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Parapharyngeal Abscess

  1. Parapharyngeal Space (Anatomy)
    1. Extent: skull base to the hyoid bone
    2. Boundaries:
      1. Shape: Inverted 5- sided pyramid
      2. Base: Greater wing of sphenoid
      3. Laterally: Rami of the mandible and deep lobe of the parotid
      4. Medially
        1. Eustachian tube
        2. Pharynx
        3. Palatine tonsil
    3. Posteriorly: Vertebral and prevertebral muscles
    4. Anteriorly: Pterygoid muscles and interpterygoid fascia
  2. Contents: Styloid process and is muscles divide the space into 2 compartments:
    1. Pre-styloid compartment:
      1. Pterygoid
      2. Tensor veli palatini
    2. Post-styloid:
      1. Neurovascular bundle
      2. Internal carotid artery
      3. Internal jugular vein
      4. IX, X, XI, XII cranial nerves
      5. Sympathetic chain
    3. Other contents:
      Loose areolar tissue and lymph nodes
  3. Features:
    The parapharyngeal space communicates with the retropharyngeal, Parotid, submandibular, carotid and visceral spaces
  4. Parapharyngeal Abscess:
    1.  Etiology: Pharynx: Tonsillitis. Adenoiditis, Peritonsillar abscess
      Teeth: Dental infections
      Ear: Petrositis & Bezold’s
      Infection from the communicating spaces
    2. External trauma: Penetrating injuries of the neck
  5. Clinical symptoms & signs:
    1. Anterior Compartment:
      1. Prolapse of the tonsil and tonsillar fossa
      2. Trismus
      3. External swelling behind the angle of the jaw
      4. Marked odynophagia
  6. Posterior Compartment:
    1. Bulge in pharyngeal wall posterior to the posterior pillar
    2. IX. X, XI, XII palsy
    3. Sympathetic chain involvement
    4. Parotid bulge
    5. Minimal trismus. This is due to medial pterygoid muscle.
  7. Treatment:
    Abscess drainage: Through a collar incision in the neck at the level of Hyoid-bone, IV antibiotics
  8. Complications:
    1. Laryngeal odema
    2. Spread to retropharyngeal space
    3. Jugular vein thrombophlebitis
    4. Spread to the mediastinum along the carotid space
    5. Erosion of the carotid artery

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