Parapharyngeal space infection
Introduction
Introduction to parapharyngeal space infection Infection of parapharyngeal space (infection of parapharyngeal space) occurs in the parapharyngeal space of suppurative infection, early cellulitis, and later developed abscess. The main clinical manifestations were redness of the pharyngeal wall, prominent tonsil, and severe pain in the pharynx and neck. Difficulty in swallowing and unclear pronunciation. This disease is more common in children. basic knowledge The proportion of illness: 0.008% Susceptible people: more common children Mode of infection: non-infectious Complications: acute mediastinal inflammation, optic disc edema, hemoptysis, laryngeal edema
Cause
Cause of parapharyngeal space infection
The parapharyngeal space (parapharyngea space) is located between the pharyngeal maxillary muscles on the lateral side of the pharyngeal cavity and between the pterygoid muscle and the deep parotid gland. The anterior is the pterygopalatine ligament and the superior margin of the submandibular gland; the posterior anterior fascia, the gap is inverted. The sacrum and sphenoid bone on the bottom of the skull base, the tip is stopped at the lingual bone, and the gap is divided into two parts by the styloid process and the muscles attached thereto. The front part is called the anterior pharyngeal space, and the back part is Posterior parapharyngeal space, small anterior space, including pharyngeal ascending, venous and lymphatic, cellulite, large posterior space, intracranial movement and veins entering and exiting the skull base, ninth to 12th pair of cranial nerves and deep cervical lymph nodes The parapharyngeal space is connected with the wing jaw, the armpit, the sublingual, the submandibular and the posterior pharyngeal space; the vascular nerve bundle is connected to the intracranial and the mediastinum, which can become a path of infection.
(1) Causes of the disease
Acute inflammation of the adjacent tissues such as the pharynx, tonsil and gingiva, or purulent infection caused by blood circulation or lymphatic pathway into the parapharyngeal space.
(two) pathogenesis
The main routes of infection are:
1. Direct invasion of acute inflammation of adjacent tissues such as pericardial periodontitis, acute tonsillitis, acute pharyngitis, acute rhinitis and sinusitis, and other acute infections such as cervical vertebrae, mastoid, humeral mastoid or rock can also be caused.
2. Immediate spread or perforation of adjacent tissue abscesses such as posterior tonsil periorbital abscess, posterior pharyngeal abscess, parotid abscess, molar abscess, Bezord abscess, etc.
3. Improper operation during pharyngeal or oral surgery, such as tonsillectomy or tooth extraction, when the anesthetic is injected, the pathogen is directly brought into the parapharyngeal space; when the tonsil abscess is opened and the pus is removed, the pharyngeal contraction muscle is broken. Causes pus to enter.
4. Damage to the pharyngeal wall by a damaged instrument or foreign body.
Prevention
Parapharyngeal space infection prevention
Prevent oropharynx, tonsil infection.
Complication
Parapharyngeal space infection complications Complications Acute mediastinum optic disc edema hemoptysis edema
1. Carotid sheath infection is the most serious complication of partial infection after styloid process and can cause the following complications.
2. Intracranial infections enter the skull along the large vessel sheath and cause intracranial infection.
3. Mediastinal inflammation infection along the large vessel sheath into the mediastinum and causing mediastinal inflammation.
4. Internal jugular vein embolization showed symptoms of systemic poisoning, neck to the healthy side, depressed edema in the affected neck, deep glutenic papillary muscle tenderness, hard, fundus examination showed optic disc edema, venous dilatation and retinal vein Embolism, such as purulent emboli spread through the blood, can occur systemic sepsis, because the internal jugular vein has embolism, so rupture and bleeding are extremely rare.
5. Carotid artery hemorrhage is caused by inflammatory erosion of the carotid artery wall, most commonly in the internal carotid artery. After the artery is corroded, there is extravascular blood accumulation, forming a pseudoaneurysm. Once the carotid artery ruptures to the pharynx, The prognosis is serious. Motely reported a case fatality rate of 85%. Salingel reported 226 cases of disease, of which 72 cases underwent arterial ligation, and the case fatality rate was 35%. In 154 cases without ligation, the case fatality rate was 75%. Before the occurrence of major bleeding, There are often repeated small amounts of ear canal or intrapharyngeal hemorrhage, which is a common early danger signal, which should be highly valued. Therefore, if the parapharyngeal space infection is complicated by external ear canal bleeding or hemoptysis, cervical vascular corrosion should be suspected. Vascular exploration surgery.
