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The main method of treating a paratonsillar or retropharyngeal abscess that occurs in the pharynx is the opening of a purulent formation by surgery. It is indicated for patients of any age, taking into account contraindications. The technology of surgical intervention recommends performing the operation 4-5 days after the onset of abscess formation. Failure to follow this recommendation may lead to the fact that the operation is carried out too early, when the abscess cavity has not yet formed. In this case, pathogenic microorganisms have already concentrated around the tonsil, but the stage of melting of the adenoid tissue has not yet begun. To clarify the stage of purulent inflammation, a diagnostic puncture is performed.
The method for diagnosing the readiness of an abscess for opening consists in piercing the top point of swollen tissues near the affected tonsil. It is desirable to carry out a puncture under control of a roentgenoscope or ultrasound. After puncturing the abscess area, the doctor draws its contents into a sterile syringe.
Possible options:
The presence of pus in the syringe barrel is a symptom of an abscess that has formed, a signal for an operation.
The presence of a mixture of lymph and blood with pus in the syringe is a symptom of an unformed abscess, when adequate antibiotic therapy can prevent surgery.
Indications for opening an abscess
Indications for the diagnosis of abscess by puncture:
A pronounced pain symptom, aggravated by turning the head, swallowing, trying to talk;
Hyperthermia over 39°c;
Angina lasting longer than 5 days;
Hypertrophy of one tonsil (rarely two);
Enlargement of one or more lymph nodes;
Symptoms of intoxication – muscle aches, fatigue, weakness, headache;
Tachycardia, palpitations.
If diagnostic puncture is performed under ultrasound or X-ray guidance, most of the pus can be removed during the procedure. However, this will not solve the problem completely, you still have to remove the abscess.
Reasons for surgery:
After cleaning the abscess cavity, the conditions for the spread of pus disappear;
During surgery, the cavity is treated with antiseptics, which cannot be done during a puncture;
If the abscess is small, it is removed along with the capsule without opening it;
After removal of pus, the general condition improves, pain disappears, symptoms of intoxication disappear, the temperature decreases;
Since the microorganisms that cause purulent inflammation are almost completely removed, the risk of recurrence is minimal;
In some cases, along with the opening of the abscess cavity, the tonsils are removed, which helps to eliminate the focus of inflammation and reduces the risk of recurrence of the disease.
Surgery to remove an abscess in the throat is performed on an outpatient basis. This is a well-established procedure that does not cause complications. After surgical opening of the abscess, the patient is sent for follow-up care at home, comes for a follow-up examination after 4-5 days.
Indications for inpatient treatment of paratonsillar abscess:
Children’s age (preschoolers are hospitalized with their parents);
Pregnant women;
Patients with somatic diseases or reduced immunity;
Patients with a high risk of postoperative complications (sepsis, phlegmon);
Patients with an unformed abscess to control its formation.
Before a planned operation, to weaken pathogenic microorganisms and prevent their spread, the patient is prescribed antibiotics. Surgical intervention is performed under local anesthesia. If the case is urgent, it is allowed to open the abscess without anesthesia.
Stages of opening an abscess
An incision is made with a depth of no more than 1-1,5 cm at the highest point of the purulent formation, since it is there that the thinnest layer of tissue is located, and the abscess is closest to the surface. The depth of the incision is determined by the risk of damage to nearby nerves and blood vessels.
Pus is released from the cavity.
The surgeon, using a blunt instrument, destroys possible partitions inside the cavity to improve the outflow of pus and prevent its stagnation.
Treatment of the abscess cavity with an antiseptic solution for disinfection.
Wound suturing.
To prevent relapse, a course of antibiotic therapy is prescribed. When opening an abscess, it may be found that the pus is not in the capsule, it has spread between the tissues of the neck. If this complication is caused by anaerobic microbes that develop without access to oxygen, drainage is performed through additional incisions on the surface of the neck to bring in air and remove pus. If the risk of recurrence is eliminated, the drainage incisions are sutured.
Rules of conduct after surgery to open abscesses:
In order to avoid swelling and slowing down regeneration, it is forbidden to warm up the neck;
To minimize the risk of vasoconstriction or dilation, it is allowed to drink drinks only at room temperature;
The use of liquid food is recommended;
Mandatory to comply with the ban on alcohol and smoking;
To prevent relapse, it is imperative to undergo a course of treatment with antibacterial and anti-inflammatory drugs, use vitamin and mineral complexes;
4-5 days after the operation, the doctor examines the patient, assessing the risk of possible complications, the regeneration process.
In most cases, postoperative recurrences are extremely rare. After a week allotted for the rehabilitation period, the patient may be recommended the usual regimen.