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Communication Stations
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Wai Sum Cho, Anna Slovick, Jameel Muzaffar, Adnan Darr
You are asked to review a 12-year-old child on your round who came in overnight with a suspected quinsy. She had been admitted by the SHO following discussion with the registrar. On the ward round, you see a stridulous child with torticollis and note an associated neck swelling. You stabilise her with adrenaline nebulisers and IV steroids. A CT is performed which confirms your suspicion of a parapharyngeal abscess. You look at the drug chart and none of the appropriate antibiotics or steroids had been prescribed since admission. The father would like to speak to you.
Adenotonsillar Conditions and Obstructive Sleep Apnoea
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Retropharyngeal abscesses are rare and are seen mainly in infants and children <5 years old. Occasionally, peritonsillar and retropharyngeal abscess may spread to the parapharyngeal space. Computed tomography (CT) is the investigation of choice and facilitates treatment planning. Initial treatment of retropharyngeal and parapharyngeal abscess is high-dose intravenous antibiotics. For DNSA >2.5 cm in diameter, incision and drainage under a general anaesthetic should be considered to minimise the risk of mediastinitis or retroperitoneal sepsis.
Pharynx, Larynx and Neck
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Parapharyngeal abscess may be confused with a peritonsillar abscess, but the maximal swelling is behind the posterior faucial pillar and there may be little oedema of the soft palate. The patient is usually a young child and there may be a severe general malaise and obvious neck swelling. In early cases, admission to hospital and the institution of fluid replacements coupled with intravenous antibiotics may produce resolution. In advanced cases, drainage and intravenous antibiotics are required. With an obvious abscess pointing into the oropharynx, drainage may be carried out with a blunt instrument or the glove finger, but general anaesthesia is frequently required and the expertise of a senior anaesthetist, good illumination and good suction are absolutely essential. A large parapharyngeal abscess may compromise both the airway and swallowing. MRI or CT scanning of the head and neck is often an invaluable aid to diagnosis and management as it allows assessment of the extent of the abscess and facilitates planning of the optimal surgical approach.
Clinical evaluation of intravenous ampicillin as empirical antimicrobial treatment of acute epiglottitis
Published in Acta Oto-Laryngologica, 2018
Ann Marlene Gram Kjaerulff, Maria Rusan, Tejs Ehlers Klug
Six (6%) patients suffered complications: A 53-year-old female developed a pruritic rash on her back after the first ampicillin administration. Allergy to ampicillin was suspected, antibiotic treatment was altered to cefuroxime and the rash subsided. A dehydrated 69-year-old male experienced severe dyspnea at home. At the time of hospitalization, the peripheral saturation was 73% and prerenal kidney insufficiency and acute myocardial infarction were diagnosed. The patient recovered without sequelae. Parapharyngeal phlegmon was observed on a CT scan one day after admission in a 63-year-old male. The antibiotic therapy was changed from ampicillin to cefuroxime and metronidazole. The patient recovered quickly and was discharged three days later. A 31-year-old female developed parapharyngeal abscess three days after admission, which was drained surgically on the same day and ampicillin was changed to cefuroxime and metronidazole. A pus aspirate revealed heavy growth of Fusobacterium necrophorum, sensitive to ampicillin and cefuroxime. A 71-year-old male developed hospital-acquired pneumonia two days after admission, thus the antibiotic regimen was altered from ampicillin to cefuroxime and metronidazole. One patient died: a 40-year-old male presented with dyspnea, odynophagia, dysphagia, muffled voice, drooling and stridor. After a failed intubation attempt, he was acutely tracheotomized. After two days of treatment at the ICU, the patient died from the hypoxic sequelae secondary to the upper airway collapse.
Isolated parapharyngeal cold abscess in a 9-year-old boy
Published in Paediatrics and International Child Health, 2019
K. G. Gopakumar, Neha Mohan, V. R. Prasanth, M. K. Ajayakumar
Primary tuberculous adenitis is the most common manifestation of extrapulmonary TB (EPT) in children. Tuberculous adenitis presenting as an isolated cold abscess in the parapharyngeal space is very uncommon, whereas retropharyngeal tuberculous abscesses are well recognised [1,2]. As far as we are aware, there are no case reports of children presenting with an isolated parapharyngeal cold abscess. It can mimic a tumour and lead to confusion and unnecessary investigations. A child with a parapharyngeal abscess is presented.