What is the pathophysiology of peritonsillar abscesses (PTAs)?

Updated: Sep 03, 2020
  • Author: Jorge Flores, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

The two palatine tonsils are on the lateral walls of the oropharynx, within the depression between the anterior and posterior tonsillar pillars. Each pillar is composed primarily of the glossopalatine and the pharyngopalatine muscles.

During embryonic development, the tonsils arise from the second pharyngeal pouch as buds of endodermal cells. [4] The tonsils then grow irregularly and reach their ultimate size and shape at approximately age 6-7 years.

Each tonsil is surrounded by a capsule, a specialized portion of the intrapharyngeal aponeurosis that covers the medial portion of the tonsils and provides a path for blood vessels and nerves. [4] It is within this potential space, between the tonsil and capsule, that peritonsillar abscesses form. [5] Note that the peritonsillar space is anatomically contiguous with several deeper spaces, and infections can potentially involve the parapharyngeal and retropharyngeal spaces. [6]

Peritonsillar abscesses usually progress from tonsillitis to cellulitis and ultimately to abscess formation. Weber glands are thought to also play a key role in the etiology of the infection. These mucous salivary glands are located superior to the tonsil in the soft palate and clear the tonsillar area of debris. If these glands become inflamed, local cellulitis develops. As the infection progresses, inflammation worsens and results in tissue necrosis and pus formation, most commonly just above the superior pole of the tonsil where the glands are located. [5]

Klug et al, citing evidence for peritonsillar abscess as a complication of acute tonsillitis and as a consequence of Weber gland infection, hypothesized that peritonsillar abscesses develop when bacteria infect the tonsillar mucosa and then, using the salivary duct system, spread to the peritonsillar space. [7]

A multi-center, prospective, observational case-control study by Lepelletier et al suggested that self-medication with systemic anti-inflammatory drugs may increase the risk of peritonsillar abscess. Male gender and smoking were also linked to the condition. The study compared 120 cases of peritonsillar abscess with 143 cases of sore throat without peritonsillar abscess. [8]


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