Parapharyngeal Abscesses Caused by Group G Streptococcus

Abstract

Deep neck abscess is a life-threatening infection that causes laryngeal edema and upper airway occlusion. The predominant bacterial species involved in this disorder is group A streptococcus. Group G streptococcus (GGS) constitutes the normal commensal flora of the human upper airway. Although rarely, it can cause pharyngitis, tonsillitis, and peritonsillar abscess. Here, we report a case of a woman with parapharyngeal abscess caused by GGS. A 56-year-old woman presented to the emergency department with complaints of sore throat and cervical swelling, and a diagnosis of parapharyngeal abscess was established. She had upper airway occlusion, requiring urgent tracheostomy. Endoscopic incision and drainage of the abscess using a specially designed, rigid curved laryngoscope was successfully performed. Since a rigid curved laryngoscope creates a wide viewing field and working space, it was useful for incision and drainage of the parapharyngeal abscess.

A dangerous cause of airway obstruction: deep neck infection

“…Besides, pain or fluid collection affecting the muscles of mastication (the masseter and pterygoid) or impairing the motor branch of the trigeminal nerve can limit maximal mouth opening can lead to trismus [42]. Presence of laryngeal edema, laryngeal spasm, loss of consciousness, or stridor is indicative of airway crisis and a difficulty in trachea intubation that requires tracheostomy [20,25,43].…”

“…Infection of the posterior compartment is potentially lethal because it can result in septicemia, internal jugular vein thrombosis (Lemierre syndrome), internal carotid artery erosion, and laryngeal edema. Parapharyngeal abscess and sudden-onset laryngeal edema can lead to acute airway obstruction; therefore, close observation for urgent airway management is critical [20].…”