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
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
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