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PubMed2003

Cervical necrotizing fasciitis: sources and outcomes.

BACKGROUND: Abscesses of the peritonsillar region are among the most common deep abscesses of the head and neck. However, cervical necrotizing fasciitis (CNF) associated with a peritonsillar abscess is an extremely rare condition, with only 12 well-documented cases described. PATIENTS: We reviewed and compared all 12 cases of CNF arising from peritonsillar abscesses, including our own case. CNF that developed after peritonsillar abscesses was also compared with that developing predominantly after odontogenic infection. RESULTS: The overall mortality was higher in the group with peritonsillar abscesses (33% vs 25%). CONCLUSION: It is probable that of all cases of CNF, that arising from peritonsillar abscess has the worst prognosis.

Fasciitis, Necrotizing↗
PubMed2004

Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses.

This review describes the microbiology, diagnosis, and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses in children. Predominant anaerobic organisms isolated in peritonsillar, lateral pharyngeal, and retropharyngeal abscesses are Prevotella, Porphyromonas, Fusobacterium and Peptostreptococcus spp.; aerobic organisms are group A streptococcus ( Streptococcus pyogenes ), Staphylococcus aureus and Haemophilus influenzae . Anaerobic bacteria can be isolated from most abscesses whenever appropriate techniques for their cultivation have been used, while S. pyogenes is isolated in only about one third of cases. More than two thirds of deep neck abscesses contain beta-lactamase producing organisms. Management of tonsillar, peritonsillar, and retropharyngeal abscesses is similar. Systemic antimicrobial therapy should be given in large doses whenever the diagnosis is made. However, when pus is formed, antimicrobial therapy is effective only in conjunction with adequate surgical drainage. Untreated abscesses can rupture spontaneously into the pharynx, causing catastrophic aspiration. Other complications are extension of infection laterally to the side of the neck or dissection into the posterior mediastinum through facial planes and the prevertebral space. Death can occur from aspiration, airway obstruction, erosion into major blood vessels, or extension to the mediastinum.

Abscess↗
PubMed1988

Peritonsillar and neck abscesses in the pediatric age group.

A retrospective study was performed on 93 abscesses in children admitted for diagnosis and treatment at Rainbow Babies and Childrens Hospital, University Hospitals of Cleveland, during a 15-year period from 1972 to 1987. Forty-five percent were peritonsillar, 20.5% superficial neck, 21.5% submandibular-submental, 9.6% retropharyngeal, and 3.4% parapharyngeal. All four complications resolved without sequelae. Early diagnosis and adequate treatment were of paramount importance to achieve a low complication rate and a short hospital stay. Bacteriology and antibiotic therapy, as well as surgical treatment, are discussed.

Abscess↗
PubMed1975

Peritonsillar, peripharyngeal, and deep neck abscesses.

Abscesses of the peritonsillar and peripharyngeal regions typically present as a sore throat and as difficulty in swallowing. One of the most ?striking clinical features is difficulty in controlling saliva. Deep neck abscesses usually are secondary to disease in the pharynx, tonsils, or teeth. Initially, attention should be devoted to finding the primary source of infection. Treatment of these abscesses is incision and drainage.

Abscess↗
PubMedDate not supplied

Peritonsillar and parapharyngeal space abscess in the older adult.

OBJECTIVE: To review the presentation and management of peritonsillar (PTA) and parapharyngeal space (PPSA) abscesses in older adults and compare this with the usual presentation and management in the younger patient. STUDY DESIGN: An 18-year retrospective review at a tertiary care hospital. METHODS: The patient database was searched by using the diagnosis codes for PTA and PPSA. The search included inpatient and outpatient visits of patients 50 years of age and older from 1983 to 2001. The charts were reviewed, and data regarding presentation, management, and outcome were recorded. Comparisons to the current literature were made. RESULTS: Fourteen patients were identified, 8 with PTA and 6 with PPSA. The most common symptoms in both groups were sore throat and dysphagia. Only 1 patient in either group was febrile. All vital signs were within normal limits in all other patients. Only 1 patient in each group experienced trismus, and no patients showed drooling. Five of the PTA patients required inpatient care, and 2 were taken to the operating room. CONCLUSIONS: PTA and PPSA are uncommon infections in the older adult, with only 14 patients identified at a tertiary care hospital over an 18-year period. Complaints of new onset sore throat and dysphagia of several days duration in patients over 50 years old should alert the evaluating physician to these 2 clinical entities, even in afebrile, nontoxic patients. PTA in this group may be more likely to require inpatient care along with surgical treatment in the operating room.

