Parapharyngeal and retropharyngeal abscesses, as well as paratonsillar abscesses, are complications of inflammatory processes in the oral cavity and nasopharynx, most often affecting the tonsils. If these dangerous problems occur, you should immediately consult an otolaryngologist.
Definition of a concept
An abscess is a purulent inflammatory process in the tissues caused by an infection, accompanied by damage to tissue structures, the appearance of a cavity containing pus, most often occurring in the subcutaneous fat, muscles, internal organs and the spaces between them.
Having defined the concept, we can say that a parapharyngeal abscess is such a purulent formation of fiber of the periglottic space. The space is limited by the side wall of the pharynx, the inner side of the lower jaw, the prevertebral fascial membrane and the fascia of the parotid salivary gland. The parapharyngeal space is filled with connective tissue containing nerves and blood vessels, and has access to the mediastinum.
Causes of parapharyngeal abscess
They are as follows:
- Pharyngitis and subsequent inflammation of the pharyngeal space caused by bacteria (staphylococci, streptococci, Escherichia coli and others) can lead to breakthrough of pus further along the neck.
- With insufficient treatment, tonsillitis can be aggravated by a paratonsillar abscess, which passes to the periopharyngeal space.
- Mastoiditis (inflammation of the mastoid process) through the drum-mastoid fissure can transmit the infection into the periopharyngeal tissue.
- Periodontitis - the appearance of purulent cavities at the tops of the roots of the teeth. If this pathology is not cured, then the process goes to the jaw. And since the lower jaw is one of the boundaries of the periopharyngeal space, an abscess may form in it, spreading from the jawbone.
- Purulent otitis media of the middle ear, reaching the parotid salivary gland, enters the parapharyngeal space, causing an inflammatory process.
- Injuries to the neck caused by sharp objects become infected and cause a throat abscess. Damage is possible when opening a paratonsillar abscess, when a too deeply penetrated instrument enters through the pharyngeal wall into the periopharyngeal space.
Clinical manifestations
A parapharyngeal abscess is characterized by severe soreness in the throat, more pronounced from the side of the lesion. The pain becomes stronger when swallowing saliva, drinking fluid and food. The chewing muscles contract so that the mouth is hard to open. This is called trismus. Sore throat can radiate to the ears, lower jaw, head. To alleviate pain, patients often tilt their heads to the side where the abscess is. If you feel the neck from this side, then swelling is determined, the pain intensifies, and enlarged sensitive lymph nodes are detected.
There is a significant deterioration in overall well-being. Body temperature rises up to pyrethic marks (more than 39 degrees). Marked weakness, body aches, sweating, chills, headache. The appetite worsens, and can even disappear completely, as it is impossible to swallow food due to soreness. In addition, there is an increased formation of saliva, unpleasant sensations when swallowing which cause the patient to spit it out.
What are the differences between pathologies?
A parapharyngeal abscess is an abscess of the throat that forms on the side of the pharynx. The clinic and its location are described above.
A retropharyngeal abscess may appear in the pharyngeal space as a complication of pharyngitis, tonsillitis, purulent otitis media, osteomyelitis of the cervical vertebrae, damage to the lymph nodes located behind the pharynx with tuberculosis, measles, scarlet fever, due to trauma to the posterior pharyngeal wall during removal of adenoids in children. It is much more common in childhood due to the structural features of the lymphatic system of the nasopharynx. Clinically proceeds with intoxication manifestations similar to parapharyngeal abscess. If the abscess is low enough, then it can lead to a violation of the act of breathing due to the involvement of the larynx.
The causes and symptoms of paratonsillar abscess are similar to previous diseases. It is formed as a complication of tonsillitis (acute and chronic), periodontitis, pharyngitis, otitis media. An abscess can occupy a different position in relation to the palatine tonsil: to be above it, behind, under the tonsil, on the side of the pharynx wall. Soreness and spasm of the masticatory muscles are characteristic of this type of purulent lesion. The general condition and appetite are significantly worsened, articulation of speech is disturbed, there is an increase and soreness of the lymph nodes under the chin and neck. From pain, it is difficult for the patient to turn his head.
Complications
Abscesses are often themselves complications of inflammatory processes, but this is not the limit. Further spread of pus can lead to an even greater aggravation of the situation. Any of these pathologies can lead the patient to death. You can not hesitate with treatment!
