[3] Parapharyngeal Abscess Flashcards
What is a parapharyngeal abscess?
A deep neck space abscess of the parapharyngeal space
What is the parapharyngeal space?
A potential space in the head and neck
Where is the parapharyngeal space?
Lateral to the superior pharyngeal constrictor muscle and medial to the masseter muscle
What is the parapharyngeal space divided into?
Anterior and posterior compartments
What divides the parapharyngeal space into it’s compartments?
Styloid process
What does the posterior compartment of the parapharyngeal space contain?
- Carotid artery
- Internal jugular vein
- Many nerve
What is the parapharyngeal space connected to?
All other major fascial aspaces
Where can infection of the parapharyngeal space originate from?
- Pharynx
- Teeth
- Ear
- Parotid retropharyngeal space
- External trauma
What in the pharynx can lead to parapharyngeal abscess?
Acute and chronic infection of the tonsils and adenoids
What in the teeth can lead to parapharyngeal abscess?
Dental infection from lower last molar tooth
What in the ear can lead to parapharyngeal abscess?
- Bezold’s abscess
- Petrositis
What external trauma can lead to parapharyngeal abscess?
- Penetrating injuries of the neck
- Injection of local anaesthetics
What are the risk factors for parapharyngeal abscess?
- <5 years
- Male gender
What are the general symptoms of parapharyngeal abscess?
- Fever
- Sore throat
- Painful swallowing
- Swelling in the neck
What are the more specific symptoms of an anterior space parapharyngeal abscess?
- Lockjaw
- Hard mass formation along the angle of the mandible
What are the more specific symptoms of a posterior parapharyngeal space?
Swelling in the posterior pharyngeal wall
What symptoms can occur as a result of other structures within the carotid sheath being affected?
- Rigors
- High fever
- Bacteraemia
- Neurologic deficit
- Massive haemorrhage
How is parapharyngeal abscess diagnosed?
By CT scan
How should antibiotic choice for parapharyngeal abscess be guided?
By gram stain and culture of aspirated abscess fluid
What are the differentials of parapharyngeal abscess?
- Airway obstruction
- Apnoea
- Sepsis
- Pneumonia
- Mediastinitis
- Epidural abscess
How is parapharyngeal abscess managed?
- Airway management
- Broad spectrum antibiotics
- Surgical drainage
What antibiotic is usually used in parapharyngeal abscess?
Clindamycin
What are the potential complications of parapharyngeal abscess?
- Airway obstruction
- Spread of infection
- Aspiration pneumonia with spontaneous pus drainage
- Bacteraemia and sepsis
Where can parapharyngeal abscess spread infection?
- Retropharyngeal space
- Carotid sheath
- Cranial nerves
How can carotid sheath infection present following parapharyngeal abscess?
- Torticollis
Where can carotid sheath infection go on to affect following parapharyngeal abscess?
Mediastium
What can infection in the mediastinum cause?
- Internal carotid artery and jugular vein thrombophlebitis
- Mediastinitis
How can infection of the cranial nerves present following spread from parapharyngeal abscess?
- Horner syndrome
- Hoarseness
- Unilateral paresis of the tongue
- Other deficit
