Peritonsillar abscess with parapharyngeal involvement: incidence and treatment

Abstract

In 2.3% of 217 patients with peritonsillar abscess, the clinical picture was atypical, with inflammatory swelling of the pharyngeal wall below and behind the tonsil, oedema of the epiglottis and a diffuse swelling on the side of the neck. The typical signs of peritonsillar abscess, i.e. trismus, a medially displaced tonsil and displacement of the uvula toward the opposite side, were either completely lacking or less pronounced than usual. The abscesses were all located in the peritonsillar space at the lower pole or behind the tonsil. To ensure rapid, uncomplicated recovery in such cases with parapharyngeal involvement, it is essential that abscess tonsillectomy under antibiotic cover with penicillin is not postponed.

Peritonsillar abscess with parapharyngeal and retropharyngeal involvement: incidence and intraoral approach

“…In those cases, we found that the conventional drainage technique at the superior part of the tonsil works imprecisely. In 2.3% of the 217 cases reported by Stage and Bonding [1], the abscesses were located in the peritonsillar space in the lower pole or behind the tonsil. In contrast, 53% of 45 cases were diagnosed as the inferior type in our study.…”

“…An atypical type of PTA [1] presents with swelling below and behind the tonsil. This type of abscess frequently involves the parapharyngeal and/or retropharyngeal space and can be life-threatening if upper airway obstruction, aspiration pneumonia, descending suppurative mediastinitis, jugular thrombophlebitis with septic pulmonary foci, and hemorrhage from carotid artery occur [2Á4].…”

Risk factors for recurrence of peritonsillar abscess

“…Stage and Bonding reported that in 2.3 per cent of 217 patients with peritonsillar abscess, the clinical picture was atypical, with inflammatory swelling of the pharyngeal wall below and behind the tonsil, oedema of the epiglottis, and a diffuse neck swelling on the side of the peritonsillar abscess 19 . The authors suggest that tonsillectomy is essential in such cases to ensure rapid and uncomplicated recovery.…”

“…19 The authors suggest that tonsillectomy is essential in such cases to ensure rapid and uncomplicated recovery. 19 The authors suggest that tonsillectomy is essential in such cases to ensure rapid and uncomplicated recovery.…”

Mediastinitis - a rare complication of a peritonsillar abscess

“…Acute tonsillitis is a common infection in which Group A beta-hemolytic Streptococcus has been recognized as the most important bacterium, followed by, more rarely, groups B, C or G and others (Snow et al, 1991;Brodsky, 1993). The most common complication of acute tonsillitis is the development of a peritonsillar abscess (Wenig et al, 1984;Brodsky, 1993;Cliven et al, 1993), and more rarely parapharyngeal and retropharyngeal abscesses (Stage and Bonding, 1988;Cliven et al, 1993). It is apparently uncommon for deep neck space infections to extend into mediastinitis (Wenig et al, 1984).…”