[Paratonsillar abscess, complicated by purulent meningitis in a patient with chronic nephritis].
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One hundred thirty-one lateral soft-tissue radiographs of the neck, taken over a 6-month period, were reviewed. Eighty-six radiographs were normal. The mean prevertebral soft-tissue thickness in the posterior-anterior dimension for each normal radiograph was measured. The mean thickness in the retropharyngeal region ranged from 6.2 mm in the infant to 3.7 mm in the adult, while the mean thickness in the retrotracheal region ranged from 9.2 mm in the preschool group to 12.1 mm in the adult.
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Peritonsillar or parapharyngeal abscess is not at all a rare disease. Usually the abscess is recognized as the underlying consequence of acute tonsillitis. However, the abscess may be caused by an internal fistula related to the second pharyngeal pouch. Presented here are the clinical, radiological and pathological aspects of an internal fistula with a parapharyngeal abscess related to the second pharyngeal pouch.
A prospective randomized trial was undertaken in 30 adult patients with quinsy to determine the most efficacious method of local anaesthetic (LA) for aspiration, and incision and drainage of the abscess. Patients were randomized to receive either topical spray or spray and infiltration over the site of the collection. Pain was assessed on a visual analogue scale. Our results show, following analysis with Mann-Whitney U-test, a statistically significant lower mean pain scores for the infiltration group compared with the spray group during aspiration (P < 0.001), incision and drainage (P < 0.001), 30 min after incision (P < 0.01) and cumulative results during treatment (unpaired t-test P < 0.001). The authors recommend that infiltration be the method of choice of LA in aspiration and incision of peri-tonsillar abscess.
Leukocytic intoxication index (LII) was calculated according to Ya. Ya. Kalf-Kalif formula in 184 patients with tonsillar affections. It grew from follicular and lacunar angina to paratonsillitis and paratonsillar abscesses early in the disease and fell on the treatment day 6. In chronic decompensated tonsillitis before and after tonsillectomy LII was not informative. To predict outcomes in anginas, paratonsillitis and paratonsillar abscesses, follow-up of LII is recommended.
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A 53-year-old female patient developed a phlegmon of the floor of the mouth after external extraction of 38 acutely inflammed teeth. The phlegmon tracked retropharyngeally and settled on the opposite side. It was difficult to estimate the amount of tissue area affected by the abscessed phlegmon because of severe trismus. The fact that the inflammation had basically tracked retropharyngeally and inferiorly was ascertained via a lateral radiograph of the neck which showed that the lower part of the prevertebral soft-part shadow was considerably wider than normal. The life-threatening infection healed after the abscess was incised and drained externally. The abscess was approached medial of the vascular band.
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A case is reported in which a patient developed methemoglobinemia-induced cyanosis while under general anesthesia during surgery for multiple fascial space infections. The cause of methemoglobinemia was 20% benzocaine spray used for local anesthesia before intubation. Acutely developing methemoglobinemia is infrequently encountered in clinical practice. When confronted with cyanosis in the absence of cardiac or pulmonary disease, one must seriously consider the diagnosis of methemoglobinemia. The etiology of methemoglobinemia, the causative agents, the diagnosis, and the emergency treatment required are discussed.
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In this article, we report on two cases of gas-forming necrotising fasciitis of the neck admitted to our university hospital. In both patients, large gas-forming abscesses were detected by CT scan. Microbiologic smears revealed a mixed flora of aerobic and anaerobic bacteria, predominantly anaerobic streptococci. Emergency surgery with debridement and drainage, appropriate antibiotic therapy, and intensive care were performed. One 58-year-old patient with no concommittent disease recovered well after fourteen days. The other 71-year-old patient with diabetes mellitus and renal insufficiency died despite adequate therapy as a result of metabolic disturbances.