[Peritonsillar abscesses in children].
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[Acute peritonsillitis and peritonsillar abscess].
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Abscess↗
[Puncture method for the treatment of peritonsillar abscess].
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Adolescent↗
Parapharyngeal lymphangioma mimicking a peritonsillar abscess.
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Abscess↗
Medical and surgical treatment of peritonsillar, retropharyngeal, and parapharyngeal abscesses.
Peritonsillar, retropharyngeal, and parapharyngeal abscesses are the most common deep cervical fascial space infections. Most develop secondary to an oropharyngeal or dental infection. Additional factors such as smoking and periodontal disease may also contribute to the formation of a peritonsillar abscess. The CT scan is used to confirm the presence of deep neck abscesses, but its accuracy has some limitations. Adequate drainage with accompanying antimicrobial therapy and hydration are the cornerstones of management. Catheter or needle drainage of these abscesses may provide an alternative to open procedures and is the drainage method of choice for peritonsillar abscesses. However, in selected cases, medical therapy alone, especially in children, can resolve parapharyngeal and hypopharyngeal abscesses. Ancillary use of steroids reduces morbidity in patients with a peritonsillar abscess and there is a limited but useful place for immediate tonsillectomy in the treatment of this disease.
Journal Article↗
Supraglottic airway infections.
Supraglottic infections are included among the more serious pediatric infections, although they are less common than other pediatric respiratory infections. Supraglottic infections include epiglottis (supraglottitis), retropharyngeal cellulitis, retropharyngeal abscess, and peritonsillar abscess. A high index of suspicion combined with rapid diagnosis and treatment are crucial to reducing the morbidity and mortality associated with these infections. A review of these infections, including diagnosis and treatment, is presented.
Adolescent↗
["Descending necrotizing mediastinitis" due to deep neck infections. Incidence and management].
BACKGROUND: "Descending necrotizing mediastinitis" (DNM) is a rare but potentially life-threatening complication of deep neck infections caused by the rapid downward spread of a oropharyngeal infection along the facial planes into the mediastinum. MATERIAL AND METHODS: Between June 1997 and December 2004, 6 patients with DNM were treated in our department. The primary etiology was a peritonsillar abscess in 2 cases, a parapharyngeal abscess in 3 cases and in 1 case an odontogenic abscess. Most patients presented with risk factors such as diabetes mellitus or alcoholism, the mean age was 44.3 years and the mean duration of signs before diagnosis was 6.3 days. Thoracotomy was associated with the cervical approach in 4 cases and tracheostomy was also performed in 4 cases. RESULTS: Four patients were successfully treated, the mean duration of hospitalisation was 48.2 days and 2 patients died from sepsis and multiorgan failure despite intensive treatment. CONCLUSIONS: Descending necrotizing mediastinitis must be detected as soon as possible. The mean symptoms are persistent complaints after treatment of oropharyngeal infections, which may be masked by analgetic treatment. Only an immediate computer tomographic scanning, aggressive surgical drainage and debridement of the neck and the mediastinum can reduce the high mortality rate.
Adult↗
[Treatment of deep neck infections].
BACKGROUND: The incidence of deep neck space infections has been significantly reduced by modern antibiotic therapy. These infections are relatively rare and yet the life-threatening complications merit special consideration by head and neck surgeons. PATIENTS: Seven cases of deep neck space infections as a consequence of purulent pharyngitis (3), peritonsillar abscess (2), retropharyngeal (1), and odontogenic (1) abscess are presented. Despite antibiotic therapy according to antibiogram all patients showed an increase in complaints with persisting febrile temperatures and rising inflammation parameters. Surgical intervention became necessary. In two cases the infection spread into the mediastinum. RESULTS: All patients were completely cured by means of early surgical intervention including extensive drainage of the primary focus, deep neck spaces and mediastinum, accompanied by intravenous antibiotic therapy. Tracheotomy was performed on one patient with increasing dyspnea. All patients had an uneventful recovery without major postoperative complications. CONCLUSIONS: The clinical course of the disease must be observed particularly closely even after starting antibiotic therapy and identification of the infectious focus. Antibiotic therapy may in some cases cover clinical symptoms. However, in the presence of abscess formation or necrotizing infections, antibiotics can prove to be ineffective. The optimum time for surgery is difficult to determine. Complete drainage of the neck spaces down to the mediastinum is a safe procedure to save the patients' life. This shortens the duration of the disease and prevents complications. The most common problems in the management of deep neck space infections are discussed.
Abscess↗
Therapeutic alternatives and clinical outcomes in peritonsillitis.
