Case report of peritonsillar space abscess misdiagnosed as parapharyngeal space abscess
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Peritonsillar abscess, the most commonly occurring deep infection of the neck, involves formation of pus in the peritonsillar space. Although abscess of the peritonsillar space and abscess of the parapharyngeal space occur in different anatomical spaces, the clinical symptoms are similar, making it difficult to distinguish between the two diseases. Delay of treatment can result in transfer of infection from one space to another. Improper treatment or delayed treatment of a peritonsillar abscess can lead to serious complications such as an abscess of the parapharyngeal space, necrotizing fasciitis, internal jugular vein thrombosis, and descending mediastinitis. These conditions can be life-threatening due to airway obstruction or sepsis. Drainage, fluid therapy, and antibiotic therapy provide the basis for treatment of peritonsillar abscess. Airway management is the most urgent priority. Airway obstruction can occur immediately during a deep infection of the neck space and is a common cause of death rather than sepsis. Immediate airway management is required in cases where there is evidence that airway obstruction is imminent. Transoral incision and drainage is the most commonly used method for drainage of peritonsillar abscesses. However, transoral incision and drainage may not be sufficient and use of a transcervical approach may be necessary. The author reports on a case of an abscess of the peritonsillar space misdiagnosed as an abscess of the parapharyngeal space and on issues that should be considered with regard to abscess of the peritonsillar space.
Abstract
Peritonsillar abscess, the most commonly occurring deep infection of the neck, involves formation of pus in the peritonsillar space. Although abscess of the peritonsillar space and abscess of the parapharyngeal space occur in different anatomical spaces, the clinical symptoms are similar, making it difficult to distinguish between the two diseases. Delay of treatment can result in transfer of infection from one space to another. Improper treatment or delayed treatment of a peritonsillar abscess can lead to serious complications such as an abscess of the parapharyngeal space, necrotizing fasciitis, internal jugular vein thrombosis, and descending mediastinitis. These conditions can be life-threatening due to airway obstruction or sepsis. Drainage, fluid therapy, and antibiotic therapy provide the basis for treatment of peritonsillar abscess. Airway management is the most urgent priority. Airway obstruction can occur immediately during a deep infection of the neck space and is a common cause of death rather than sepsis. Immediate airway management is required in cases where there is evidence that airway obstruction is imminent. Transoral incision and drainage is the most commonly used method for drainage of peritonsillar abscesses. However, transoral incision and drainage may not be sufficient and use of a transcervical approach may be necessary. The author reports on a case of an abscess of the peritonsillar space misdiagnosed as an abscess of the parapharyngeal space and on issues that should be considered with regard to abscess of the peritonsillar space.
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