Key Clinical Message
Puncture drainage is usually needed to treat peritonsillar abscess. However, inadvertent carotid artery puncture may result in devastating complications. Preoperative transoral carotid ultrasonography (TOCU) is useful to delineate the anatomical relationship between the abscess and carotid artery. We present a case of peritonsillar abscess illustrating the utility of TOPU for safe drainage.
A peritonsillar abscess is a common deep infection that is usually related to acute tonsillitis. Needle aspiration is often performed for diagnosis and treatment, but several complications, including puncture of the carotid artery, may occur, even when performed by properly trained physicians. The utility of transoral pharyngeal ultrasonography (TOPU) equipped with a biopsy adaptor for safe and full aspiration is presented. A 19-year-old man was admitted to our hospital because of a peritonsillar abscess. TOPU showed the abscess and a branch of the carotid artery, and an otolaryngologist performed puncture through the biopsy adaptor with the aid of the ultrasound image. Needle aspiration was accomplished by avoiding arterial puncture and monitoring the shrinkage of the abscess. TOPU-guided needle aspiration is useful in the safe drainage of peritonsillar abscesses.
Transoral pharyngeal ultrasonography (TOPU) is a new ultrasound technique for otorhinolaryngology. TOPU is applicated from transoral carotid ultrasonography, and useful for delineation of pharyngeal lesions. Peritonsillar abscesses is well known as common disease in otorhinolaryngology, and often needed a puncture drainage of abscesses. This procedure usually is performed blindly into the inside of pharynx, thus, it has a risk of fatal complications and low success rate. TOPU-guided needle aspiration appears to be useful for safe drainage of peritonsillar abscesses. We report a case of peritonsillar abscess whom we performed puncture drainage with TOPU guiding.
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