---
title: "Parapharyngeal Abscess"
description: "Detailed anatomy of the Parapharyngeal Space, and the clinical features, diagnosis, treatment, and complications of Parapharyngeal Abscess."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/parapharyngeal-abscess"
categories: ["Neck"]
video: "https://www.youtube.com/watch?v=nCn20B50C3k"
image: "https://media.theentresident.com/og-images/parapharyngeal-abscess.png"
---

# Parapharyngeal Abscess

Detailed anatomy of the Parapharyngeal Space, and the clinical features, diagnosis, treatment, and complications of Parapharyngeal Abscess. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=nCn20B50C3k

## Parapharyngeal Space and Abscess

### 📌 Introduction

>What are the other names for Parapharyngeal Space?

- Shaped like an **inverted cone**:
  - **Base**: Petrous part of the temporal bone
  - **Apex**: At the level of the **hyoid bone**

- 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

- **Contrast-enhanced CT** scan of the neck

- **MR Angiography**:
  - Useful in suspected **internal jugular vein thrombosis**
  - Detects **internal carotid aneurysm**

---

### 💊 Treatment of Parapharyngeal Abscess

1. **Antibiotics**

- Must cover **aerobic and anaerobic organisms**

- **Culture sensitivity** of pus should guide antibiotic choice

>What are the Antibiotics used in Parapharyngeal abscess?

2. **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

---

## About This Note

This free ENT note on Parapharyngeal Abscess was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/parapharyngeal-abscess

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

## Related Notes by Category

- Neck: https://www.theentresident.com/ent-notes-lectures/category/neck.md

## About The ENT Resident

The ENT Resident is an educational website and resource library created by Dr. Mausumi Das (MS ENT) for ENT residents, ENT postgraduates preparing for exams, and MBBS students.

Dr. Mausumi Das writes the notes, draws the diagrams, and records the lectures herself.

Browse all ENT notes and lectures on The ENT Resident: https://www.theentresident.com/ent-notes-lectures.md

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The ENT Resident provides educational material for medical learning and revision. It does not provide patient-specific medical advice, diagnosis, or emergency care, and it is not a substitute for evaluation by a qualified healthcare professional.

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