Parapharyngeal abscess
{{Short description|Deep neck abscess}}
A parapharyngeal abscess is a deep neck space abscess of the parapharyngeal space (or pharyngomaxillary space), which is lateral to the superior pharyngeal constrictor muscle and medial to the masseter muscle. {{cite web|last1=Cuete|first1=David|display-authors=etal|title=Radiology Reference Article: Parapharyngeal abscess|url=https://radiopaedia.org/articles/parapharyngeal-abscess|website=Radiopaedia.org|accessdate=28 February 2017}} This space is divided by the styloid process into anterior and posterior compartments. The posterior compartment contains the carotid artery, internal jugular vein, and many nerves.{{cite web|last1=Sasaki|first1=Clarence T.|title=Ear, Nose, and Throat Disorders: Parapharyngeal Abscess|url=http://www.msdmanuals.com/professional/ear,-nose,-and-throat-disorders/oral-and-pharyngeal-disorders/parapharyngeal-abscess|website=MSD Manual Professional Edition|publisher=Merck Sharp & Dohme Corp|accessdate=28 February 2017|language=en|date=October 2016}}
Signs and symptoms
Symptoms include fever, sore throat, painful swallowing, and swelling in the neck.
An anterior space abscess can cause lockjaw (spasm of jaw muscle), and hard mass formation along the angle of the mandible, with medial bulging of the tonsil and lateral pharyngeal wall. A posterior space abscess causes swelling in the posterior pharyngeal wall, and lockjaw is minimal. Other structures within the carotid sheath may be involved, causing rigors, high fever, bacteremia, neurologic deficit, or a massive haemorrhage caused by carotid artery rupture.
Cause
Infection can occur from:
- Pharynx: acute and chronic infection of tonsil and adenoids
- Teeth: dental infection occurs from lower last molar tooth
- Ear: Bezold's abscess and petrositis
- Other space: infection of parotid retropharyngeal space
- External trauma: penetrating injuries of neck, injection of local anaesthetic{{cite book |last1=Dhingra |first1=PL |year=2014 |title=Diseases of Ear, Nose and Throat & Head and Neck Surgeries |edition=6th |publisher=Elsiver |isbn=978-81-312-3431-0 }}{{page needed|date=November 2016}}
Epidemiology
Parapharyngeal abscess is more common in male than the female gender.{{cite web |url= https://www.lecturio.com/concepts/parapharyngeal-abscess/| title= Parapharyngeal Abscess
|website=The Lecturio Medical Concept Library |access-date= 2 September 2021}}{{cite journal |vauthors= Grisaru-Soen G, Komisar O, Aizenstein O, Soudack M, Schwartz D, Paret G |date= September 2010|title= Retropharyngeal and parapharyngeal abscess in children--epidemiology, clinical features and treatment |url= https://pubmed.ncbi.nlm.nih.gov/20598378/|journal= Int J Pediatr Otorhinolaryngol |volume= 74 |issue= 9 | pages= 1016–20 |doi= 10.1016/j.ijporl.2010.05.030 |pmid= 20598378 |access-date= 2 September 2021}} Any age group can develop a parapharyngeal abscess but it is most commonly seen in children and adolescents.{{cite journal |doi=10.1016/j.anpedi.2011.03.010 |pmid=21531183 |title=Abscesos retrofaríngeo y parafaríngeo: Experiencia en hospital terciario de Sevilla durante la última década |trans-title=Retropharyngeal and parapharyngeal abscess: experience in a tertiary-care center in Seville during the last decade |journal=Anales de Pediatría |volume=75 |issue=4 |pages=266–72 |year=2011 |last1=Croche Santander |first1=B. |last2=Prieto Del Prado |first2=A. |last3=Madrid Castillo |first3=M.D. |last4=Neth |first4=O. |last5=Obando Santaella |first5=I. }} Adults who are immunocompromised are also at high risk.{{cite journal |doi=10.1007/s00405-004-0800-6 |pmid=15235797 |title=Parapharyngeal abscess: Diagnosis, complications and management in adults |journal=European Archives of Oto-Rhino-Laryngology |volume=262 |issue=4 |pages=345–50 |year=2004 |last1=Alaani |first1=A. |last2=Griffiths |first2=H. |last3=Minhas |first3=S. S. |last4=Olliff |first4=J. |last5=Drake Lee |first5=A. B. }}
References
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