© Borgis - New Medicine 3/2008, s. 50-51
*Małgorzata Dębska, Monika Jabłońska-Jesionowska, Mieczysław Chmielik
PARAPHARYNGEAL ABSCESSES IN CHILDREN – SYMPTOMS, DIAGNOSIS AND TREATMENT
Department of Paediatric Otorhinolaryngology, Medical University of Warsaw
Head of Department: Prof. Mieczysław Chmielik, MD, PhD
Introduction: Parapharyngeal abscesses are a rare complication of acute inflammation of the upper respiratory tract. Since the parapharyngeal space is surrounded by muscle and fasciae from all sides, the inflammatory processes are difficult to recognise and can therefore cause life-threatening complications. The treatment of choice is an incision of the parapharyngeal space and intravenous antibiotic therapy.
Aim: In the Clinic of Paediatric Otolaryngology in Warsaw between July 2007 and July 2008 we treated three boys for abscesses of the parapharyngeal space only with combined antibiotic therapy. The treatment process and the results are described.
Material and methods: Children were treated conservatively for abscesses of the parapharyngeal space.
To confirm the diagnosis a CT scan of the neck and repeated ultrasound images were made in order to monitor the treatment.
Results: All patients treated only with combined antibiotic therapy were completely cured.
Conclusions: When no life-threatening symptoms are present, a conservative therapy may be administered. If the general condition improves and the inflammatory parameters lower within 24-48 h only this treatment may be continued. All our patients presented with anaemia. We do not know whether it was primary anaemia that predisposed children to a serious complication or it was the abscess of the parapharyngeal space which led to them becoming anaemic.
Parapharyngeal abscesses are a rare complication (2, 3, 5) of acute inflammation of the lymphoid tissue of the throat, the tonsils, the parotid gland, the paranasal sinuses and of the middle ear. The boundaries of the parapharyngeal space are the lateral pharyngeal wall medially and anteriorly, the medial pterygoid muscle and the parotid gland laterally, and the prevertebral fascia posteriorly. It extends from the base of the skull to the hyoid bone and encompasses the internal carotid, the internal jugular, nerves IX, X, XII, and the cervical sympathetic trunk. Since the area is surrounded by muscle and fasciae from all sides, the inflammatory processes do not usually manifest outside. They can therefore cause life-threatening complications: mediastinitis and meningitis. The treatment of choice is an incision and intraoral or extraoral drainage of the parapharyngeal space and intensive target intravenous antibiotic therapy.
Diagnostic considerations and an evaluation of the results of conservative treatment of parapharyngeal abscesses in infants.
MATERIAL AND METHODS
Three boys aged 7, 12 and 14 months were treated in the Clinic of Paediatric Otolaryngology in Warsaw between July 2007 and July 2008 for abscesses of the parapharyngeal space. Each child underwent an interview, a physical examination and additional tests, including mainly an ultrasound and a CT scan of the cervical area.
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