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Peritonsillar Abscess (Quinsy)

  1. Definition:
    Is a collection of pus between the fibrous capsule and the superior constrictor (tonsillar bed)
  2. Commonest site: Upper pole of tonsils, usually unilateral.
    1. Occurs as a complication of acute tonsillitis
    2. May arise de novo without a proceeding history of tonsillitis
  3. Etiology:
    Adults commonly
  4. Organisms:z
    Mixed flora (anaerobes and aerobes)
  5. Clinical feature:
    1. Fever (104°F) with chills and rigors                   
    2. General body ache
    3. Earache                                                                  
    4. Trismus (spasm of pterygoid muscles)
    5. Halitosis                                                                  
    6. Hot potato voice
  6. Treatment:
    I.V. fluids, antibiotics, analgesics
    (Abscess requires drainage, but peritonsillitis may respond to conservative measures)
    Interval Tonsillectomy - Patient to undergo tonsillectomy at 6 wks if recurrent quinsy                            
    Hot Tonsillectomy / Abscess Tonsillectomy - Tonsillectomy performed in the acute stage of quinsy
Table: Important spaces of the head and neck and their source of infection
  Space Extent Location Source of infection  
  Parotid space Within two layers of
superficial layer of deep
cervical fascia
Parotid area
Infection of oral
cavity via
Stenson’s duct
  (submaxillary plus
Sublingual space
Oral mucosa to
mylohyoid muscle
Submandibular space
Mylohyoid muscle to
superficial layer of deep
cervical fascia extending
from mandible to hyoid
Submental triangle Sublingual sialadenitis
tooth infection
Submandibular gland
Molar tooth infection
Base of skull to tracheal    Between alar fascia and
bifurcation (T4)
the buccopharyngeal
fascia covering
constrictor muscles
Extension of infection
from parapharyngeal
space, parotid or
masticator space
Suppuration of
retropha­ryngeal nodes
  Danger space Base of skull to
Between prevertebral
fascia and alar fascia
Infected by rupture of
retropharyngeal abscess
Tuberculosis of spine
Penetrating trauma
  Prevertebral space Base of skull to coccyx Between vertebrae
on one side and
prevertebral muscles
and the prevertebral
Infected by rupture of
retropharyngeal abscess
Tuberculosis of spine
Penetrating trauma
  space or
  maxillary space)
Base of skull to hyoid
bone and submandibular
Buccopharyngeal fascia
covering lateral aspect
of pharynx medially,
and fascia covering
pterygoid muscles,
mandible and parotid
gland laterally
Peritonsillar abscess
Parotid abscess
Submandibular gland
Masticator space
  Masticator space Base of skull to lower
border of mandible
Between superficial
layer of deep cervical
fascia and the muscles
of mastication-masseter
medial and lateral
pterygoid insertion of temporalis muscle
and the mandible
Infection of 3rd molar

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