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