--- title: "Parapharyngeal Abscess" description: "Detailed anatomy of the Parapharyngeal Space, and the clinical features, diagnosis, treatment, and complications of Parapharyngeal Abscess - ideal for medical students and ENT residents." source: "The ENT Resident" 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 - ideal for medical students and ENT residents. 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 note on Parapharyngeal Abscess is one of the free ENT study notes published by The ENT Resident. It is free to read on the website, and it is paired with a full video lecture on YouTube. This note is categorized under [Neck](https://www.theentresident.com/ent-notes-lectures/category/neck.md). The category page lists all the free ENT notes on that topic. 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. ## About The ENT Resident The ENT Resident is a free library of ENT notes and video lectures created by Dr. Mausumi Das (MS ENT), the ENT doctor and educator behind The ENT Resident YouTube channel (https://www.youtube.com/c/TheENTResident). These notes are written for ENT residents, ENT postgraduates preparing for exams, and MBBS students, to help them learn ENT clearly and score well. 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Other contact options are on the contact page: https://www.theentresident.com/contact.md ## Related ENT Notes & Lectures #### Neck - [Anatomy of Deep Neck Spaces](https://www.theentresident.com/ent-notes-lectures/deep-neck-spaces.md) - [Anatomy of Superficial and Deep Cervical Fascia](https://www.theentresident.com/ent-notes-lectures/deep-cervical-fascia-layers.md) - [Deep Neck Space Infections](https://www.theentresident.com/ent-notes-lectures/deep-neck-space-infections.md) - [Ludwig’s Angina](https://www.theentresident.com/ent-notes-lectures/ludwig-angina.md) - [Lymphatic Levels in the Neck](https://www.theentresident.com/ent-notes-lectures/lymph-node-levels-neck.md) - [Peritonsillar Abscess (Quinsy)](https://www.theentresident.com/ent-notes-lectures/peritonsillar-abscess-quinsy.md) - [Pharyngeal Arches and Their Derivatives](https://www.theentresident.com/ent-notes-lectures/pharyngeal-arch-derivatives.md) - [Retropharyngeal Abscess](https://www.theentresident.com/ent-notes-lectures/retropharyngeal-abscess.md) --- Complete index of all pages on this site, with descriptions and markdown links: https://www.theentresident.com/llms.txt