A retrospective study was conducted on 32 patients with the discharge diagnosis of peritonsillar abscess or peritonsillar cellulitis. Three had pre-existing chronic conditions that may have contributed to the peritonsillitis. The average duration of symptoms prior to diagnosis was 7.4 days. Most patients responded to penicillin given parenterally until the patient were able to take medication orally. Pus was obtained in 88 percent of the patients who underwent drainage procedures. Eight patients were treated with parenteral antibiotics without drainage, including three from whom pus was aspirated. All eight recovered without complication. The most common organism cultured was beta-hemolytic streptococcus, group A (seen in 31 percent). There was no association between the dose or type of oral antibiotic used prior to diagnosis of peritonsillar cellulitis. The clinical outcome suggests that some patients with peritonsillitis may respond to parenteral antibiotics without drainage procedures or tonsillectomy.
Adolescent↗
Demographics of pediatric head and neck infections in a tertiary care hospital.
EDUCATIONAL OBJECTIVE: Discuss potential patterns in the epidemiology of infectious disease of the head and neck. STUDY OBJECTIVES: To investigate patterns in the epidemiology of severe head and neck infections that may reflect the impact of host factors. STUDY DESIGN: Population-based, historic cohort study. METHODS: Information on 1,010, incident head and neck infections occurring over a 5-year period was reviewed for demographics, location, and time of year. A nonparametric Kruskal-Wallis test was used to identify significant differences in the age distributions among the diagnosis groups. A Bonferroni, pair-wise comparison procedure was used for comparison of the average age of first onset of severe head and neck infections. Chi-square test was used to identify any significant association between season of the year and disease. RESULTS: Significant differences were identified in the age distributions among the diagnosis groups (P < .001). The average age of first onset of cellulitis of the neck and retropharyngeal abscess is earlier than peritonsillar abscess, at 2 to 3 years and 13 years, respectively. Parapharyngeal and periapical abscesses and cellulitis of the face occur at approximately age 6. The incidence of parapharyngeal abscess and diseases of the pharynx is decreased during Spring, whereas peritonsillar abscesses and acute periodontitis occurs more often in Spring and Summer. Age does not appear to be related to season of first occurrence. CONCLUSIONS: Head and neck infections are not random occurrences based on exposure alone; host factors are clearly important. Given the lack of correlation with school age, the results cannot be explained on the basis of exposure alone. Developmental patterns of the host immune response may be related to the age differential identified in the current study and are cause for further investigation.
Abscess↗
Hemorrhage risk after quinsy tonsillectomy.
BACKGROUND: The goal of the study was to evaluate the incidence and possible predictive factors of post-tonsillectomy hemorrhage (PTH) in patients with peritonsillar abscess, treated by acute abscess tonsillectomy. METHODS: A retrospective cohort study was performed on 205 patients who underwent bilateral abscess tonsillectomy under general anesthesia. Age, sex, smoking habits, history of recurrent tonsillitis or prior peritonsillar abscess, current medical treatment, side of the peritonsillar abscess, initial treatment, surgeon's experience, procedure duration, intra- and postoperative anti-inflammatory medications, and side of bleeding were analyzed. RESULTS: Bleeding occurred in 27 patients (13%). Ipsilateral hemorrhage was observed in 8 patients (4%) and contralateral hemorrhage in 19 patients (9%). The higher incidence of PTH in the side contralateral to the abscess was found to be statistically significant (P = 0.02). Male gender (P = 0.042), smoking (P = 0.009), and aspirin intake (P = 0.008) were statistically significant factors associated with an increased PTH risk. CONCLUSION: The risk of bleeding following abscess tonsillectomy seems higher than reported in elective tonsillectomy. This high incidence is mainly due to patients with prior aspirin intake or to bleeding in the side contralateral to the abscess. Postoperative bleeding could be reduced by performing a unilateral acute abscess tonsillectomy in selected patients. An algorithm is proposed for the management of peritonsillar abscess based on age, prior history of pharyngo-tonsillar infections, aspirin intake, and clinical improvement after initial drainage and antibiotherapy. EBM RATING: C.
Acute Disease↗
Routine abscess tonsillectomy: late results.
The late results of abscess tonsillectomy as a routine treatment of peritonsillar abscess were investigated. The material comprises 113 patients. Follow-up was performed two to five years after the operation (bilateral dissection tonsillectomy under general anesthesia). Symptoms of pharyngitis, recurrent or chronic, were present in 17 percent of the patients, in most cases without major objective changes in the throat. The incidence of these symptoms was highest--70 percent--in patients past middle age without any history of trouble from the throat before the peritonsillar abscess. Tonsil remnants were seen in 28 percent, but only 6 percent of the patients had new episodes of febrile throat infections. The results are discussed. A reserved attitude to abscess tonsillectomy (and to interval tonsillectomy) is recommended for peritonsillar abscess in elderly patients without previous trouble from the throat.
Adolescent↗
Distribution of minor salivary glands in the peritonsillar space.
