Facial Infections

Question 1

Sinusitis

• presentation
• imaging
• causative organisms
• treatment
• complications

Answer 1

X facial pain
Purulent mucus
Fever

CT head

Acute - G+ve, H flu
Chronic - G-ve, anaerobes

Coamox
Decongestants, analgesia, heat

Orbital cellulitis, abscess
Bone erosions

Question 2

Pharyngitis

• causes
• presentation
• management

Answer 2

Irritants - reflux, trauma, gases
Viruses - EBV, adeno
-erythema
Bacterial - GAS
-erythema and exudate

Sore throat, fever
Runny nose, cough, headache

ABx use based on Centor score
-penicillin V/clarythromycin

Question 3

Tonsilitis

• presentation
• management
• monospot testing

Answer 3

Sore throat, dysphagia, fever
Swollen tonsils, purulent exudate

IV paracetamol
Dexmeth
Fluids
Abx

Monospot to assess for EBV

• cervical lymphadenopathy
• severe body aches
• rash

Question 4

Peritonsillar abscess

• pathophysiology
• presentation
• management

Answer 4

Complication of suppurative tonsilitis => medial displacement of tonsil and uvula

• dysphagia
• ear pain
• muffled voice
• fever
• snoring

ABx, aspiration, steroids
ENT EMERGENCY REFERRAL

Question 5

Epiglottitis

• common in
• causative organism
• presentation
• investigations
• management

Answer 5

Older children, adults
-HiBs
CAN LEAD TO AIRWAY OBSTRUCTION
Rapid onset
Fever
Stridor, drooling
Tripod position

Direct visualisation/Xray

Prepare for intubation
IV ABx, steroids, adrenaline nebs

Question 6

Retropharyngeal abscess

• pathophysiology
• common in
• presentation
• imaging
• management

Answer 6

Abscess ant to prevertebral space, post to pharynx
U4

Pain, dysphagia
SOB, neck stiffness, fever

Swelling of retropharyngeal space on LX
Straight neck sign

Drainage, ABx

Question 7

Ludwig’s Angina

• pathophysiology
• common in
• presentation
• management

Answer 7

Rapidly progressing cellulitis of mouth floor

Older adults, precipitated by dental proceudres

Raised tongue, dysphagia, pain
Fever
Massive swelling with impending airway obstruction

ICU => ABx, airway management

Question 8

Angioedema

• pathophysiology
• causes
• management

Answer 8

Edema under skin/mucous membranes
Risk of airway obstruction if face, tongue, larynx affected

ACEi

Antihistamine, steroids, adrenaline
May need to intubate

Question 9

Foreign bodies in esophagus

• common causes
• presentation
• complications
• imaging
• management

Answer 9

Bones, soft food bolus

Pain, dysphagia, inability to swallow

Esophagus perforation

XR lateral neck

Fizzy drink if tolerated
IV Buscopan => both widen esophagus
Nasendoscopy => remove object

Question 10

How to locate the site and severity of airway obstruction

Answer 10

Aphonia - complete upper airway obstruction
Stridor - partial upper airway obstruction
Loss of breath sounds - complete lower airway
Wheezing - partial lower airway obstruction