LAPT-Laser assisted partial turbinectomy being done under Local anesthesia using Co2 Laser, in ENT OPD, SUT Speciality hospital, Trivandrum, Kerala, South India.
Drainage of Peritonsillar Abscess (Quinsy)
Peritonsillar abscess (Quinsy)is a complication of acute tonsillitis. In peritonsillar abscess, there is pus trapped between the tonsillar capsule and the lateral pharyngeal wall.
Complaints
• Severe throat pain which may become unilateral
• Fever
• Drooling of saliva
• Foul smelling breath
• Swallowing may be painful
• Difficulty opening the mouth
• Altered voice quality (’hot potato voice’) due to pharyngeal oedema and trismus
• Earache on the affected side
• Neck stiffness symptoms
• Headache and general malaise
Findings
• Examination may be difficult as trismus may make it difficult to open the mouth in up to two thirds of cases.
• Breath is fetid.
• There may be drooling and salivation.
• Look for a temperature.
• Tender, enlarged ipsilateral cervical lymph nodes.
• Torticollis may be present.
• There is unilateral bulging usually above and lateral to one of the tonsils; occasionally the bulging is inferiorly.
• There is medial or anterior shift of the affected tonsil and the tonsil may be erythematous, enlarged and covered in exudate.
• The uvula is displaced away from the lesion.
• Examine for signs of dehydration.
• Compromise of the airway is rare.
• Spontaneous rupture of the abscess into the pharynx can rarely occur and can lead to aspiration.
Medical Management
• Intravenous fluids may be required to correct dehydration.
• Analgesia should be prescribed.
• Intravenous antibiotics give higher blood levels than oral therapy and are usually used.
• intravenous steroids
Surgical Management
• Needle aspiration: Needle aspiration can be therapeutic in itself; in some studies, up to 85% of patients were effectively treated with outpatient needle aspiration and oral antibiotics. Aspiration can also be used to confirm the diagnosis and localize the Quinsy for incision and drainage.
• Incision and drainage under Local anesthesia(see picture)
• Quinsy tonsillectomy-rarely advocated
Complications
• The abscess can spread to the deeper neck tissues and can result in necrotizing fasciitis. Infection can spread from the parapharyngeal space through the anatomical planes to cause mediastinitis, pericarditis and pleural effusions.
• Airway compromise is rare.
• Recurrence of peritonsillar abscess can occur.
• Haemorrhage may follow tonsillectomy.
• Death can occur from aspiration, airway obstruction, erosion into major blood vessels or extension to the mediastinum.
• The rate of recurrence is around 10 to 15%.