Sequestration of the Styloid Process Complicating a Parapharyngeal Abscess

Abstract

A review of the literature does not reveal the record of a case similar to that which is being reported. REPORT OF A CASEA white woman aged 38 was admitted to the hospital on Oct. 29, 1935. She presented the following history: A week before admission two molar teeth were extracted from her left lower jaw. On the following day, a swelling appeared on the right side of her neck, extending from the chin to the angle of the jaw.Six days later, at the time of admission, she presented a swelling in the floor of the mouth, on the right side, which was pushing the tongue upward. There were tenderness and swelling in the neck on this side. The temperature ranged between Sequestration of the styloid process. 102 and 104 F. for several days. The blood count was as follows : red cells, 4,210,000; hemoglobin content, 83 per cent; white cells, 25,000; neutrophilic polymorphonuclears, 88 per cent ; lymphocytes, 5 per cent ; monocytes, 7 per cent. The urine revealed traces of albumin and sugar. The blood culture was negative, as was the Wassermann reaction of the blood.Operation.-With the patient under local anesthesia, an incision 2 inches (5.1 cm.) long was made parallel to the body of the mandible. An abscess in the submaxillary space containing an ounce (29.6 cc.) of foul-smelling pus was evacuated. The presence of hemolytic streptococci was revealed by the culture.Postoperative Course.-The swelling in the neck subsided. The tongue receded, and the temperature returned almost to normal. On the fifth day after operation, the temperature rose to 103 F. The patient complained of soreness in the throat and pain along the right side of the neck. Examination revealed the following condition: The right tonsil protruded; some trismus was present, and the parotid gland was slightly tender and more prominent than is normal. Tenderness and swelling were noted along the anterior border of the sternocleidomastoid muscle.We now felt that we were dealing with an infection of the submaxillary space extending into the parapharyngeal region. The previous incision was carried