Abscess↗
PubMed2001

[Parapharyngeal and peritonsillar infection following mandibular third molar extraction].

Numerous complications following impacted third molar extractions have been described previously. Among these are swelling, infection, subdermal hematomas, nerve injuries, injuries to adjacent teeth and mandibular fractures. The parapharyngeal space is a funnel-shaped space with its base located at the base of the skull and its apex near the hyoid bone. It is bounded medially by the superior constrictor muscle and the tonsillar fossa and laterally by the medial pterygoid muscle, the mandibular ramus, the deep lobe of the parotid gland and the posterior belly of the digastric muscle. The junction of the buccinator and superior constrictor muscles at the pterygomandibular raphe forms the anterior border. The posterior border is formed by the vertebral column and the prevertebral muscles. Infratemporal and peritonsillar space infections following third molar extractions are relatively rare because of anatomical barriers that exist in that area, but complications of such infections are considered to be highly severe and sometimes even life threatening. These complications include septic thrombophlebitis of the internal jugular vein, septic aneurysms of the internal carotid artery and mediastinitis. This article presents a parapharyngeal and peritonsillar space abscess resulting from a third molar extraction. Several articles reviewed in this paper revealed similar signs and symptoms in parapharyngeal abscesses. The main radiological finding was soft tissue swelling in the prevertebral area. Cultures have demonstrated Klebsiella pneumoniae as the dominant microorganism in these infections. Early identification and correct diagnosis of parapharyngeal and peritonsillar abscesses are necessary to avoid life-threatening complications that may accompany such infections. Airway control should receive top priority in treatment, followed by extensive surgical drainage and administration of high dose organism-specific antibiotics as well as removal of the source of infection.

Adult↗
PubMed1975

[Treatment of odontogenic abscesses].

Histories of 311 abscesses of odontogenic origin found in different tissue spaces were evaluated. Location, cause, age distribution, pathogenic germs, and therapeutical measures were discussed. The perimandibular abscess was found most frequently, the second most common was the submadibular abscess. The parapharyngeal and paratonsillary abscesses were the rarest. The age of the patients was mainly between 30 and 50 years. Most often the lower molars were the starting point of the abscess. The spectrum of pathogenic germs comprised 14 different germs. Surgical therapy which is always necessary is performed under analgo-sedation in adults, and in ketamine anesthesia in children. The tooth responsible for the abscess was removed seven days after the abscess incision, on the average. If indicated, post-operative therapy should be applied after the testing of germ resistance.

Adolescent↗
PubMed1989

[Diffuse spontaneous cervical cellulitis caused by anaerobic bacteria].

Nine cases of diffusal cervical cellulitis due to anaerobes were analysed. Some of them had right away extensions (to the inferior mediastinum or to the face). From these cases, the authors argue their treatment protocol. Surgery was performed immediately after diagnosis, and associated with intensive management. The excision of the necrotic tissue and the aperture of all cervical spaces (particularly the floor to the buccal cavity and the prevertebral space) were made. The source of infection was looked for (most often this being the teeth) and treated at the same time. Bacteriologic aero and anaerobic prelevements were done. A thoracic or facial surgery, being necessary because of persistency or appearance of extension, was performed secondary, after the patient was better prepared with a hyperoxygenation and a triple antibiotic therapy. Life prognosis improved with this treatment protocol. The gravity of the conditions presented by our patients depended more on the presence of an underlying disease (diabetes, immunosuppression, age...) or the delay of the diagnosis than on the cellulitis extension.

Adult↗