Peritonsillar Abscess (Quinsy)

Peritonsillar Space and Peritonsillar Abscess (Quinsy)

📌 Boundaries of Peritonsillar Space

The peritonsillar space is a potential space between:

• Medially: Fibrous capsule of the palatine tonsil
• Laterally: Superior constrictor muscle
• Anteriorly: Anterior pillar (palatoglossal fold)
• Posteriorly: Posterior pillar (palatopharyngeal fold)

📌 Contents of Peritonsillar Space

• Loose areolar tissue
• Communicates with parapharyngeal and retropharyngeal spaces

💡 What is Peritonsillar Abscess (Quinsy)?

It is the collection of pus in the peritonsillar space, typically occurring between the tonsillar capsule and the superior constrictor muscle.

🔬 Etiology and Pathogenesis of Peritonsillar Abscess

• Most commonly follows acute tonsillitis

• May also occur de novo, without prior sore throat

• Frequently involves the crypta magna, leading to:

  1. Intratonsillar abscess
  2. Burst through capsule → Peritonsillitis
  3. Progression to abscess

Common Organisms

• Streptococcus pyogenes
• Staphylococcus aureus
• Anaerobes
• Typically a mixed growth

👨‍⚕️ Clinical Presentation of Peritonsillar Abscess

Demographics

• Adults > Children
• Unilateral > Bilateral cases (rare)

General Symptoms (due to septicemia)

• Fever, chills, rigor
• Malaise, body ache
• Headache, nausea
• Constipation

Local Symptoms

• Severe unilateral throat pain
• Odynophagia (cannot swallow saliva)
• Hot potato voice (muffled, thick speech)
• Foul breath
• Referred ear pain (via glossopharyngeal nerve)
• Trismus (due to pterygoid muscle spasm)

🔍 Clinical Examination

• Congested, swollen soft palate and pillars
• Tonsil may appear normal or buried in oedema
• Uvula deviated to opposite side
• Bulging above the upper pole of tonsil
• Mucopus over tonsillar region
• Jugulodigastric lymphadenopathy
• Torticollis (neck tilted to affected side)

🛠️ Management of Peritonsillar Abscess

Conservative Treatment (for Peritonsillitis)

• Hospitalization

• IV fluids for dehydration

• Broad-spectrum antibiotics (aerobic + anaerobic)

• Analgesics (e.g., Paracetamol)

  • Avoid aspirin (risk of bleeding)

• Oral hygiene: Hydrogen peroxide/saline mouthwash

• Incision and Drainage (for Abscess)

What are the indications for Incision and Drainage in Peritonsillar Abscess?

Where is the site of incision for I&D in Peritonsillar Abscess?

• Tonsillectomy

What is Interval Tonsillectomy? When is it done?

What is Hot Tonsillectomy? What is it's Indication?

⚠️ Complications of Peritonsillar Abscess

• Parapharyngeal abscess
• Laryngeal edema
• Septicemia → Endocarditis, nephritis, brain abscess
• Pulmonary complications: Pneumonitis, lung abscess
• Jugular vein thrombosis
• Hemorrhage from carotid artery or jugular vein
• Airway obstruction
• Mediastinitis

🧩 Differential Diagnosis of Peritonsillar Abscess

1. Infectious

   • Parapharyngeal abscess
   • Upper third molar abscess
   • Infectious mononucleosis

2. Inflammatory

   • Kawasaki disease

3. Vascular

   • Internal carotid artery pseudoaneurysm

4. Benign

   • Benign lymphoepithelial cyst

5. Malignant

   • Tonsillar carcinoma
   • Tonsillar lymphoma
   • Rhabdomyoma
   • Minor salivary gland tumors