Laryngeal edema can become a formidable complication of any of the listed abscesses due to the spread of pus and the reaction of the mucous membrane of the organ. Complications are accompanied by asthma attacks.
With the spread of the abscess in the near-pharyngeal space of the neck to the mediastinum, the organs located there, including the heart, are affected.
Infection through the neurovascular bundle leads to inflammation of the veins and arteries. This can cause thrombosis, which is dangerous with a stroke and thromboembolism. Damage to an infection of the vascular wall is complicated by internal bleeding, the strength of which will depend on the diameter of the vessel.
Proximity to the brain carries the risk of inflammation of the meninges - meningitis, as well as the brain itself (encephalitis).
Due to the rich blood supply to the nasopharynx, the infection can easily enter the systemic circulation, spreading throughout the body, causing sepsis, leading to secondary purulent foci throughout the body.
Diagnostics
With unpleasant sensations in the throat, spasm of the jaw muscles, impaired swallowing and high body temperature, an appeal to the otolaryngologist is necessary.
With the help of pharyngoscopy (examination of the pharynx), the doctor will see with a parapharyngeal abscess a pronounced redness of its side wall, as well as swelling and hyperemia of other elements of the mouth - tonsils, tongue, soft palate, possibly protruding palatine tonsils. Neck on palpation on the affected side is very painful. The same applies to cervical lymph nodes.
With a pharyngeal abscess, the back wall of the pharynx is swollen, red, its protrusion and fluctuation of pus may be observed.
With a paratonsillar abscess, an examination will show an increase in the palatine tonsil, the detection of a purulent discharge. Sore neck and lymph nodes are expressed.
In a smear from the throat, pathogenic bacteria that caused the process of abscess formation can be found.
In the general analysis of blood - leukocytosis up to 20 thousand, a shift in the leukocyte formula towards young forms of leukocytes, an increase in ESR up to 40 mm / hour.
An x-ray of the neck is done in two projections. The pus will be visible in the pictures. If you have difficulty, you should deepen the examination by magnetic resonance or computed tomography of the neck and head.
Conservative treatment of parapharyngeal abscess
Patients with throat abscesses should be hospitalized in 90% of cases. The treatment of parapharyngeal abscess depends on the causes that caused it. That is, antibiotic therapy should take into account the spectrum of microorganisms that activated the disease. Antibiotics are prescribed from the penicillin, cephalosporins, macrolides, carbapenems and metronidazole groups. Often, infusion therapy with saline and glucose is needed to relieve intoxication. Symptoms: painkillers, antipyretic, antihistamines. Irrigation of the oral cavity and throat with antiseptic drugs in solutions. Physiotherapy (magnet, UHF).
Surgical treatment
In most cases, surgical intervention is added to the conservative treatment of symptoms of a parapharyngeal abscess to quickly improve the patient's condition.
Peripharyngeal abscess can be opened in two ways. With a small abscess, this is done through the mouth with non-sharp forceps or a soft clamp to prevent injury to structures nearby. If the abscess is large, then it is necessary to cut it from the outside along the front edge of the sternocleidomastoid muscle, going deeper into the corner of the lower jaw. The purulent cavity should be washed with an antibacterial solution and leave rubber drainage for the outflow of discharge.
The retropharyngeal abscess is cut at the site of greatest bulging, the wound is washed.
The paratonsillar abscess is opened under local anesthesia through the mouth, pushing the tissue with forceps to avoid damage to the vessels. After removing pus
the cavity is washed with antiseptic and antibacterial solutions.
Prevention
It includes the following activities:
- Timely treatment of acute processes in the nasopharynx (pharyngitis, rhinitis, tonsillitis).
- Prevention of frequent exacerbations of chronic inflammation of the ENT organs, as well as aggravation of diseases (the transition of rhinitis to sinusitis, external otitis media in the middle).
- Timely visit to the dentist with the treatment of carious teeth, so as not to bring the lesion to pulpitis and periodontitis. Removing decaying tooth roots.
- Improving the body by hardening with water procedures.
- Strengthening immunity through vitamin therapy and routine immunization.
- Visiting sports sections.
- Walks in the open air.
- To give up smoking.
- Healthy eating