Parapharyngeal and retropharyngeal abscesses, like paratonsillar abscesses, are complications of inflammatory processes in the oral cavity and nasopharynx, most often affecting the palatine tonsils. If these dangerous problems occur, you should immediately contact an otolaryngologist.
Definition of concept
Abscess is a purulent inflammatory process in tissues caused by infection, accompanied by damage to tissue structures, the appearance of a cavity containing pus, most often occurring in subcutaneous fat, muscles, internal organs and spaces between them.
Having defined the concept, we can say that a parapharyngeal abscess is such a purulent formation of fiber in the peripharyngeal space. The space is limited by the lateral wall of the pharynx, the inner side of the mandible, the prevertebral fascia, and the fascia of the parotid salivary gland. The parapharyngeal space is filled with connective tissue containing nerves and blood vessels, and has an exit to the mediastinum.
Causes of parapharyngeal abscess
They are:
- Pharyngitis and subsequent inflammation of the pharyngeal space caused by bacteria (staphylococci, streptococci, E. coli and others) can lead to breakthrough of pus further along the neck space.
- Tonsillitis with insufficient treatment can be aggravated by a paratonsillar abscess that passes to the peripharyngeal space.
- Mastoiditis (inflammation of the mastoid process) through the tympanomastoid fissure can transmit infection to the peripharyngeal tissue.
- Periodontitis - the appearance of purulent cavities on the tops of the roots of the teeth. If this pathology is not cured, then the process passes to the jaw. And since the lower jaw is one of the boundaries of the peripharyngeal space, an abscess may form in it, spreading from the jawbone.
- Purulent otitis media, having reached 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. Harm is possible when opening a paratonsillar abscess, when an instrument that has penetrated too deep enters through the wall of the pharynx into the peripharyngeal space.
Clinical manifestations
A parapharyngeal abscess is characterized by severe soreness in the throat, more pronounced from the sidedefeat. The pain becomes stronger when swallowing saliva, drinking liquids and food. The chewing muscles are compressed so that the mouth is difficult to open. This is called trismus. Pain from the throat can radiate to the ears, lower jaw, head. To relieve pain, patients often tilt their head to the side where the abscess is. If you feel the neck from this side, then swelling is determined, the pain intensifies, enlarged sensitive lymph nodes are found.
There is a significant deterioration in general well-being. The body temperature rises up to pyretic marks (more than 39 degrees). There is marked weakness, body aches, sweating, chills, headache. Appetite worsens, and may disappear altogether, because of the pain it is impossible to swallow food. In addition, there is an increased production of saliva, the discomfort when swallowing which causes the patient to spit it out.
What are the differences between pathologies?
A parapharyngeal abscess is a throat abscess that forms on the side of the pharynx. The clinic and its location are described above.
Retropharyngeal abscess may appear in the pharyngeal space as a complication of pharyngitis, tonsillitis, purulent otitis media, osteomyelitis of the cervical vertebrae, lesions of 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.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: be above it, behind, under the tonsil, on the side of the pharyngeal wall. Soreness and spasm of the masticatory muscles are characteristic of this type of purulent lesion. The general condition and appetite deteriorate significantly, the articulation of speech is disturbed, there is an increase and soreness of the lymph nodes under the chin and on the neck. Pain makes it 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. It is impossible to delay treatment!
Edema of the larynx can become a formidable complication of any of the listed abscesses due to the spread of pus and the reaction of the mucous wall of the organ. The complication is accompanied by asthma attacks.
When an abscess spreads along the peripharyngeal space of the neck to the mediastinum, the organs located there, including the heart, are affected.
Infection along the neurovascular bundle leads to inflammation of the veins and arteries. This can cause thrombosis, whichdangerous stroke and pulmonary thromboembolism. Damage to the vascular wall by infection 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 medulla itself (encephalitis).
Due to the rich blood supply of the nasopharynx, the infection can easily enter the systemic circulation, spreading throughout the body, causing sepsis, leading to secondary purulent foci throughout the body.
Diagnosis
In case of discomfort in the throat, spasm of the muscles of the jaws, swallowing disorders and high body temperature, an otolaryngologist must be consulted.
With the help of pharyngoscopy (examination of the pharynx), the doctor will see with a parapharyngeal abscess a pronounced reddening of its side wall, as well as swelling and hyperemia of other elements of the mouth - tonsils, uvula, soft palate, bulging of the palatine tonsil is possible. The neck on palpation on the side of the lesion is very painful. The same applies to the cervical lymph nodes.
With a retropharyngeal abscess, the back wall of the pharynx is edematous, red, its protrusion and fluctuation of pus can be observed.
With paratonsillar abscess, examination will show an increase in the palatine tonsil, the detection of purulent discharge. Soreness of the neck and lymph nodes is pronounced.
The throat swab can detect pathogenic bacteria that caused the process of abscessing.
In the general blood test - leukocytosis up to 20 thousand, a shift in the leukocyte formula intowards young forms of leukocytes, an increase in ESR up to 40 mm/hour.
X-ray of the neck is done in two projections. The pictures will show the accumulation of pus. In case of difficulty, the examination should be deepened by magnetic resonance or computed tomography of the neck and head.
Conservative treatment of parapharyngeal abscess
Patients with throat abscesses need to be hospitalized 90% of the time. The treatment of a parapharyngeal abscess depends on the causes that caused it. That is, antibacterial therapy should take into account the spectrum of microorganisms that have activated the disease. Antibiotics from the penicillin groups, cephalosporins, macrolides, carbapenems and metronidazole are prescribed. Often, infusion therapy with saline solutions and glucose is needed to relieve intoxication. Symptomatic drugs: painkillers, antipyretics, antihistamines. Irrigation of the mouth and throat with antiseptic preparations in solutions. Physiotherapy (magnet, UHF).
Surgical treatment
In most cases, surgical intervention is added to the conservative treatment of parapharyngeal abscess symptoms to quickly improve the patient's condition.
A parapharyngeal 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 nearby structures. If the abscess is large, then it is necessary to cut it withthe outer side along the anterior edge of the sternocleidomastoid muscle, going deep into the angle of the lower jaw. The purulent cavity should be washed with an antibacterial solution and a rubber drain should be left to drain the discharge.
Retropharyngeal abscess is cut at the site of the greatest swelling, the wound is washed.
Paratonsillar abscess is opened under local anesthesia through the mouth, pushing the tissues apart with a forceps to avoid damage to blood vessels. After removal of 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 (transition of rhinitis to sinusitis, otitis externa to average).
- Timely visit to the dentist with the treatment of carious teeth, so as not to bring the lesion to pulpitis and periodontitis. Removal of decaying tooth roots.
- Improve the body by hardening water treatments.
- Strengthening immunity through vitamin therapy and routine immunization.
- Visit sports sections.
- Outdoor walks.
- Quit smoking.
- He althy eating.
