Quinsy
From Orlhns
Quinsy or peritonsillar abscess is a deep neck space abscess involving the peri-tonsillar space. It is one of the commonest abscess of the head and neck region. The pus collects in the potential space between capsule of the tonsils and superior constrictor muscles.
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[edit] Aetiology
Quinsy usually follows an attack of acute tonsillitis and often considered an complication of the same. The tonsillar crypts get blocked due to inflammation. The infection breaches the tonsillar capsule and causes suppuration in the peri-tonsillar space with pus formation.
Nevertheless, Quinsy is known to occur de novo and may not follow an acute tonsillitis. Another theory of quinsy formation considers it to be a suppuration of a minor salivary gland located in the peri-tonsillar space. These glands are referred to as 'Weber's Glands'.
Quinsy may rarely occur in a post tonsillectomy person also.
The commonest bacteria to be isolated in cases of quinsy is the Group A beta-hemolytic Streptococcus pyogenes. The infection is usually mixed with aerobic and anaerobic organisms
[edit] Clinical features
[edit] Symptoms
- Odynophagia is severe with the patient having severe pain on swallowing even his own saliva.
- Dysphagia
- Change in voice occurs as it becomes thick and muffled - hot potato voice
- Drooling may be present as the patient is unable to swallow his saliva.
- Referred Otalgia may often occur
- Fever
[edit] Signs
- Trismus
- Bulge on the soft palate pushing the tonsil medially and downwards. The bulge imparts an asymmetric look to the oropharynx
- Edema of the soft palate often extending to the uvula
- The tonsillar fossa may or may not show signs of acute inflammation.
- Tender lymphadenopathy of the ipsilateral jugulodigastric nodes
- The patient is usually severly toxic with fever and dehydration.
[edit] Treatment
Surgical drainage. A quinsy is an surgical emergency and the pus should be drained. Sometimes in early cases, an aspiration of the pus with a wide bore needle would suffice. The drainage can be usually done without any anaesthesia in the OPD settings using a guarded No 11 blade. The incision is made over the point of maximum bulging and pus evacuated. Another technique popularly used to determine site of incision is by drawing an imaginary vertical line from the anterior pillar and another horizontal line from the base of the uvula. The point of intersection of these lines is the preferred place of stab incision. All loculi inside the abscess cavity should be broken down using a quinsy forceps.
Medical management A patient of quinsy should be managed with parentral antibiotics. The rest of the treatment is essentially supportive in nature with maintainence of hydration and nutrition. Analgesics and anti-inflammatory medications are often required.
After the acute symptoms have subsided, the patient is often counselled to get a tonsillectomy done after 6-8 weeks, a procedure referred to as interval tonsillectomy. Rarely, a tonsillectomy is done during the attack of quinsy when it is referred to as hot tonsillectomy.
[edit] Complications
- aspiration pneumonitis
- Spread of infection to other deep neck spaces parapharyngeal abscess leading to airway compromise
- Mediastinitis
- Septicaemia
