Parapharyngeal abscess

Parapharyngeal abscess is a deep neck space abscess also known as abscess of pharyngomaxillary or lateral pharyngeal space. A parapharyngeal abscess involves Parapharyngeal space, which is lateral to the superior pharyngeal constrictor and medial to the masseter muscle. [1] This space is divided by styloid process into anterior and posterior compartment. It also contains the carotid artery, internal jugular vein, numerous nerves.

Epidemiology

Both genders are equally affected. Any age group can develop a parapharyngeal abscess but it is most commonly seen in children and adolescents.[2] Adults who are immunocompromised are also at high risk.[3]

Aetiology

Infection can occur from:

  • Pharynx: acute and chronic infection of tonsil and adenoids
  • Teeth: dental infection occurs from lower last molar tooth
  • Ear: bezold abscess and petrositis
  • Other space: infection of parotid retropharyngeal space
  • External trauma: penetrating injuries of neck, injection of local anaesthetic[4]

Clinical features

Symptoms

Fever, sore throat, odynophagia (painful swallowing), swelling in neck.

Signs

Anterior space abscess can cause trismus (spasm of jaw muscle) and hard mass formation along the angle of the mandible, with medial bulging of the tonsil and lateral pharyngeal wall. Posterior space abscess causes swelling in posterior pharyngeal wall. Trismus (spasm of jaw muscle) is minimal. Posterior abscess may involve structures within the carotid sheath, causing rigors, high fever, bacteremia, neurologic deficit, massive haemorrhage caused by carotid artery rupture.[5]

References

  1. ↑ Cuete, David; et al. "Radiology Reference Article: Parapharyngeal abscess". Radiopaedia.org. Retrieved 28 February 2017.
  2. ↑ Croche Santander, B.; Prieto Del Prado, A.; Madrid Castillo, M.D.; Neth, O.; Obando Santaella, I. (2011). "Abscesos retrofaríngeo y parafaríngeo: Experiencia en hospital terciario de Sevilla durante la última década" [Retropharyngeal and parapharyngeal abscess: experience in a tertiary-care center in Seville during the last decade]. Anales de Pediatría. 75 (4): 266–72. doi:10.1016/j.anpedi.2011.03.010. PMID 21531183.
  3. ↑ Alaani, A.; Griffiths, H.; Minhas, S. S.; Olliff, J.; Drake Lee, A. B. (2004). "Parapharyngeal abscess: Diagnosis, complications and management in adults". European Archives of Oto-Rhino-Laryngology. 262 (4): 345–50. doi:10.1007/s00405-004-0800-6. PMID 15235797.
  4. ↑ Dhingra, PL (2014). Diseases of Ear, Nose and Throat & Head and Neck Surgeries (6th ed.). Elsiver. ISBN 978-81-312-3431-0.
  5. ↑ Sasaki, Clarence T. (October 2016). "Ear, Nose, and Throat Disorders: Parapharyngeal Abscess". MSD Manual Professional Edition. Merck Sharp & Dohme Corp. Retrieved 28 February 2017.
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