What Is a Parapharyngeal Abscess?

The parapharyngeal abscess is a purulent inflammation of the parapharyngeal space. It is early in cellulitis and then develops into an abscess. There are many approaches to the infection of the parapharyngeal space, such as the acute inflammation of the palatine tonsils, pharyngeal tonsils, teeth, pharynx, parotid glands and nose, and the lymph nodes to which the pharynx belongs, which can spread to the parapharyngeal space. Especially in children, these parts are still common places where infections form abscesses.

Basic Information

English name

parapharyngeal abscess

Visiting department

ENT

Common locations

Parapharyngeal space

Common causes

Inflammation of adjacent tissues, abscesses of adjacent tissues, infections caused by foreign body or device damage in the pharyngeal wall, bloodstream and lymphatic infections

Common symptoms

Sore throat and deep neck pain, high fever, chills, etc.

Contagious

no

Causes of parapharyngeal abscess

Inflammation of adjacent tissues

Such as acute pharyngitis, tonsillitis, acute rhinitis, sinusitis, etc., direct invasion or blood infection into the parapharyngeal space to form an abscess.

2. Abscess of adjacent tissue

Direct ulceration or extension, such as peritonsillar abscess, retropharyngeal abscess, alveolar abscess, temporal bone rock abscess, and otogenic deep neck abscess (Bezold's abscess), etc., may cause this disease.

3. Infection caused by foreign body or instrument damage in the pharyngeal wall

Such as fishbone stab wounds, injuries during endoscopy, inflammation spread to the parapharyngeal space, can form an abscess; pharyngeal or oral surgery, such as tonsillectomy or tooth extraction, anesthesia needles can bring bacteria directly into the parapharyngeal space to cause infection.

4. Menstrual flow and lymphatic infection

Infection of adjacent organs or tissues, which affects the parapharyngeal space through the hematogenous and lymphatic systems, leading to this disease.

Clinical manifestations of parapharyngeal abscess

Local symptoms

Mainly manifested as sore throat and deep neck pain, exacerbated when swallowing, mouth opening and head movement. It can be accompanied by reflex ear pain, invading the internal pterygoid muscles, and the teeth can be tightly closed and difficult to open.

2. Systemic symptoms

High fever, chills, loss of appetite, headache, and fatigue. When the condition is severe, it is exhausted.

Parapharyngeal abscess examination

The submandibular area and mandibular angle of the affected neck swelled, and it was hard to touch and tender. In severe cases, the parotid glands were seen, and the sternocleidomastoid muscle and the supraclavicular fossa were all swollen. Because the infection was located in the deep part of the neck, the surface skin was not congested. Also, the sense of undulation is not touched. The pharyngeal wall is raised and slightly congested. The tonsils themselves have no or no lesions and can be pushed inward. Because the abscess is located deep, it is not easy to feel the undulations when palpating outside the neck, so the presence or absence of undulations cannot be used as a basis for diagnosing parapharyngeal abscesses.

Puncture and pus

You can puncture the pus from the swelling of the neck.

2.B-ultrasound

Can reach the liquid level.

3.X-ray neck radiography

The pharynx soft tissue shadow widened.

4. Hematology examination

The total number of white blood cells increased significantly.

Diagnosis of parapharyngeal abscess

A clear diagnosis can be made based on clinical manifestations and related examinations.

Parapharyngeal abscess treatment

1. When the abscess has not formed in the early stage of infection

Mainly anti-inflammatory treatment. To prevent the spread of inflammation and complications, a sufficient amount of antibiotics and appropriate steroid drugs can be applied. Local hot compress or physical therapy. The patient rested in bed, drank more water and ate soft food.

2. After abscess formation, in addition to the above treatment, abscess incision and abscess surgery should be performed

(1) Outer diameter of the neck: If the submandibular and neck swelling is obvious, or the abscess is deep, or the pharynx and external auditory canal are bleeding, the disease course is long, and the pus should be excised from the side of the neck.

(2) Transapereal approach: If the abscesses protrude to the lateral wall of the pharynx and no pulsations are seen or palpable, incision can be performed via the caliber incision.