of pre-vertebral shadow
and sometimes presence of gas
 Treatment: incision and drainage, systemic
antibiotics, tracheostomy

11. RETROPHARYNGEAL
ABSCESS
 Chronic retropharyngeal abscess: it is
tubercular in nature and is result of
1. Caries of cervical spine
2. Tubercular infection of retropharyngeal
lymph node secondary to tuberculosis of
deep cervical nodes
 Caries of cervical spine presents
centrally behind the prevertebral fascia
 Tuberculosis of retropharyngeal node is
limited to one side of midline

12. RETROPHARYNGEAL
ABSCESS
 Clinical features: discomfort in throat,
dysphagia,
 On examination: posterior pharyngeal wall
shows a fluctuant swelling centrally or on one
side of midline. Neck may show tuberculous
lymph nodes
 X-ray lateral view neck is diagnostic for caries
spine
 Treatment: incision and drainage, anti
tubercular therapy

13. PARAPHARYNGEAL
ABSCESS
 Etiology:
 Pharynx: acute or chronic infection of
adenoids or tonsil, bursting of peritonsillar
abscess
 Teeth: dental abscess (lower last molar)
 Ear: bezold’s abscess, petrositis
 Infection of parotid, retropharyngeal and
submaxillary space
 Penetrating neck injury

14. PARAPHARYNGEAL
ABSCESS
 Clinical features:
 External swelling behind the angle of jaw
 Prolapse of tonsil and tonsillar fossa
 Trismus
 Paralysis of cranial nerve 9, 10, 11, 12
 Swelling of parotid region
 Fever
 Sore throat
 Odynophagia
 Signs of toxemia

15. TREATMENT
 Incision And Drainage Of Abscess
external drainage
 Systemic antibiotics
 analgesics

16. COMPLICATION
 Acute laryngeal edema
 Thrombophlebitis of jugular vein
 Retropharyngeal abscess
 Mediastinitis
 Erosion of carotid artery