ACUTE
CHRONIC RETROPHARYNGEAL
VINCENT’S ANGINA LUDWIG’S ANGINA PARAPHARYNGEAL ABSCESS RETROPHARYNGEAL
ABSCESS
ABSCESS
Infection in the parapharyngeal space
It is an acute necrotizing It is rapidly progressive cellulitis
which extends from base of skull to Acute retropharyngeal abscess is Chronic retropharyngeal abscess is
ulcerative involving one or both involving submandibular neck
hyoid bone bounded by caused by suppuration of caused by tuberculous infection,
DEFINITION tonsils, which may spread to space, characterized by induration
buccopharyngeal fascia medially, retropharyngeal LN, most seen in elder children, adolescent,
involve faucial pillars, soft palate of sub mental region and floor of
pterygoid muscle and parotid laterally common in children <4 years. adults
and gums mouth
and pre-vertebral fascia posteriorly
Extension from naso/Oro
Dental abscess, tonsillar infection, Extension from infection of tonsils,
pharynx via lymphatic channel, Infection reaches the
mandibular fracture. tonsillar fossa, penetrating foreign
Gram -ve bacillus, Vincent’s penetrating injury in post. retropharyngeal space from erosion
CAUSE spirochete (borrelia vincentii)
Streptococci, staphylococci, E.coli, bodies, lower wisdom tooth, external
Pharyngeal wall or cervical of cervical vertebrae due to
Bacteroides trauma to neck and ear infection.
esophagus tuberculosis of vertebrae
Staphylococci
Streptococcus pneumonie
High grade fever, dysphagia,
High grade fever, odynophagia, High grade fever, severe pain in Low grade fever, weight loss, sore
High grade fever, odynophagia, difficulty in breathing, croupy
S/S Fetor oris,
trismus, drooling of saliva, muffled throat, marked trismus, tender
cough, stridor, nasal obstruction,
throat, cough, slight dysphagia, pain
voice, respiratory obstruction swelling in neck. or discomfort in throat
torticollis
CLINICAL
FEATURE
T&E cervical LN, Gray membrane Congestion of whole pharynx,
Fluctuant swelling in posterior
covering the tonsils, which when Firm brawny swelling of structure Tonsil and posterior pharyngeal wall lateral swelling of posterior
O/E removed show ulceration and in floor of mouth pushed medially, palsies of last 4 CN pharyngeal wall, laryngeal
pharyngeal wall, enlarged cervical
LN
can bleed easily edema
X-ray Neck: Lateral view, X-ray: vertebral disease pr
Microscopic examination of x-ray: bubbles below mylohyoid widening of prevertebral space, calcification in retropharyngeal LN
DIAGNOSIS scrapping from lesion muscle loss of cervical curvature TB evaluation: CBC, ESR, X-ray chest,
C/S of the pus sputum for AFB
Systemic antibiotic, anti-inflammatory,
Penicillin + metronidazole Broad spectrum IV antibiotics, incision Broad spectrum IV antibiotics,
antipyretic, incision drainage (if frank
TREATMENT local: antiseptic gargles,
pus), tracheostomy (if respiratory
& drainage (if fluctuation +ve) under incision & drainage under GA & Incision & drainage + anti TB therapy
analgesic, antipyretic obstruction) GA endotracheal intubation
Laryngeal edema, spread of Laryngeal edema, thrombophlebitis of
COMPLICATION infection, septicemia, aspiration IJV, Septicemia, direct spread to
pneumonia retropharyngeal space, carotid burst
DIFFERENTIAL Tonsilitis, Quincy, Pharyngeal Tumors of salivary gland, neurogenic
DIAGNOSIS diphtheria tumor, lymphoid tissue tumor
CHRONIC RETROPHARYNGEAL
VINCENT’S ANGINA LUDWIG’S ANGINA PARAPHARYNGEAL ABSCESS RETROPHARYNGEAL
ABSCESS
ABSCESS
Infection in the parapharyngeal space
It is an acute necrotizing It is rapidly progressive cellulitis
which extends from base of skull to Acute retropharyngeal abscess is Chronic retropharyngeal abscess is
ulcerative involving one or both involving submandibular neck
hyoid bone bounded by caused by suppuration of caused by tuberculous infection,
DEFINITION tonsils, which may spread to space, characterized by induration
buccopharyngeal fascia medially, retropharyngeal LN, most seen in elder children, adolescent,
involve faucial pillars, soft palate of sub mental region and floor of
pterygoid muscle and parotid laterally common in children <4 years. adults
and gums mouth
and pre-vertebral fascia posteriorly
Extension from naso/Oro
Dental abscess, tonsillar infection, Extension from infection of tonsils,
pharynx via lymphatic channel, Infection reaches the
mandibular fracture. tonsillar fossa, penetrating foreign
Gram -ve bacillus, Vincent’s penetrating injury in post. retropharyngeal space from erosion
CAUSE spirochete (borrelia vincentii)
Streptococci, staphylococci, E.coli, bodies, lower wisdom tooth, external
Pharyngeal wall or cervical of cervical vertebrae due to
Bacteroides trauma to neck and ear infection.
esophagus tuberculosis of vertebrae
Staphylococci
Streptococcus pneumonie
High grade fever, dysphagia,
High grade fever, odynophagia, High grade fever, severe pain in Low grade fever, weight loss, sore
High grade fever, odynophagia, difficulty in breathing, croupy
S/S Fetor oris,
trismus, drooling of saliva, muffled throat, marked trismus, tender
cough, stridor, nasal obstruction,
throat, cough, slight dysphagia, pain
voice, respiratory obstruction swelling in neck. or discomfort in throat
torticollis
CLINICAL
FEATURE
T&E cervical LN, Gray membrane Congestion of whole pharynx,
Fluctuant swelling in posterior
covering the tonsils, which when Firm brawny swelling of structure Tonsil and posterior pharyngeal wall lateral swelling of posterior
O/E removed show ulceration and in floor of mouth pushed medially, palsies of last 4 CN pharyngeal wall, laryngeal
pharyngeal wall, enlarged cervical
LN
can bleed easily edema
X-ray Neck: Lateral view, X-ray: vertebral disease pr
Microscopic examination of x-ray: bubbles below mylohyoid widening of prevertebral space, calcification in retropharyngeal LN
DIAGNOSIS scrapping from lesion muscle loss of cervical curvature TB evaluation: CBC, ESR, X-ray chest,
C/S of the pus sputum for AFB
Systemic antibiotic, anti-inflammatory,
Penicillin + metronidazole Broad spectrum IV antibiotics, incision Broad spectrum IV antibiotics,
antipyretic, incision drainage (if frank
TREATMENT local: antiseptic gargles,
pus), tracheostomy (if respiratory
& drainage (if fluctuation +ve) under incision & drainage under GA & Incision & drainage + anti TB therapy
analgesic, antipyretic obstruction) GA endotracheal intubation
Laryngeal edema, spread of Laryngeal edema, thrombophlebitis of
COMPLICATION infection, septicemia, aspiration IJV, Septicemia, direct spread to
pneumonia retropharyngeal space, carotid burst
DIFFERENTIAL Tonsilitis, Quincy, Pharyngeal Tumors of salivary gland, neurogenic
DIAGNOSIS diphtheria tumor, lymphoid tissue tumor