Minor salivary glands can usually be found along the mucous membrane of the upper aerodigestive tract. Their presence in the peritonsillar space was of little interest until it was postulated that infection of Weber's gland (minor salivary gland at the superior pole of the peritonsillar space) might be the possible cause of peritonsillar abscess. This study was designed to examine the distribution of minor salivary glands in the peritonsillar space and their role in pathogenesis of peritonsillar abscess. Tonsillectomy specimens from fifty-five patients who were suffering from repeated tonsillitis, obstructive sleep apnea, tonsillar mass and peritonsillar abscess at Srinagarind Hospital from September 1995 to November 1996 were histologically examined. The locations of these minor salivary glands were found at the upper, middle, and lower portions of the peritonsillar space. This small sample study precludes any definitive statement regarding the association of Weber's gland and the pathogenesis of peritonsillar abscess.
Adolescent↗
[Clinical relevance of the Streptococcus milleri group in head and neck infections].
Streptococcus constellatus, S. intermedius, and S. anginosus, the 3 species of the S. milleri group, form part of the normal flora commonly found in the mouth, throat, and gastrointestinal and genital tracts. This group has become known as an important pathogen in infections and abscesses, but data on the anatomical distribution of these species is lacking in relation to clinical significance. We obtained 275 strains of the S. milleri group from different departments at our hospital over the last 3 years, including 54 strains from dental surgery, 47 from internal medicine, 44 from otolaryngology (head and neck), 43 from surgery, 32 from gynecology, 17 from urology, 16 from dermatology, 11 from brain surgery, 6 from pediatrics, 3 from orthopedics, and 2 from opthalmology. The 44 strains from head and neck were found in 42 patients,--23 with primary infection and 19 with secondary infection induced by cancer treatments. The primary infection group included 4 deep neck abscesses, 1 peritonsillar abscess, 5 tonsillitis, 4 paranasal sinusitis, 3 congenital aural fistula infections, 2 dental infections, 2 paranasal sinus cysts, 1 supprative parotitis, and 1 postoperative wound infection. The secondary infection group included 7 postoperative wound infections, 3 postoperative pulmonary infections, 3 laryngitis and pharyngitis, 3 terminal pneumonias, and 3 infections of the local recurrence site. The S. milleri group was the only isolated organism in 13 cases (56.5%) of primary infection and in 5 (26.3%) of secondary infection. Among other organisms from the primary infection group, no so-called major pathogens were found. Antimicrobial susceptibility tests of the S. milleri group showed that 50% were resistant to CCL and 33% to CTM. ABPC, CPDX, and CFDN were also found to be less sensitive, although no resistant strains were detected. To adequately culture the S. milleri group, incubation in air containing carbon dioxide or in an anaerobic atmosphere is required, and differentiation of the 3 requires biochemical reactivity tests. Since not all facilities use identical techniques in routine bacteriological examination, a considerable number of the S. milleri group could be missed in unknown species of alpha-,beta-, and gamma-streptococci and culture-negative cases. With antibiotics now being used widely, normal flora such as the S. milleri group may have become an important pathogen in head and neck infections due to an imbalance between organisms and host defense.
Humans↗
Parapharyngeal abscess: diagnosis, complications and management in adults.
Parapharyngeal abscess may cause life-threatening complications. Peritonsillar abscess and tonsillitis may result in parapharyngeal abscess. Since the introduction of antibiotics, the incidence of parapharyngeal abscess secondary to tonsillitis and peritonsillar abscess has decreased dramatically. We present five cases of parapharyngeal abscess resulting from tonsillitis and peritonsillar infection extending to the parapharyngeal space in adult patients. Two were complicated by mediastinitis despite early treatment by wide spectrum antibiotics. We believe that early diagnosis and aggressive antibiotic treatment with early surgical drainage in cases associated with pus collection are the key points in preventing serious and fatal complications. We emphasize the diagnostic role of computerized tomography (CT) scan and the importance of early and proper drainage of these abscesses.
Adult↗
Quinsy tonsillectomy.
The usual treatment for peritonsillar abscess in the United States is incision, drainage and antibiotic therapy followed by tonsillectomy several weeks later. Why this treatment began is not clear but it probably originated from fear of complications which might arise from operating during the acute stage. This therapy requires two hospitalizations and tonsillectomy after previous abscess can be difficult. Tonsillitis or peritonsillar abscess can recur any time after the initial abscess is treated. A series of 50 cases of peri-tonsillar abscesses treated by immediate tonsillectomy is presented and evaluated. The results show this operation has a low morbidity and no significantly greater complication rate than elective tonsellectomy.
Adolescent↗
Peritonsillarlike lateral oropharyngeal abscess after tonsillectomy.
Peritonsillar abscess is a well-known sequela of acute tonsillitis. However, not so well known is the occurrence of a peritonsillarlike oropharyngeal abscess in patients with previous tonsillectomy. No case report or review exists in the American medical literature. We present four cases of abscess after tonsillectomy and a review of the world literature. A discussion of the evaluation and treatment of posttonsillectomy abscess based on these cases is included. An attempt is made to alert the practitioner to the fact that patients who have undergone tonsillectomy can develop peritonsillarlike oropharyngeal abscesses.
Abscess↗