Parapharyngeal space infection: Difference between revisions
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==Background== | ==Background== | ||
*The parapharyngeal space is one of three potential spaces that can cause deep neck space infections | *The parapharyngeal space is one of three potential spaces that can cause deep neck space infections | ||
#retrophanygeal space | *#retrophanygeal space | ||
#submandibular space | *#submandibular space | ||
#parapharyngeal space | *#parapharyngeal space | ||
*Infections arise from foci in the mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes, middle ear, or sinuses. | *Infections arise from foci in the mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes, middle ear, or sinuses. | ||
*Polymicrobial | *Polymicrobial | ||
*Proximity to the carotid sheath makes erosion into vasculature a possible complication | |||
==Clinical Features== | ==Clinical Features== | ||
*[[Sore throat]] | |||
*Sore | |||
*Trismus | *Trismus | ||
*Swelling below angle of mandible | *Swelling below angle of mandible | ||
*Lymphadenopathy | *[[Lymphadenopathy]] | ||
*Poor handling of oral secretions | *Poor handling of oral secretions | ||
*Asymetric pharyngeal swelling | *Asymetric pharyngeal swelling | ||
* | *[[Fever]]s/chills | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Sore throat DDX}} | |||
==Evaluation== | |||
== | |||
*CT neck soft tissues with IV contrast | *CT neck soft tissues with IV contrast | ||
*MRI neck | *MRI neck | ||
==Management== | ==Management== | ||
*ABC's | *ABC's | ||
*ENT Consult for potential surgical drainage | *ENT Consult for potential surgical drainage | ||
*Antibiotics ( | *[[Antibiotics]] ([[ampicillin-sulbactam]], [[clindamycin]], [[penicillin]] plus [[metronidazole]]) | ||
*Analgesia | *[[Analgesia]] | ||
==Disposition== | ==Disposition== | ||
*Admit to ICU | *Admit to ICU | ||
==See Also== | ==See Also== | ||
*[[Retropharyngeal abscess]] | |||
*[[ | |||
*[[Ludwig's Angina]] | *[[Ludwig's Angina]] | ||
| Line 53: | Line 41: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ENT]] | |||
[[Category:ID]] | |||
Latest revision as of 22:19, 30 September 2019
Background
- The parapharyngeal space is one of three potential spaces that can cause deep neck space infections
- retrophanygeal space
- submandibular space
- parapharyngeal space
- Infections arise from foci in the mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes, middle ear, or sinuses.
- Polymicrobial
- Proximity to the carotid sheath makes erosion into vasculature a possible complication
Clinical Features
- Sore throat
- Trismus
- Swelling below angle of mandible
- Lymphadenopathy
- Poor handling of oral secretions
- Asymetric pharyngeal swelling
- Fevers/chills
Differential Diagnosis
Acute Sore Throat
Bacterial infections
- Streptococcal pharyngitis (Strep Throat)
- Neisseria gonorrhoeae
- Diphtheria (C. diptheriae)
- Bacterial Tracheitis
Viral infections
- Infectious mononucleosis (EBV)
- Patients with peritonsillar abscess have a 20% incidence of mononucleosis [1]
- Laryngitis
- Acute Bronchitis
- Rhinovirus
- Coronavirus
- Adenovirus
- Herpesvirus
- Influenza virus
- Coxsackie virus
- HIV (Acute Retroviral Syndrome)
Noninfectious
Other
- Deep neck space infection
- Peritonsillar Abscess (PTA)
- Epiglottitis
- Kawasaki disease
- Penetrating injury
- Caustic ingestion
- Lemierre's syndrome
- Peritonsillar cellulitis
- Lymphoma
- Internal carotid artery aneurysm
- Oral Thrush
- Parotitis
- Post-tonsillectomy hemorrhage
- Vincent's angina
- Acute necrotizing ulcerative gingivitis
Evaluation
- CT neck soft tissues with IV contrast
- MRI neck
Management
- ABC's
- ENT Consult for potential surgical drainage
- Antibiotics (ampicillin-sulbactam, clindamycin, penicillin plus metronidazole)
- Analgesia
Disposition
- Admit to ICU
See Also
External Links
References
- ↑ Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.