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

• 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
• Laryngitis
• Acute Bronchitis
• Rhinovirus
• Coronavirus
• Adenovirus
• Herpesvirus
• Influenza virus
• Coxsackie virus
  • Herpangina
  • Hand-foot-and-mouth disease
• HIV (Acute Retroviral Syndrome)

Noninfectious

• Stevens-Johnson Syndrome
• Pemphigus
• Angioedema

Other

• Deep neck space infection
  • Retropharyngeal abscess
  • Ludwig's angina
  • Parapharyngeal 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

• Retropharyngeal abscess
• Ludwig's Angina