THROAT -Peritonsillar abscess-quinsy

Synonym: Peritonsillar abscess

What is quinsy?

 A peritonsillar abscess is collection of pus between the fibrous capsule of tonsillar upper pole and the superior constrictor muscle of the pharynx.

What is Aetiology of Quinsy?

  1. usually seen in adult males
  2. As a complication of acute tonsillitis
  3. Foreign bodies like small fish bone embedded into tonsillar tissue.

Bacteriology – B hemolytic streptococcus is the most frequent organism along with multiple organisms both aerobic and anaerobic as contrast to acute tonsillitis where it is usually only  B hemolytic streptococcus.

 What are the Clinical features of quinsy?

1. Usually fit young adult male
2. May have had repeated attacks or acute tonsillitis or may be de-novo
3. It is preceded by sore throat 2 or 3 days which gradually becomes more severe and unilateral
4. Usually unilateral but occasionally can be bilateral
5. Patient presents with high grade fever
6. Voice is plumy as a result of oropharyngeal swelling
7. Foetor may be present due to secondary infection.

Signs:
1) Classical appearance is striking asymmetry, enlargement, hyperemia and displacement of the affected tonsil with oedema and hyperaemia of soft palate.

2. Tender, enlarged lymph nodes in the jugulodigastric region on same side
3) Patient has foul oral odour

What is treatment of pertonsillar abscess?

Medical
1) Hospitalisation
2) Intravenous antibiotics
3) Analgesics and oral antiseptic gargles

Surgical
Incision and drainage if:
1) Presence of discrete abscess
2) Infection not responding to antibiotics
3) Patient should undergo interval tonsillectomy after 4-6 weeks
after the acute attack subsides.
4) Emergency abscess tonsillectomy. This is rarely done due to the
increased chances of bleeding and thromboembolism.

Incision sites for drainage of Quinsy:
1) A horizontal line is drawn through the base of the uvula and vertical line along the base of the anterior tonsillar pillar. The incision is taken at this site.
2) At the site of maximum projection.
3) Through the intratonsillar cleft
After drainage of the abscess, dilute hydrogen peroxide and povid01111
iodine gargles are given.

 

What are complications of surgery?
a)       Rapidly increasing inflammation oedema can lead to laryngeal
oedema with respiratory obstruction. Hence patient may require
tracheostomy
b)      Parapharyngeal abscess involving carotid sheath leading to
jugular vein thrombosis or fatal carotid hcmorrhage.
c)       In severe cases mediastinitis




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