Medical and surgical treatment of peritonsillar, retropharyngeal, and parapharyngeal abscesses

Abstract

Peritonsillar, retropharyngeal, and parapharyngeal abscesses are the most common deep cervical fascial space infections. Most develop secondary to an oropharyngeal or dental infection. Additional factors such as smoking and periodontal disease may also contribute to the formation of a peritonsillar abscess. The CT scan is used to confirm the presence of deep neck abscesses, but its accuracy has some limitations. Adequate drainage with accompanying antimicrobial therapy and hydration are the cornerstones of management. Catheter or needle drainage of these abscesses may provide an alternative to open procedures and is the drainage method of choice for peritonsillar abscesses. However, in selected cases, medical therapy alone, especially in children, can resolve parapharyngeal and hypopharyngeal abscesses. Ancillary use of steroids reduces morbidity in patients with a peritonsillar abscess and there is a limited but useful place for immediate tonsillectomy in the treatment of this disease.