Opening of paratonsillar abscess

Peritonsillar abscess is an inflammatory process in the tissue around the tonsils. Usually, the cause of its appearance is angina, when inflammation passes from the palatine tonsils to nearby tissues. Also, an abscess can form as a complication of purulent or streptococcal pharyngitis.

Weakened by infectious lesions, injuries of the gums, palate and tongue, smoking and caries, the oral cavity, as well as reduced immunity are factors that contribute to the development of the disease. The accumulation of pus provokes pain and prevents the patient from swallowing food normally, talking, and even moving his head.

Paratonsillitis: etiology and danger of its development

Acute inflammation of the peri-almond tissue is felt as a huge lump in the back of the throat, filled with pus. It can be unilateral, or it can affect the right and left tonsils at the same time.

The development of the disease occurs against the background of acute tonsillitis, streptococcal pharyngitis and a general weakening of the body. When the infection enters the tissue around the tonsils from festering follicles and lacunae, purulent contents begin to accumulate in it.

The concept of “peritonsillar abscess” characterizes the already formed process of the cavity with pus. At the same time, the patient feels a strong growing pain in the throat, notes difficulty with swallowing, weakness, chills, and a strong fever. He has swollen lymph nodes and bad breath.

Painful sensations are given to the ear and jaw, because of them trismus of masticatory muscles develops, and the patient cannot open his mouth normally.

The danger of pathology lies in the fact that if pus continues to accumulate in the throat, it can get into the deeper tissues of the neck and cause the development of sepsis, acute laryngeal stenosis, neck phlegmon and mediastinitis. In severe cases, death is possible. The presence of these complications is an indication for hospitalization of the patient.

Depending on the location of the cavity with pus, paratonsillitis is classified into several forms.

The posterior abscess is localized between the palatopharyngeal arch and tonsil, with a high probability of inflammation moving to the larynx.

The anterior form is located between the upper part of the tonsil and the palatoglossal arch. Such an abscess often opens on its own, after which the pus enters the throat.

Some inflammatory dental conditions cause the formation of lower paratonsillitis – an abscess behind the lower edge of the tonsil.

An external paratonsillar abscess is diagnosed quite rarely – it is localized outside the tonsil. In this case, the rupture of the abscess is dangerous due to the ingress of pus into the soft tissues of the neck.

Differences in pathological changes in the pharynx, which generates paratonsillitis, allows us to distinguish the following types of pathology:

• edematous;
• infiltration;
• abscessing.

The first type of pathology develops without pronounced inflammation, and is characterized by severe swelling of the tissues, despite the fact that the symptoms appear at this stage in the form of moderate sore throats.

Further, symptoms of the progression of inflammation appear, pain increases and an increase in temperature is noted. At this stage, it is already possible to diagnose the disease.

The abscess form occurs 2-4 days after the onset of inflammation. At this time, a massive formation filled with pus is formed, which leads to deformation of the pharynx.

Methods for detecting and treating pathology

Given that an abscess, especially at the abscessing stage, has characteristic manifestations, the doctor usually does not have problems making a preliminary diagnosis.

After examining and collecting an anamnesis, the doctor will refer the patient to pharyngoscopy and passing some tests – a general analysis and biochemistry of blood, a smear for bacteriological culture and the causative agent of diphtheria from the pharynx.

To determine the degree of depth of the lesion, ultrasound and computed tomography of the neck can be additionally prescribed. It is important to differentiate the disease from other lesions – scarlet fever, diphtheria, carotid artery aneurysms.

Treatment of paratonsillitis includes drug therapy and surgical intervention – opening of the paratonsillar abscess.

Antibiotics are mandatory prescribed as etiotropic therapy. In addition, the patient must be prescribed antipyretic, anti-inflammatory and analgesic drugs. For a local effect on the inflammatory process, it is necessary to rinse the mouth and throat with antiseptic solutions.

Surgery is the most effective method to eliminate an abscess. It can be performed on patients according to indications, regardless of gender and age.

