Peritonsillar abscess [quinsy]

Aetiology

often mixed infection : Strep pyogenes, Staph aureus, anaerobes
H/O denovo / acute tonsillitis
Infection & blockage of 1 crypt[C.magna] &larr intratonsillar abscess &larr bursts capsule causing peritonsillitis & abscess.

CFs : mostly in adults; usually unilateral pus in peritonsillar space [capsule &harr superior constrictor ms]

1. local :
   • unilateral severe throat pain
   • odynophagia [ ∴ no swallowing & dehydration]
   • ipsilateral earache [CN9 to tonsil & ear]
   • muffled thick voice
   • foul breath [sepsis]
   • trismus [pterygoid near sup constr]
2. general : septicaemia [104Ffever-chills-rigor, malaise, headache, bodyache, nausea, constipation

Signs:

• unilateral congested & swollen - tonsils, pillars, soft palate
• mucoid pus
• uvula pushed to opposite side
• torticollis - neck tilted towards abscess side
• jugulodigastric lymphadenopathy

Complications:

1. parapharyngeal abscess
2. laryngeal edema &rarr tracheostomy
3. septicaemia &rarr endocarditis, nephritis, brain abscess
4. aspirated pus &rarr pulmonitis, abscess
5. carotid artery & jugular venous thrombosis & spontaneous hmrrg

Rx : Hospitalization

• peritonsillitis -
  1. IV fluids &rarr dehydration
  2. IV antibiotics -high dose
  3. strong analgesics [pethidine] [not aspirin - bleeding]
  4. H2O2, saline, mouth washes &rarr oral hygiene
• abscess -
  1. incise[guarded knife, sinus forceps -drain] at max bulge at upper pole/lateral to junction of uvula base & ant pillar
     4-6wks later – interval tonsillectomy
  2. abscess tonsillectomy -less preferred since abscess rupture & bleeding.

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