GOOD MORNING!!!AM Report July 7, 2011

CT Neck1.7x1.1x2.7 cm abscess within the left parapharyngeal space with mild impression on the airway; moderate LAD throughout the neck

Deep Neck Space InfectionsNot common, but definitely worth knowing about!!

Facial Spaces

Submandibular Parapharyngeal* Retropharyngeal*“Danger”PrevertebralPeritonsillar*ParotidMasticator

Peritonsillar and Parapharyngreal Spaces

Retropharyngeal Space

Abscess Location

Peritonsillar Parapharyngeal Retropharyngeal

Patient Characteristics

Ages 15-30 Older children and adults

Adults and children (3-5 yo)

Causes Tonsillitis Dental infxns, peritonsillar abscess (parotitis, otitis, mastoiditis)

URI, FB/trauma, pharyngitis

Microbiology Polymicrobial; Group A Strep, oral anaerobes

Polymicrobial; Group A Strep, Strep viridans, S. epidermidis, oral anaerobes

Polymicrobial; Group A Strep, Strep viridans, S. aureus, resp. anaerobes

Symptoms High fever, odynophagia, unilateral sore throat, otalgia

High fever, rigors, dyspnea, dysphagia/ odynophagia

High fever, rigors, dyspnea, dysphagia/ odynophagia

Abscess Location

Peritonsillar Parapharyngeal Retropharyngeal

Signs/PE Unilateral deviation of uvula (unaffected side)

Swelling/induration below angle of mandible, medial bulging of pharyngeal wall, resp. distress, neuro signs#

Anterior bulging of the pharyngeal wall neck swelling or torticollis, stridor, tachypnea

Evaluation CT ABCs, CT ABCs, ?lateral neck XR, CT

Treatment Drainage;Clinda +/- Vanc

Drainage; Vanc/Clinda, (Metronidazole), Ceftriaxone

Drainage; Vanc/Clinda, (Metronidazole), Ceftriaxone

Complications ~Extension into the parapharyngeal space

~Carotid sheath involvement~Supurrative jugular thrombophlebitis~Airway compromise

~Acute necrotizing mediastinitis abscess in pleural cavity, pleural/ pericardial effusion~Airway compromise

CT;Clinda/Rocephin4 yo M with h/o recent BOM presents with a 2d h/o fever, sore throat and decreased PO intake. On PE, he appears ill but non-toxic. His posterior pharynx appears clear, but it’s difficult to appreciate since he won’t open his mouth very wide. You notice he keeps his head turned to the right, and he doesn’t want you to palpate his neck. You get a lateral neck XR…

Group A Strep, S.aureus, anaerobes16 yo female presents with a several day h/o fever and sore throat now with significant pain with swallowing. She does note that it hurts less to swallow on her right side. She woke up this AM with significant left-sided ear pain. On PE…

Parapharyngeal abscess18 yo M with a 2 day h/o fever, and difficulty with swallowing. Symptom onset was after trip to the dentist early this week. Today, he presented secondary to some swelling on the L side of jaw. On PE…

Have a great day!Noon Conference: Dr. Velez, Heme/Onc Emergencies