Indications for opening an abscess

The possibility of developing such complications can be assumed in the presence of the following symptoms:

• angina, the duration of which exceeds 5-6 days: during this time, an abscess may form;
• severe severe pain in the throat that is felt when swallowing or moving the head;
• temperature increase over 39 degrees;
• a significant increase in one or two tonsils;
• signs of intoxication and fever (weakness, malaise, muscle pain, apathy and drowsiness);
• enlarged lymph nodes;
• increased heart rate and breathing.

The development of an abscess, which is accompanied by such symptoms, is a direct indication for the opening of the abscess.

Usually, the operation is performed on the 4-5th day from the onset of the inflammatory process – by this time the abscess is already fully formed. To check the readiness of the cavity for removal, the doctor may prescribe a diagnostic puncture – a puncture of the cavity with a thick needle in the place that protrudes most of all above the tonsil. The course of the procedure is most often controlled by endoscopic or ultrasound observation. If pus is found in the cavity of the syringe with which the puncture is performed, then an abscess has formed and is ready for removal.

An autopsy is performed on an outpatient basis, that is, for its implementation, the patient does not need to go to the ENT department of a medical institution.

How is the removal of the abscess

A few days before the planned operation, the patient needs to start taking antibiotics.

Before proceeding with the autopsy, the patient is injected with an anesthetic for local anesthesia. In the place where the wall of the pharynx protrudes the most and has the smallest thickness, the doctor makes an incision of the purulent formation. Its depth does not exceed 10-15 millimeters – this way it is possible to prevent damage to adjacent vessels and nerves. With a special suction, the surgeon removes purulent contents from the cavity, after which he inserts a blunt instrument into the incision and destroys the partitions of the cavity from the inside in order to improve the outflow of pus. Next, an antiseptic is introduced into the cavity, the doctor stops the bleeding and sutures the edges of the wound.

If during the process it is found that the pus does not have a clear localization, but has spread between the fascia of the neck, the surgeon decides to take the necessary therapeutic measures. The scale of the operation is expanding, since such a condition is deadly for the operated person. If necessary, the patient can introduce a drainage tube through incisions in the neck. Each specific situation requires different surgical procedures.

Mandatory hospitalization for paratonsillar abscess

The development of a purulent cavity in the tissues of the tonsils in some cases can pose a real danger to the patient’s life. The attending physician decides on the admission to the hospital of the following categories of patients:

• children;
• pregnant women;
• people with a pronounced decrease in immunity;
• those who have severe comorbidities;
• patients with the risk of developing complications;
• in the presence of drug allergies;
• patients with the absence of a localized location of pus, when it is distributed in the tissues of the neck.

Recovery measures after surgery

A mandatory requirement for the rehabilitation of an abscess after opening is the appointment of antibiotics, antiseptic and anti-inflammatory drug therapy. The doctor may prescribe mouth rinses with healing agents and decoctions of medicinal plants.

Within 7-10 days after opening, the patient must adhere to certain rules so as not to interfere with the healing process of tissues.

It is forbidden to warm the neck and the operation site, as this increases the swelling and promotes the spread of infection.

To avoid local or generalized vasodilation, it is forbidden to consume very hot or very cold drinks and food. Meals should be liquid or semi-liquid.

During the entire rehabilitation period, you can not take alcohol and smoke. The next day, an audit of the cavity is performed to exclude re-suppuration.

2-3 days after the operation, you should come to the doctor for a preventive appointment so that he evaluates the effectiveness of the intervention and the healing process of the autopsy site.

Usually, after a week, the patient can return to his usual way of life, and a full recovery occurs in 2-3 weeks.

A paratonsillar abscess is a collection of pus in the tissue surrounding the tonsils in the pharynx. The presence of prolonged inflammatory processes, smoking, diseases of the teeth, gums and throat increase the risk of developing pathology. Most often, the disease affects children, adolescents, young people under the age of 30 years.

Surgical opening of the cavity is not required in every case – normally, an abscess forms on the fifth day of illness, after which it spontaneously bursts, and pus from it enters the throat. However, if the development of pathology is accompanied by dangerous symptoms, and the patient feels a pronounced malaise, surgical removal becomes an objective necessity.

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