PERITONSILLER

SPACE INFECTION

BY:BANU HIWA
 CONTENTS
Peritonsillar space borders and Anatomy

What is Peritonsillar space infection?

Epidemiology

Etiology

Symptoms

Diagnosis

Treatment
Peritonsillar space borders
and Anatomy
The two tonsillar pillars define the palatine
tonsils anteriorly and posteriorly.

The tonsil lays in the depression between the

palatoglossal and the palatopharyngeal arches.

Peritonsillar abscesses form in the area between

the palatine tonsil and its capsule. If the abscess
progresses, it can involve the surrounding
anatomy, including the masseter muscles and the
pterygoid muscle. If severe, the infection can
also penetrate the carotid sheath.
What is peritonsillar space
infection?
It is the most common deep infection of
the head and neck that occurs in adults, is
typically formed by a combination of
aerobic and anaerobic bacteria.
-An infection can cause a pus filled swelling
abscess to develop in this space which is
also called (QUINSY) . .
If not treated ,the infection can spread to
the neck , roof of the mouth and lungs .
Patient with right peritonsillar abscess.
 EPIDEMIOLOGY
It is most common in persons 20 to 40 years
of age.

This infection affects males and females

equally.

Evidence shows that chronic tonsillitis or

multiple Trials of oral antibiotics for acute
tonsillitis may predispose persons to the
development of a Peritonsillar abscess.
 ETIOLOGY
Streptococcus pyogenes (group A beta-
hemolytic streptococcus) is the most
common aerobic organism associated with
peritonsillar abscess.

The most common anaerobic organism is

Fusobacterium.
ETIOLOGY
 SYMPTOMS
Throat pain (progressively worsening sore throat).

Fever.

Dysphagia (difficulty swallowing).

Inability to open the mouth or limited mouth

opening.

Otalgia (pain in ear).

Thickened, muffled voice (hot potato) quality.

Odynophagia (pain during swallowing/eating).

SYMPTOMS AND
DIAGNOSIS
 DIAGNOSIS
Patient history; the location of
throat pain which suggests the
location of abscess.
Asking if possible ingestion of
foreign objects.
Physical examination;
Next often
slide
trismus is present (????)
 DIAGNOSIS
Due to the surrounding anatomy of
pharyngomaxillary space and pterygoid
muscle, infection can possibly inflame these
structures.

A distinguishing feature on physical

examination is the inferior medial
displacement of the infected tonsil
with a contralateral deviation of the
uvula.
 Differential
Diagnosis
Peritonsillar Cervical Adenitis
cellulitis Dental infections
Foreign body Salivary gland
aspiration infections
Mastoid infection
Mononucleosis
Aneurysm of
Tonsillar internal carotid
abscess artery

Neoplasms Tonsillar abscess

 DIAGNOSIS
Ultrasonography

Computed tomography CT

Needle Aspiration

The gold standard for diagnosis of

peritonsillar abscess is the collection of
pus from the abscess through needle
aspiration.
Computed tomography of a right peritonsillar abscess.
 DIAGNOSIS
An endocavity transducer is inserted into the mouth to scan the
peritonsillar region, A.
A syringe with an 18-gauge needle is inserted next to the transducer
to allow ultrasound-guided abscess aspiration, B.
An abscess is shown on intraoral ultrasound (f: fluid) that is deep to
the tonsil (t), C.
A needle (arrows) is seen inserting into the abscess for drainage, D.
 Complications of
PTA
Airway obstruction.

Aspiration pneumonitis or lung abscess

secondary to peritonsillar abscess rupture.

Death secondary to hemorrhage from erosion

or septic necrosis into carotid sheath.

Extension of the infection into the tissues of

the deep neck or posterior mediastinum.

Post-streptococcal sequelae (e.g.,

glomerulonephritis, rheumatic fever) when
infection is caused by Group A streptococcus.
 TREATMENT
Require both antibiotic therapy and surgical
procedure : -Antibiotic of choice : 500mg
clindamycin twice daily or 2nd or 3rd
generation of cephalosporin .
-Three main
surgical procedures are available :
1.Needle aspiration
2.incison and drainage
3.immediate
tonsillectomy
 REFERENCES
Peritonsillar Abscess: Diagnosis and Treatment
TERRENCE E. STEYER, M.D., University of
Michigan Medical School, Ann Arbor, Michigan

Intraoral Ultrasound in the Diagnosis and

Treatment of Suspected Peritonsillar Abscess in the
Emergency Department Matthew Lyon, MD, RDMS,
Michael Blaivas, MD, RDMS

Peritonsillar Abscess
NICHOLASJ.GALIOTO,MD,Broadlawns Medical
Center, Des Moines, Iowa
THANK YOU