5/14/16

Throat Beyond

Deidre Larrier, MD Department of Surgery Texas Children’s Hospital Associate Professor Bobby Alford Department of Otolaryngology Baylor College of Medicine

Today We Will Cover:

• Peritonsillar • • Parapharyngeal abscess

Listed objective: To differentiate between the different kinds of deep space

1 5/14/16

Peritonsillar Abscess – Diagnosis

• / • • “Hot potato voice”

• Unilateral palate swelling • Uvular deviation

• *A clinical diagnosis

Peritonsillar Abscess – Schematic

2 5/14/16

Peritonsillar Abscess – CT Scan

Peritonsillar Abscess – Referral and Treatment

When to Refer How We Treat Asymmetric soft palate • Pretreat: following – Steroid, – – IV fluids – Lidocaine with Epi • Needle aspiration • Incision and drainage • ED vs. OR • Home if obtained

3 5/14/16

Deep Neck Spaces: Retro- and Parapharyngeal Spaces

Deep Neck Space Infections (DNSI) – Diagnosis

• Sore throat/odynophagia • Trismus • Neck pain +/- torticollis

• + Neck pain/torticollis + NO obvious neck mass • With subtle oropharyngeal bulge

• Think airway compromise (retropharyngeal) • Obtain CT scan: neck +/- chest

4 5/14/16

Retropharyngeal Abscess – CT Scan

Parapharyngeal Abscess – CT Scan

5 5/14/16

CT Scan: Accuracy in Diagnosis

Accurate Diagnoses (%) Inaccurate Diagnoses (%)

True Positives True Negatives False Positives False Negatives

Deep Neck 60 12 21 7 Infections

Lateral Neck 76 4 12 8 Infections

Vezina et al Accuracy Radiographic Assessment of Cervical neck Infections in Children. J Otol 2001

DNSI – Treatment

Retropharyngeal Abscess Parapharyngeal Abscess • Monitored bed • Airway compromise unlikely • Consider securing the airway • Medical management • Surgical incision and drainage – 2 week course of antibiotic – Consider steroid • May extend into Danger Space • May extend into Vascular Space – Extension into with , and – Suppurative thrombophlebitis, carotid empyema artery aneurysm, erosion and rupture

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