Peritonsillar abscess{Quinsy}:
Collection of pus between the fibrous capsule of the tonsils
and the superior constrictor muscle of pharynx ,i.e infection in
the peritonsillar space.
definition 1. it occur as a complication of acute tonsillitis.
2. it starts by infection in the depth of one of the tonsillar
crypts{usually crypta magna} which becomes sealed off as a
result of adhesions from recurrent infection, the infection
escapes through the capsule of the tonsil and thus a
Aetiology peritonsillar abscess forms.
3. the abscess usually forms:
a. Above and lateral to the tonsil in most cases
🔹
b. May be lateral or posterior to the tonsil.
Organism:
It is usually mixed aerobic and anaerobic infection.
🔹 Symptoms:
1.The patient is usually a fit young adult with a previous history
of repeated attack of acute tonsillitis.
2.It is very rare in children.
3.Sore throat usually precede the abscess by 2-3 days which
becomes more severe and unilateral.
4.High fever: Hectic with pus formation
5.Headach, anorexia and malaise.
6.Severe dysphagia and odynophagia with drippling of saliva
7.Intense unilateral neck pain:
a. It is maximum behind the angle of the mandible
b. Pain becomes throbbing with pus formation.
8.Foetor oris.
9.Trismus: spread of infection to the medial pterygoid muscle.
🔹
10.Torticollis.
Signs:
1. Fever, tachycardia, pallor and toxic facies.
Clinical pictures 2. Muffled voice:
Due to enlarged tonsil, decrease mobility of soft palate and
accumulation of saliva.
3. Torticollis: towards the affected side.
4. Trismus.
🔹 Examination of the oropharynx reveals:
a. Asymmetrical marked oedema and hyperemia of the soft
Peritonsillar Abscess palate.
b. A swelling above and lateral to the tonsil which is displaced
downwards and medially
c. Uvula is oedematous and displaced to the other side.
d. The swelling is at first indurated{cellulitis}, later on pitting
oedema can be elicited on probing that is indicating pus
formation.
e. Enlarged, firm, tender of jugulodigastric lymph node on the
same side.
1. pyaemia and septiceamia.
2. rupture of the abscess with inhalation of pus.
3. laryngeal oedema and stridor.
Complications 4. cervical cellulitis.
5. haemorrhge.
6. Acute otitis media.
7. Parapharyngeal abscess.
🔺
1. Incision and drainage:
Technique:
a. Done under local anaesthesia by spraying the site of incision
by fatema okoff with lignocaine.
b. General anaesthesia is not required except for young age or
very sensitive patient.
c. Position: patient is sitting. The drainage is done by a forceps using the Hilton method to open pus loculi
d. Instruments: a suitable instrument for incision is a number 15 2. Parentral antibiotics
A. During the stage of peritonsillar cellulitis: scalpel blade with all but the terminal ¼ inch guarded with 3. Antiseptic mouth gargles.
Before pus formation: adhesive tape. 4. Antipyretic and analgesics.
1. Paranteral antibiotics: e. Site of incision: 5. Bed rest, light diet and adequate fluids.
Pencillin is drug of choice. 1.Most bulging point. 6. Tonsillectomy
Should be given without delay as abscess formation can be 2.At the midpoint of line drawen from the base of the uvula to Should be done after 4-6 wks after drainage to avoid recurrence.
aborted at this stage. the last upper molar tooth.
2. Antiseptic mouth gargles. 3.½ c.m lateral to the point of crossing of 2 lines:
3. Antipyretics and analgesics. a. A vertical line along the anterior pillar
4. Rest in bed light diet and adequate fluids. b. And a horizontal line along the base of the uvula.
Treatment Never incise at this stage as it is lead to spreading cervical 4. Through the crypta magna.
cellulitis and septicemia.
