Parapharyngeal abscess //Dr Krishna Koirala //Dr Krishna's ENT Lectures // Manipal Pokhara//

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Parapharyngeal abscess is defined as collection of pus in the parapharyngeal space.
It may be due to different reasons
Pharynx : Acute tonsillitis, peritonsillar abscess
Teeth : Dental infections - lower last molar
Ear : Bezold’s abscess
Others : Parotid, retropharyngeal, submandibular
Penetrating injuries

Clinical features depend upon the compartment involved
Fever, sore throat, odynophagia, torticollis are the common clinical features
Anterior Compartment : Tonsils pushed medially, Induration along the angle of the mandible, Trismus and External swelling behind the angle of jaw

Posterior compartment: Neck swelling , Bulge of pharynx behind the posterior pillar, Paralysis of IX, X, XI, XII cranial nerves and cervical sympathetic chain
Erode into the carotid artery or cause septic thrombophlebitis of the internal jugular vein (Lemierre syndrome)

Treatment:
Systemic antibiotics: Ceftriaxone 1 gm. iv BD, Amoxiclav 1.2 gm. iv TDS, Metronidazole 500mg iv TDS
Incision & drainage: Intraoral drainage from tonsillar fossa or External incision from the neck.
The external approaches are: Transcervical , Transcervical plus Transparotid, Transparotid , Infratemporal fossa .