Parapharyngeal abscess
Introduction
Introduction to parapharyngeal abscess Parapharyngeal abscess (parapharyngealabscess) is a purulent inflammation of the parapharyngeal space, and early development of cellulitis into an abscess. It has many infection pathways, such as sputum tonsils, pharyngeal tonsils, teeth, parotid glands and nose, and acute inflammation of the lymph nodes of the pharynx, which can spread to the parapharyngeal space. Especially in children, these parts are common parts of infection, so one of the most susceptible gaps in the parapharyngeal head and neck. basic knowledge The proportion of illness: 0.003%--0.004% Susceptible people: no special people Mode of infection: non-infectious Complications: phlebitis, sepsis
Cause
Cause of parapharyngeal abscess
1. Inflammation of adjacent tissues, such as acute pharyngitis, tonsillitis and acute rhinitis, sinusitis, etc., directly invaded or infected by blood to invade the parapharyngeal space to form an abscess.
2. Abscesses adjacent to the tissue directly collapse or extend, such as abscess around the tonsils, posterior pharyngeal abscess, alveolar abscess, sacral bone abscess and otogenic deep neck abscess (Bezold's abscess), etc., may cause the disease.
3. The pharyngeal wall is damaged by foreign objects or instruments, causing infections, such as fishbone stab wounds, injuries during endoscopy, etc., inflammation spreads to the parapharyngeal space, which can form abscesses; pharyngeal or oral surgery, such as tonsillectomy or tooth extraction Etc., anesthesia needles can bring bacteria directly into the parapharyngeal space to cause infection. In addition, when the abscess around the tonsils is cut and drained, the pharyngeal muscles can be mistakenly penetrated, which can also cause the disease.
Prevention
Parapharyngeal abscess prevention
Parapharyngeal abscess occurs in children. In addition to fever, the family first finds that they are swallowing disorders. The speech is unclear. They mistakenly think that there are foreign bodies in the throat of the child. In this case, they should go to the hospital for treatment.
Complication
Parapharyngeal abscess complications Complications phlebitis sepsis
Due to the spread of inflammation, it can be accompanied by infection of surrounding tissues such as the posterior pharyngeal space and the parotid gland. Carotid sheath infection is the most common infection of the parapharyngeal space. The most serious complication is that inflammation can invade the carotid artery wall can cause fatal bleeding, internal jugular vein involvement, can cause thrombophlebitis and septic sepsis life-threatening.
Symptom
Symptoms of parapharyngeal abscess Common symptoms Zhang mouth difficult abscess sore throat high fever swallowing disorder severe pain chills shivering
According to the clinical manifestations and related examinations, the diagnosis can be confirmed. If you can puncture the pus in the neck swelling, B-ultrasound can explore the liquid level, X-ray neck film, visible soft tissue shadow on the pharynx side; blood count examination white blood cell count is significantly increased, but because the abscess is located in the deep, from the neck It is not easy to feel the sense of volatility when palpation, so it is not possible to use the sense of fluctuation as the basis for the diagnosis of parapharyngeal abscess. This disease needs to be differentiated from the posterior pharyngeal abscess and peritons around the tonsils.
The patient is apathetic, loss of appetite, headache, discomfort, persistent high fever, chills, septic heat, severe pain in the pharyngeal and neck, dysphagia, linguistic ambiguity, infection of the anterior space of the pharynx due to invasion of the pterygoid muscle. It is difficult to open the jaws and open the mouth.
The submandibular area of the affected side is swollen, localized and hard, and the tenderness is obvious. The patient's head is biased to the affected side to relieve pain. In severe cases, the swelling range can reach the parotid gland, and the lower sternocleidomastoid muscle reaches the supraclavicular fossa. If an abscess has formed. , the local may become soft, pharyngeal examination can be seen in the pharyngeal wall bulge, soft palate and zygomatic arch congestion and edema, tonsil is pushed to the center of the pharynx, and the tonsils themselves have no obvious lesions, oral secretions, due to mouth limitation, sometimes Pharyngeal lesions can not be seen clearly, such as the infection of the posterior gap, does not cause the jaws to close, the tonsils are not moved.
Examine
Examination of parapharyngeal abscess
The affected side of the neck and the submandibular area and the mandibular angle are swollen, hard to touch, tender, severely reach the parotid gland, and the sternocleidomastoid and supraclavicular fossa are swollen. Because the infection is located deep in the neck, the surface skin is not congested. It also does not touch the sense of volatility. The pharyngeal side wall is raised and slightly congested. The tonsil itself has or does not have lesions and can be pushed to the medial side. If necessary, puncture and pus can be diagnosed.
Diagnosis
Diagnosis and differentiation of parapharyngeal abscess
The disease needs to be differentiated from the posterior pharyngeal abscess and the abscess around the tonsils.
