Parapharyngeal space infection

Background

  • The parapharyngeal space is one of three potential spaces that can cause deep neck space infections
    1. retrophanygeal space
    2. submandibular space
    3. 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

Viral infections

Noninfectious

Other

Evaluation

  • CT neck soft tissues with IV contrast
  • MRI neck

Management

  • ABC's
  • ENT Consult for potential surgical drainage
  • Antibiotics (amp-sulbactam, clindamycin, penicillin plus metronidazole)
  • Analgesia

Disposition

  • Admit to ICU

See Also

External Links

References

  1. Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.