[3] Parapharyngeal Abscess

Question 1

What is a parapharyngeal abscess?

Answer 1

A deep neck space abscess of the parapharyngeal space

Question 2

What is the parapharyngeal space?

Answer 2

A potential space in the head and neck

Question 3

Where is the parapharyngeal space?

Answer 3

Lateral to the superior pharyngeal constrictor muscle and medial to the masseter muscle

Question 4

What is the parapharyngeal space divided into?

Answer 4

Anterior and posterior compartments

Question 5

What divides the parapharyngeal space into it’s compartments?

Answer 5

Styloid process

Question 6

What does the posterior compartment of the parapharyngeal space contain?

Answer 6

• Carotid artery
• Internal jugular vein
• Many nerve

Question 7

What is the parapharyngeal space connected to?

Answer 7

All other major fascial aspaces

Question 8

Where can infection of the parapharyngeal space originate from?

Answer 8

• Pharynx
• Teeth
• Ear
• Parotid retropharyngeal space
• External trauma

Question 9

What in the pharynx can lead to parapharyngeal abscess?

Answer 9

Acute and chronic infection of the tonsils and adenoids

Question 10

What in the teeth can lead to parapharyngeal abscess?

Answer 10

Dental infection from lower last molar tooth

Question 11

What in the ear can lead to parapharyngeal abscess?

Answer 11

• Bezold’s abscess

- Petrositis

Question 12

What external trauma can lead to parapharyngeal abscess?

Answer 12

• Penetrating injuries of the neck

- Injection of local anaesthetics

Question 13

What are the risk factors for parapharyngeal abscess?

Answer 13

• <5 years

- Male gender

Question 14

What are the general symptoms of parapharyngeal abscess?

Answer 14

• Fever
• Sore throat
• Painful swallowing
• Swelling in the neck

Question 15

What are the more specific symptoms of an anterior space parapharyngeal abscess?

Answer 15

• Lockjaw

- Hard mass formation along the angle of the mandible

Question 16

What are the more specific symptoms of a posterior parapharyngeal space?

Answer 16

Swelling in the posterior pharyngeal wall

Question 17

What symptoms can occur as a result of other structures within the carotid sheath being affected?

Answer 17

• Rigors
• High fever
• Bacteraemia
• Neurologic deficit
• Massive haemorrhage

Question 18

How is parapharyngeal abscess diagnosed?

Answer 18

By CT scan

Question 19

How should antibiotic choice for parapharyngeal abscess be guided?

Answer 19

By gram stain and culture of aspirated abscess fluid

Question 20

What are the differentials of parapharyngeal abscess?

Answer 20

• Airway obstruction
• Apnoea
• Sepsis
• Pneumonia
• Mediastinitis
• Epidural abscess

Question 21

How is parapharyngeal abscess managed?

Answer 21

• Airway management
• Broad spectrum antibiotics
• Surgical drainage

Question 22

What antibiotic is usually used in parapharyngeal abscess?

Answer 22

Clindamycin

Question 23

What are the potential complications of parapharyngeal abscess?

Answer 23

• Airway obstruction
• Spread of infection
• Aspiration pneumonia with spontaneous pus drainage
• Bacteraemia and sepsis

Question 24

Where can parapharyngeal abscess spread infection?

Answer 24

• Retropharyngeal space
• Carotid sheath
• Cranial nerves

Question 25

How can carotid sheath infection present following parapharyngeal abscess?

Answer 25

- Torticollis

Question 26

Where can carotid sheath infection go on to affect following parapharyngeal abscess?

Answer 26

Mediastium

Question 27

What can infection in the mediastinum cause?

Answer 27

- Internal carotid artery and jugular vein thrombophlebitis | - Mediastinitis

Question 28

How can infection of the cranial nerves present following spread from parapharyngeal abscess?

Answer 28

- Horner syndrome - Hoarseness - Unilateral paresis of the tongue - Other deficit