Paraglottic and Pre-epiglottic Space Abscess in Adults: Report of Two Cases

Abstract

Introduction: Acute epiglottitis or supraglottitis is a rapidly progressing upper respiratory tract infection that can often threaten the airway patency. Epiglottic abscess that expands to the paraglottic (PGS) or preepiglottic (PES) space and acute airway obstruction constitute rare complications, exclusively presented in adults.

Case report: We report two cases. In the first case flexible fiberoptic Rhino-Pharyngo-Laryngoscopy showed epiglottitis that was obstructing the airway and abscesses on the lingual surface of the epiglottis. Abscesses were opened using laser CO2. In the following days flexible fiberoptic endoscopy revealed persisting protrusion of the left hemilarynx. A CT scan was performed showing an abscess in the paraglottic space. Under direct laryngoscopy the abscess was drained. In the second case endoscopic examination revealed epiglottitis that did not cause airway obstruction. The patient was admitted for follow-up and treated with intravenous antibiotics. On the 5th day showed an exacerbation of her symptoms. A CT scan was performed that showed the existence of an abscess in the preepiglottic space. She was taken to surgery and the abscesses were drained through a cervical- U shaped- incission.

Conclusion: Existance of an abscess means, by default, an adequate surgical treatment to ensure the airway, and immediate drainage under direct laryngoscopy or through an external approach. Diagnosis is based exclusively on medical history and clinical examination. CT scan is necessary to reveal "secret" abscesses and "silent" extension of the infection inside pre-epiglottic and paraglottic space even if epiglottitis is mild. Postoperative management includes proper care of the surgical wound and antibiotics.

Keywords: Abscess; Airway obstruction; Epiglottitis; Supraglottitis; Tracheostomy.

Fig 1

The appearance of the epiglottitis: A) thickened, edematous, reddish obstructing the airway Β) with abscesses on the lingual surface, the area over the left arytenoid fold and the right epiglottic vallecula

Fig 2

Contrast enhanced Computerized Tomography Scan of patient 1 showing an abscess in the left paraglottic space (3,1 X 0,9 X 0,5) cm

Fig 3

Normal larynx as observed on the13th post-operative day

Fig 4

Contrast enhanced Computerized Tomography Scan of patient 2 with existence of an abscess in the preepiglottic space and small abscesses anteriorly to the thyroid cartilage (5,7 X 1,7 X 0,7) cm

Fig 5

The surgical strategy: A) drainage of the spaces between the superficial layer of the deep cervical fascia and the pretracheal cervical fascia through a cervical- U shaped- incision B) tracheostomy to secure the airway C) direct (green arrow: suprahyoid epiglottis, black arrow: valeccula, red arrow: pre-epiglottic space)