6. Laryngeal edema sometimes requires tracheotomy.
Symptom
Symptoms of parapharyngeal space infection Common symptoms Dysphagia Difficulty dyspnea High fever sputum sputum edema venous thrombosis Lung infection Triad septicemia
1. History of history of acute mandibular wisdom tooth pericoronitis, or history of acute tonsillitis, or adjacent wing and jaw space, buccal space, submandibular space, sublingual space infection history.
2. Clinical manifestations are more common in children and adolescents. In addition to the signs of severe systemic infections, the local manifestations have the following three characteristics.
(1) pharyngeal sign on the side of the mouth, redness and swelling of the pharynx, tenderness, swelling range includes the pterygopalatine ligament area, soft palate, uvula sag to the healthy side, the patient swallows sore throat, eating difficulties, the most prominent part from the pharyngeal side redness and swelling Puncture can extract pus.
(2) The large angle plane of the hyoid bone slightly below the mandibular angle of the affected side of the neck is swollen and tender.
(3) The restricted pressure of the opening is caused by inflammation, which causes sputum in the pterygoid muscle of the lateral boundary of the gap, thereby exhibiting a certain degree of opening limitation.
The local symptoms of parapharyngeal space infection are mainly redness and swelling of the pharyngeal wall, and the tonsil is prominent. The swelling can spread to the ipsilateral soft palate, the lingual arch and the pharyngeal arch, and the uvula is pushed to the healthy side; if accompanied by the pterygopalatine space When the submandibular space is inflamed, the swelling of the pharyngeal side and the upper part of the neck is more extensive.
The patient consciously swallows pain, eating difficulties, and restricting mouth opening; if accompanied by edema of the throat, hoarseness may occur, as well as varying degrees of dyspnea and eating cough, and infection of the parapharyngeal space may result in serious lung infection if not treated promptly. Complications such as sepsis and internal jugular vein thrombophlebitis.
In addition to sore throat, difficulty swallowing, strong neck and high fever, headache, loss of appetite and other systemic symptoms and white blood cell count, ESR is accelerated, because of the different parts of the infection, the symptoms and signs are not the same.
(1). Infection of the anterior part of the styloid process. Because the pterygoid muscle is stimulated by inflammation, there is obvious closed jaw, the submandibular area is swollen, hard and tender. In severe cases, the swelling can reach the parotid gland and the lower sternocleidomastoid muscle extends. Before reaching the midline of the neck, the pharyngeal wall and tonsils are pushed to the center of the pharyngeal cavity to the center of the pharynx, similar to the tonsil abscess, but the tonsils are not swollen, only mild inflammation, the so-called typical parapharyngeal space infection triad ( The tonsils are prominent, the teeth are closed, and the parotid gland is swollen. In fact, only the infection of the anterior part of the styloid process will occur. Because the teeth are closed, the mouth is difficult to open, and the pharyngeal lesions are often difficult to see. Pay attention to the examination to avoid misdiagnosis. .
(2). Partial infection after styloid process is not stimulated by the pterygoid muscle, no or only mild dental closure, no tonsil protrusion, because the infection often involves the parotid space, it may have parotid gland area, pharyngeal side wall and sputum The pharyngeal bow is swollen.
If the two parts are infected at the same time before the styloid process, the above symptoms can occur at the same time.
Examine
Examination of parapharyngeal space infection
Otolaryngology specialist examination and blood examination, CT examination excluded the parapharyngeal space mass.
Diagnosis
Diagnosis and diagnosis of parapharyngeal space infection
diagnosis
According to the clinical manifestations, it is generally not difficult to diagnose, but because the abscess is deep, it is not easy to touch the fluctuation when it is palpated from the neck. Therefore, it is not possible to use the fluctuation as the basis for diagnosis. If necessary, puncture the puncture at the most obvious external tenderness of the neck. To confirm the diagnosis.
Differential diagnosis
1. Abscess around the tonsils The tonsils are obviously congested and edema, but the mouth is normal.
2. Post-pharyngeal abscess can be identified according to its age and clinical features.