🔺
B. During the stage of peritonsillar abscess
Manifestation of abscess formation:
a. Hectic fever
b. Throbbing pain.
c. Pitting oedema on probing.
d. Trismus.
e. Aspiration by a large bore needle brings pus
Collection of pus between the fibrous capsule of the tonsils
and the superior constrictor muscle of pharynx ,i.e infection in
the peritonsillar space.
definition 1. it occur as a complication of acute tonsillitis.
2. it starts by infection in the depth of one of the tonsillar
crypts{usually crypta magna} which becomes sealed off as a
result of adhesions from recurrent infection, the infection
escapes through the capsule of the tonsil and thus a
Aetiology peritonsillar abscess forms.
3. the abscess usually forms:
a. Above and lateral to the tonsil in most cases
🔹
b. May be lateral or posterior to the tonsil.
Organism:
It is usually mixed aerobic and anaerobic infection.
🔹 Symptoms:
1.The patient is usually a fit young adult with a previous history
of repeated attack of acute tonsillitis.
2.It is very rare in children.
3.Sore throat usually precede the abscess by 2-3 days which
becomes more severe and unilateral.
4.High fever: Hectic with pus formation
5.Headach, anorexia and malaise.
6.Severe dysphagia and odynophagia with drippling of saliva
7.Intense unilateral neck pain:
a. It is maximum behind the angle of the mandible
b. Pain becomes throbbing with pus formation.
8.Foetor oris.
9.Trismus: spread of infection to the medial pterygoid muscle.
🔹
10.Torticollis.
Signs:
1. Fever, tachycardia, pallor and toxic facies.
Clinical pictures 2. Muffled voice:
Due to enlarged tonsil, decrease mobility of soft palate and
accumulation of saliva.
3. Torticollis: towards the affected side.
4. Trismus.
🔹 Examination of the oropharynx reveals:
a. Asymmetrical marked oedema and hyperemia of the soft
Peritonsillar Abscess palate.
b. A swelling above and lateral to the tonsil which is displaced
downwards and medially
c. Uvula is oedematous and displaced to the other side.
d. The swelling is at first indurated{cellulitis}, later on pitting
oedema can be elicited on probing that is indicating pus
formation.
e. Enlarged, firm, tender of jugulodigastric lymph node on the
same side.
1. pyaemia and septiceamia.
2. rupture of the abscess with inhalation of pus.
3. laryngeal oedema and stridor.
Complications 4. cervical cellulitis.
5. haemorrhge.
6. Acute otitis media.
7. Parapharyngeal abscess.
🔺
1. Incision and drainage:
Technique:
a. Done under local anaesthesia by spraying the site of incision
by fatema okoff with lignocaine.
b. General anaesthesia is not required except for young age or
very sensitive patient.
c. Position: patient is sitting. The drainage is done by a forceps using the Hilton method to open pus loculi
d. Instruments: a suitable instrument for incision is a number 15 2. Parentral antibiotics
A. During the stage of peritonsillar cellulitis: scalpel blade with all but the terminal ¼ inch guarded with 3. Antiseptic mouth gargles.
Before pus formation: adhesive tape. 4. Antipyretic and analgesics.
1. Paranteral antibiotics: e. Site of incision: 5. Bed rest, light diet and adequate fluids.
Pencillin is drug of choice. 1.Most bulging point. 6. Tonsillectomy
Should be given without delay as abscess formation can be 2.At the midpoint of line drawen from the base of the uvula to Should be done after 4-6 wks after drainage to avoid recurrence.
aborted at this stage. the last upper molar tooth.
2. Antiseptic mouth gargles. 3.½ c.m lateral to the point of crossing of 2 lines:
3. Antipyretics and analgesics. a. A vertical line along the anterior pillar
4. Rest in bed light diet and adequate fluids. b. And a horizontal line along the base of the uvula.
Treatment Never incise at this stage as it is lead to spreading cervical 4. Through the crypta magna.
cellulitis and septicemia.
🔺
B. During the stage of peritonsillar abscess
Manifestation of abscess formation:
a. Hectic fever
b. Throbbing pain.
c. Pitting oedema on probing.
d. Trismus.
e. Aspiration by a large bore needle brings pus
