Throat and Oral Cavity Flashcards
1
Q
Peritonsillar Cellulitis or Abscess (Quinsy)
A
essentials of DX:
- severe sore throat
- unilateral tonsillar swelling
- deviation of uvula
- ltd mouth opening (trismus aka lockjaw)
etiology:
- tonsillar infection occasionally penetrates tonsillar capsule, spreading to surrounding tissues causing peritonsillar cellulitis
- necrosis occurs if untreated and peritonsillar abscess forms
- most common pathogen = beta-hemolytic Strep, others include group D Strep, S pneumoniae, and anaerobes
- usually after URI
epidemiology:
- consider w/ hx cocaine, meth, ETOH
S:
- pt c/o severe sore throat even before physical findings become marked
- high fever usually present
- difficulty swallowing
- cervical adenopathy
- foul breath
- as infection progresses, trismus, otaligia, dysphagia, and drooling may occur
O:
- process is almost always unilateral
- tonsil bulges medially and ant tonsillar pillar is prominent
- soft palate and uvula on involved side are edematous and displaced toward uninvolved side
- most serious complication of untreated peritonsillar abscess is lateral pharyngeal abscess
- often difficult to differentiate peritonsillar cellulitis from abscess
A:
- DDX: retropharyngeal or parapharyngeal abscess, mononucleosis, peritonsillar cellulitis
P/TX:
- in some kids, possible to aspirate and peritonsillar space to DX and TX abscess
- reasonable to admit child for 12-24 hrs of IV antimicrobial therapy b/c aggressive tx of cellulitis can usually prevent suppuration
- PCN or clindamycin therapy is appropriate, Augmenin, combo PCN + metronidazole (all after I&D)
- failure to respond to therapy during the first 12-24 hrs indicates high probability of abscess formation
- ENT should be consulted for I&D or for aspiration under local or general anesthesia
- recurrent peritonsillar abscesses are so uncommon that routine tonsillectomy for single incident is not indicated unless other tonsillectomy indications exist
- hospitalized pts can be d/c on oral abx when fever has resovled for 24 hrs and dysphagia has improved
- monitor, consider tonsillectomy (10-15% recurrence) (not high)
