What are pearls for the performance of peritonsillar abscess drainage?

Updated: May 09, 2018
  • Author: Jeffrey D Suh, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Airway protection should be considered for large abscesses. If the airway is in doubt, consider intubation and drainage under general anesthesia. [14] Tracheostomy is rarely necessary.

The carotid artery lies lateral and posterior to the tonsil. Take care that the incision and dissection procedure is not performed too deep or in a lateral position. Be aware of anatomic variants of the internal carotid artery (aka aberrant carotid artery). In some patients, the carotid can be much more midline and can be in danger of iatrogenic injury during needle aspiration or incision and drainage.

Axial CT scan with contrast demonstrating a left a Axial CT scan with contrast demonstrating a left aberrant carotid artery.

The incision is made superior to the tonsil in the area of the soft palate. An incision in the tonsil itself causes excessive bleeding and may miss the abscess, which is located in the peritonsillar soft tissues of the soft palate.

Although physical examination is sufficient in most cases to make the diagnosis of a PTA, consider a contrast-enhanced CT scan of the neck or an intraoral ultrasound [3] to aid in the diagnosis or to evaluate for associated complications such as deep space neck abscess, especially if the patient has an ipsilateral neck mass or fluctuance.

In some cases, simply injecting local anesthetic into the area of maximal fluctuance can localize the abscess cavity to make the incision and drainage very simple.

Patients with a PTA usually report pain in this area of the neck

Usual location of neck pain. Usual location of neck pain.

Group A streptococci [15] and anaerobic [16] bacteria are the 2 most common bacteria isolated from PTA cultures. [17] Antibiotics used for the treatment of PTA should cover gram-positive and anaerobic bacteria. [18, 19]

A single high dose of steroid prior to antibiotic therapy can be useful in improving symptoms of patients with PTAs postdrainage. [13]


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