How is exposure of the posterior oropharynx for aspiration and incision and drainage achieved during treatment of peritonsillar abscess (PTA), and what are the benefits of incisional drainage of PTA?

Updated: Apr 06, 2020
  • Author: Udayan K Shah, MD, FACS, FAAP; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Exposure of the posterior oropharynx for aspiration and incision and drainage is achieved by using the nondominant hand to grasp the tongue with a sponge while the patient opens his or her mouth. In patients with severe trismus, a tongue blade may be used to depress the midportion of the tongue. Magnifying and illuminating loupes, such as the LumiView, are the best sources of light. A headlight or mirror is also effective. Arranging the instruments in order of use on a tray adjacent to the physician's dominant hand facilitates rapid accomplishment of this procedure. In experienced hands, this procedure should take fewer than 3 minutes from aspiration to rinsing with peroxide.

After the procedure, the patient is observed in accordance with sedation and anesthetic protocols. Hospitalization for adults and for older children is rarely required. The patient is discharged with a prescription for an oral antibiotic (10-day course of therapy), a prescription for an oral narcotic for pain control (taking care to avoid antiplatelet agents), and instructions to maintain hydration and control fever. Antibiotic therapy may be altered after cultures return. A follow-up office visit or telephone call is made in 2-4 weeks after the procedure to confirm symptomatic resolution.

A retrospective study by Windfuhr and Zurawski indicated that incisional drainage as a first-line treatment for peritonsillar abscess decreases the hemorrhage rate from that associated with abscess tonsillectomy (0.3% vs 5.1%, respectively) and significantly reduces inpatient treatment days (4 vs 7 days, respectively). The study involved 775 patients, including 443 who underwent abscess tonsillectomy and 332 who were treated with incisional drainage. [33]


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