Parapharyngeal Abscess
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Parapharyngeal Space and Abscess
📌 Introduction
What are the other names for Parapharyngeal Space?
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Shaped like an inverted cone:
- Base: Petrous part of the temporal bone
- Apex: At the level of the hyoid bone
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Divided by the aponeurosis of Zuckerkandl and Testut into:
- Pre-styloid compartment
- Post-styloid compartment
📐 Boundaries of the Parapharyngeal Space
| Direction | Boundary |
|---|---|
| Superior | Skull base |
| Inferior | Apex at the hyoid bone |
| Anterior | Pterygomandibular raphe |
| Posterior | Cervical vertebrae and paravertebral muscles |
| Lateral | Mandibular ramus, deep lobe of parotid, medial pterygoid |
| Medial | Oropharynx and nasopharynx |
🧭 Compartments of the Parapharyngeal Space
🔹 Pre-Styloid Compartment
- Location: Anterior to the styloid process
🔹 Post-Styloid Compartment
- Location: Posterior to the styloid process
What are the contents of Pre Styloid and Post Styloid compartment?
🔗 Communications of Parapharyngeal Space
- Retropharyngeal space
- Carotid space
- Submandibular space
- Parotid space
- Visceral space
🦠 Parapharyngeal Abscess
🧬 Etiology of Parapharyngeal Abscess
| Source | Examples |
|---|---|
| Pharynx | Acute/chronic tonsillitis, adenoiditis, peritonsillar abscess rupture |
| Dental | Infections from lower 3rd molar tooth |
| Ear | Petrositis, Bezold's abscess |
| Other Spaces | Spread from parotid, retropharyngeal, submandibular spaces |
| External Trauma | Penetrating injuries, tonsillar injection, mandibular nerve block |
🩺 Clinical Features of Parapharyngeal Abscess
🧭 Based on Compartment Involved:
✅ Pre-Styloid Compartment
- Tonsillar prolapse
- Trismus (medial pterygoid spasm)
- Swelling behind angle of mandible
- Severe odynophagia
✅ Post-Styloid Compartment
- Pharyngeal bulge behind posterior pillar
- Cranial nerve palsy (IX–XII)
- Sympathetic involvement
- Parotid swelling
- Minimal trismus or tonsillar displacement
⚠️ Common Features in Both
- High fever
- Odynophagia
- Sore throat
- Torticollis (due to prevertebral muscle spasm)
- Signs of toxemia
🧪 Diagnosis of Parapharyngeal Abscess
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Contrast-enhanced CT scan of the neck
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MR Angiography:
- Useful in suspected internal jugular vein thrombosis
- Detects internal carotid aneurysm
💊 Treatment of Parapharyngeal Abscess
- Antibiotics
-
Must cover aerobic and anaerobic organisms
-
Culture sensitivity of pus should guide antibiotic choice
What are the Antibiotics used in Parapharyngeal abscess?
- Surgical Drainage
- Mandatory in abscess cases
- Under General Anesthesia
- Pre-op tracheostomy if marked trismus
⚠️ Complications of Parapharyngeal Abscess
- Laryngeal edema
- Jugular vein thrombophlebitis with septicemia
- Retropharyngeal space spread
- Descending mediastinitis
- Mycotic aneurysm of carotid artery
- Carotid blowout
- Pharyngeal perforation
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