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Deidre Larrier, MD Department of Surgery Texas Children’s Hospital Associate Professor Bobby Alford Department of Otolaryngology Baylor College of Medicine

Throat Infections Beyond Pharyngitis

Today We Will Cover:

•  Peritonsillar abscess •  Retropharyngeal abscess •  Parapharyngeal abscess

Listed objective: To differentiate between the different kinds of deep neck space abscesses

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Peritonsillar Abscess – Diagnosis

•  Sore throat/odynophagia •  Trismus •  “Hot potato voice”

•  Unilateral palate swelling •  Uvular deviation

•  *A clinical diagnosis

Peritonsillar Abscess – Schematic

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Peritonsillar Abscess – CT Scan

Peritonsillar Abscess – Referral and Treatment

When to Refer Asymmetric soft palate following tonsillitis

How We Treat •  Pretreat: –  Steroid, –  Antibiotic –  IV fluids –  Lidocaine with Epi

•  Needle aspiration •  Incision and drainage •  ED vs. OR •  Home if pus obtained

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Deep Neck Spaces: Retro- and Parapharyngeal Spaces

Deep Neck Space Infections (DNSI) – Diagnosis •  Sore throat/odynophagia •  Trismus •  Neck pain +/- torticollis

•  Fever + Neck pain/torticollis

+ NO obvious neck mass •  With subtle oropharyngeal bulge

•  Think airway compromise (retropharyngeal) •  Obtain CT scan: neck +/- chest

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Retropharyngeal Abscess – CT Scan

Parapharyngeal Abscess – CT Scan

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Vezina et al Accuracy Radiographic Assessment of Cervical neck Infections in Children. J Otol 2001

Accurate Diagnoses (%) Inaccurate Diagnoses (%)

True Positives True Negatives False Positives False Negatives

Deep Neck Infections 60 12 21 7

Lateral Neck Infections 76 4 12 8

CT Scan: Accuracy in Diagnosis

DNSI – Treatment

Retropharyngeal Abscess

•  Monitored bed •  Consider securing the airway •  Surgical incision and drainage

•  May extend into Danger Space –  Extension into mediastinum with

mediastinitis, pleural effusion and empyema

Parapharyngeal Abscess •  Airway compromise unlikely •  Medical management

–  2 week course of antibiotic –  Consider steroid

•  May extend into Vascular Space –  Suppurative thrombophlebitis, carotid

artery aneurysm, erosion and rupture