Paratonsillar abscess

Paratonsillar pharyngeal abscess

Opening an abscess

is the main method of treating purulent diseases in the pharynx (paratonsillar abscess, retropharyngeal abscess).

It is performed on almost all patients, regardless of their age or gender.

It is believed that an abscess can be opened 4–5 days after its formation. If you perform the operation earlier, it may turn out that the cavity with pus has not yet formed. At this stage, pyogenic microbes have already saturated the fiber around the tonsil, but the melting of the tissue has not yet occurred. To check the “readiness” of the abscess for opening, a diagnostic puncture is sometimes performed.

A diagnostic puncture is an injection with a special thick needle into the most protruding area near the tonsil. If possible, the course of the needle is monitored using fluoroscopy or ultrasound. After the puncture, the doctor carefully pulls back the syringe plunger and draws a small amount of content into the cylinder. Detection of pus is a signal that an abscess has formed and is ready to be opened.

If the syringe does not collect liquid, or a mixture of blood, lymph and a small amount of pus is collected, then an abscess is still forming. At this stage, it is better to start intensive antibiotic therapy, since there is still a chance to avoid surgery.

Indications for diagnostic puncture are:

• sore throat lasting more than 5 days (this time is enough for an abscess to form);
• severe sore throat (worse when swallowing, talking, moving the head);
• temperature more than 39 degrees;
• severe enlargement of one of the tonsils (Bilateral peritonsillar abscess is also very rare.);
• enlargement of regional lymph nodes (at least one);
• signs of general intoxication – headaches, apathy, drowsiness, muscle pain;
• moderate increase in breathing and heart rate.

In principle, during a puncture under ultrasound or fluoroscopy control, most of the pus can be removed from the cavity. However, it is still recommended to open the abscess.

Opening a paratonsillar abscess

is considered a necessary procedure for the following reasons:

• It helps prevent the spread of pus. The contents of the cavity are released or sucked out with a special syringe.
• During the autopsy (unlike puncture) the doctor has the opportunity to treat the abscess cavity. To do this, he washes it with special antiseptic solutions.
• For small abscesses (up to 1 centimeter in diameter) a decision may be made not to open the cavity, but to remove it entirely, including the walls.
• After releasing the pus, a sharp improvement in the patient’s condition is observed. The pain subsides, body temperature decreases, and the general condition returns to normal within a few days.
• Opening an abscess involves destroying pyogenic microbes (unlike puncture), therefore the risk of re-formation of a purulent cavity is very small.
• When opening an abscess, a parallel tonsillectomy is often performed (removal of tonsils). This facilitates access to deep abscesses and eliminates the chronic inflammatory focus. Due to the removal of the tonsils, there is a risk of relapse (re-formation of abscess) is greatly reduced.

From a medical point of view, the operation itself is quite simple and rarely leads to any complications. Most patients are not even admitted to hospital treatment. Opening a paratonsillar abscess is carried out on an outpatient basis, after which the patient is prescribed a detailed course of treatment at home and warned of the need for a follow-up examination in a few days.

The following categories of people with peritonsillar abscess are subject to hospitalization:

• children (preschool children can be hospitalized with one of their parents);
• persons with reduced immunity;
• persons with severe concomitant diseases;
• pregnant women;
• patients with a high risk of complications (sepsis, phlegmon, mediastinitis);
• patients whose puncture showed the absence of a formed cavity with pus are hospitalized for careful medical monitoring.

Direct opening of the abscess is carried out under local anesthesia (dicaine solution 2%, cocaine solution 5%). In emergency cases, dissection of the abscess wall is allowed without additional local anesthesia.

An incision is made at the site of the greatest protrusion of the pharyngeal wall (here the wall is thinnest and the abscess lies more superficially). The depth of the incision should not exceed 1 – 1,5 cm, so as not to damage nearby bundles of blood vessels and nerves.

After releasing the bulk of the pus, the doctor penetrates the cavity with a blunt instrument and destroys the partitions inside it, if any. This improves the outflow of pus and prevents its point accumulations, which can subsequently lead to relapse.

After this, a disinfectant solution is pumped into the cavity. After suturing the cavity, additional measures to stop bleeding are usually not required.

Mandatory element of surgical treatment paratonsillar abscess is antibiotic therapy. For planned surgery, antimicrobial drugs are started several days before the intervention. This weakens pyogenic microbes and prevents them from spreading to neighboring areas during the operation. After opening the peritonsillar abscess, antibiotics are taken for several more days. This is necessary to prevent relapse of the disease.

If an abscess is opened, but it is discovered that the pus is not localized, but has begun to spread between the fascia of the neck, the doctor acts according to the situation.

Such cases pose a danger to the patient’s life, so there are no uniform rules for such operations.

If the abscess has formed under the influence of anaerobic microbes, the scope of the operation can be expanded. These microorganisms develop best in conditions without access to air. To create unfavorable conditions for them, drainage (a special tube or tubes) can be left in place.

They are brought out through additional incisions in the skin of the neck. This creates additional air flow and outflow of forming pus and blood. After a few days, if there are no signs of relapse, the drainage is removed and the incisions are sutured.

After opening a paratonsillar abscess, the patient must follow the following rules:

• It is forbidden to warm the neck, as this will increase swelling and slow down healing;
• It is forbidden to drink excessively hot or cold drinks, so as not to cause severe local narrowing or dilatation of blood vessels;
• it is advisable to eat semi-liquid or liquid food;
• During the rehabilitation period, it is prohibited to drink alcohol and it is advisable to refrain from smoking;
• to avoid relapse, you must take anti-inflammatory drugs, antibiotics and vitamin-mineral complexes prescribed by your doctor;
• A few days after surgery, you should definitely see your doctor so that he can evaluate the healing process.

In the vast majority of patients, the opening of the peritonsillar abscess occurs without any complications. The rehabilitation period usually lasts no more than a week, after which the patient can return to normal life.