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Abscess of pharyngomaxillary or lateral
pharyngeal space
Parapharyngeal space is pyramidal in shape
with its base at the base of skull and its apex at
the hyoid bone
Medial-Buccopharyngeal fascia covering the
constrictor muscles
Posterior-Prevertebral fascia covering
prevertebral muscles and transverse processes
of cervical vertebrae
Lateral-Medial pterygoid muscle, mandible and
deep surface of parotid gland.
Styloid process and the muscles attached to it
divide the parapharyngeal space into anterior and
posterior compartments
Anterior compartment is related to tonsillar fossa
medially and medial pterygoid muscle laterally
Posterior compartment is related to posterior part
of lateral pharyngeal wall medially and parotid
gland laterally.
Through the posterior compartment pass the
carotid artery, jugular vein, IXth, Xth, XIth, XIIth
cranial nerves and sympathetic trunk
Pharynx. Acute and chronic infections of tonsil
and adenoid, bursting of peritonsillar abscess.
Teeth. Dental infection usually comes from the
lower last molar tooth.
Ear. Bezold abscess and petrositis.
Other spaces. Infections of parotid,
retropharyngeal and submaxillary spaces
5. External trauma. Penetrating injuries of neck,
injection of local anaesthetic for tonsillectomy
or mandibular nerve block
Anterior compartment infections-
?
prolapse of tonsil and tonsillar fossa
?
Trismus
?
External swelling behind the angle of jaw
?
Odynophagia
q Posterior compartment
?
bulge of pharynx behind the posterior pillar
?
paralysis of CN IX, X, XI, and XII and sympathetic
chain
?
swelling of parotid region
Fever, odynophagia, sore throat, torticollis (due
to spasm of prevertebral muscles) and signs of
toxaemia are common to both compartments
Contrast-enhanced CT scan neck will reveal the
Extent of lesion
Magnetic resonance arteriography is useful if
thrombosis of internal jugular vein or aneurysm
of internal carotid artery is suspected
Systemic antibiotics
?
Intravenous antibiotics may become necessary
to combat infection
Amoxicillin-clavulanic acid,imipenam or
meropenem with clindamycin or
metronidazole
Gentamicin-gram negative bacteria
Done under general anaesthesia
If the trismus is marked, preoperative
tracheostomy becomes mandatory
If the trismus is marked, preoperative
tracheostomy becomes mandatory. Abscess is
drained by a horizontal incision, made 2?3 cm
below the angle of mandible.
Blunt dissection along the inner surface of
medial pterygoid muscle towards styloid
process is carried out and abscess evacuated
A drain is inserted
Acute oedema of larynx with respiratory
obstruction.
Thrombophlebitis of jugular vein with septicaemia.
Spread of infection to retropharyngeal space.
Spread of infection to mediastinum along the
carotid space.
Mycotic aneurysm of carotid artery from
weakening of its wall by purulent material. It may
involve common carotid or internal carotid artery.
Carotid blow out with massive haemorrhage
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This post was last modified on 12 August 2021