Parapharyngeal Space Infection Research Articles

Parapharyngeal Abscess: A Model of Continuity and Contiguity Deep-Neck Space Infections: A Diagnostic Dilemma!

The aims of the present case report were to review, computed tomography (CT) scans, clinical signs, treatment, and outcome of parapharyngeal space infections. These infections remain an important health problem with significant risks of morbidity and mortality. The term parapharyngeal abscess or infection is composed of two different disorders: infection located in the posterior part of the PPS with no invasion into the parapharyngeal fat and the second disorder is when the infection involving the parapharyngeal fat may be termed parapharyngeal abscess or deep neck abscess. Diffusion into the mediastinum and other severe complications are frequent. A 59 year old male, presented with three days history of intermittent high grade fever and left neck swelling which was rapidly increasing in size and associated with stridor, odynophagia and neck pain. The infection and accumulation of purulent discharge extend into the pharyngomaxillary space and inferiorly is located at the greater cornu of the hyoid bone. Temporary tracheostomy for respiratory assistance was performed. The frequent co-existence of parapharyngeal abscess and peritonsillar abscess favours careful consideration of addition of tracheotomy to lateral cervicotomy. Parapharyngeal abscess are deep neck abscesses that are common and thorough knowledge of their complex anatomy and aetiologies is essential in their treatment. Urgent surgical drainage is therefore mandatory.

Analysis of a delayed diagnosis of carotid artery aneurysm presenting as a parapharyngeal space infection.

It is very rare for extracranial carotid artery dissection to present as a carotid pseudoaneurysm. A delayed diagnosis and delayed treatment will lead to rupture of carotid pseudoaneurysm and massive hemorrhage and death. In this paper, we reviewed the progress of the disease in one patient and reviewed the relevant literature reports to understand the characteristics of the disease. The patient had two consultations within the otolaryngology department. The patient later showed signs of infection in the parapharyngeal space and then died of an aneurysmal rupture and massive hemorrhage.

Odontogenic Infection Pathway to the Parapharyngeal Space: CT Imaging Assessment.

Parapharyngeal space infection may lead to severe and potentially life-threatening complications. The aim of this study was to assess the odontogenic infection pathway to the parapharyngeal space using CT imaging. Nineteen patients in mandibular odontogenic infections with abscess who underwent contrast-enhanced CT were evaluated in this study. We reviewed the location of abscess and spread of odontogenic infections to the different components of the buccal space, submandibular space, sublingual space, masticator space and parapharyngeal space using CT imaging. The location of abscess and spread of odontogenic infections were analyzed with the Pearson Chi-square test. Regarding the odontogenic infection pathway to parapharyngeal space, the masticator space (100%) was the most frequent, followed by the buccal space (85.7%), submandibular space (85.7%) and sublingual space (57.1%), while those without parapharyngeal space, the submandibular space (83.3%) was the most frequent, followed by the buccal space (75.0%), masticator space (58.3%) and sublingual space (33.3%). The masticator space was significant space in patients with/without parapharyngeal space infection (P = 0.047). CT imaging could be an effective method in assessment of odontogenic infection pathway to the parapharyngeal space. The odontogenic infection in masticator space tends to display spread of parapharyngeal space.

咽旁间隙感染致声带麻痹一例并文献复习

咽旁间隙感染致声带麻痹一例并文献复习

Deep neck cellulitis: limitations of conservative treatment with antibiotics

Conclusion: When the parapharyngeal space is infected, concurrent involvement of other spaces is likely, and involvement of multiple deep neck spaces is a key risk factor for abscess formation.Objectives: Deep neck infection is treated with antibiotics when abscesses have not yet been formed. However, in some cases, abscesses will form later and surgical drainage is warranted. This study retrospectively examined which cases were less likely to achieve cure, to clarify the limitations of conservative treatment for deep neck cellulitis.Patients and methods: Subjects comprised 19 patients with deep neck cellulitis who initially underwent conservative treatment with antibiotics. Patients were divided into two groups: Group A (n = 7), patients who recovered by conservative treatment; and Group B (n = 12), patients who did not recover and underwent surgical drainage. Age, state of DM control, etiology, treatment, spaces infected, and duration of hospitalization were investigated.Results: The number of infected spaces was one in all Group A patients, whereas Group B showed multiple infected spaces in all except two cases. In particular, among the 10 cases with parapharyngeal space infection, eight (80%) showed multiple lesions.

Suppurative parotitis and parapharyngeal space infection in an elderly patient – a Case report

Case report In this paper we present the case of an elderly woman with acute suppurative parotitis and parapharyngeal extension of the abscess. The patient had low hemoglobin levels, high uremic values and consequent tissue acidosis which determined an acute suppurative response. The patient underwent operative drainage of the abscess and removal of necrotic material. Intravenous antibiotics were also administered.

Surgical management of parapharyngeal space infections

Parapharyngeal space (PPS) infections often arise from pharyngeal or dental infections and, if left untreated, can result in serious complications such as mediastinitis, Lemierre syndrome, and death. The PPS is an inverted triangle spanning the skull base to the greater cornu of the hyoid, the inferior constrictor medially, and the ramus of the mandible laterally with many vital structures contained within. Treatment begins with assessing the airway, considering the need for computed tomography or magnetic resonance imaging with intravenous contrast and broad-spectrum antibiotics. With evidence that a PPS infections has resulted in an abscess or there is failure of conservative management with 24-48 hours of intravenous antibiotics or in severe cases, surgical drainage is performed. This is done via the traditional transcervical route or, if the abscess is medial to the great vessels, a transoral approach. Complications of surgery are rare, and resolution of symptoms with prompt antibiosis and surgical treatment prevents the possibility of infectious spread and its dangerous sequelae.

Nueva definición de las infecciones del espacio parafaríngeo: presentación de un caso y revisión de la literatura científica

BackgroundIt has been difficult to standardize criteria for the diagnosis and treatment for infections of the parapharyngeal space; however, the use of computed axial tomography (CAT) technology has allowed redefining two separate entities: anterior and posterior parapharyngeal space infections. Case summaryGirl of 3 years and 11 months of age with right ear pain, fever, drooling and neck spasm. The physical exam revealed right trapezius and sternocleidomastoid muscles spasm, and painful neck mobilization. The CAT showed right posterior parapharyngeal abscess. The patient was treated with crystalline penicillin, clindamycin and acetaminophen. The subsequent clinical evolution was excellent, and was discharged after ten days of treatment. ConclusionsThe two infections of the parapharyngeal space have different clinical features, treatment and prognosis. Anterior infections are prone to rapid expansion, leading to potentially fatal complications without fast and aggressive treatment, which includes surgical drainage. On the other hand, posterior space infections have a less aggressive course and usually require medical treatment only.

Accuracy of Ultrasonography Versus Computed Tomography Scan in Detecting Parapharengeal Abscess in Children

Significant morbidity and rarely mortality have been described in parapharyngeal space infections in children; hence, the decision on the timing of surgical intervention might be crucial. The aim of this study was to compare the accuracy of plain x-rays, ultrasonography (US), and contrast-enhanced computed tomography (CT) in demonstrating a parapharyngeal abscess. A retrospective study on all patients with parapharyngeal abscess admitted and operated on from January 1996 to December 2000 was carried out. Charts were reviewed for patients' demographics, symptoms and signs, details of workup, intraoperative findings, and culture results. The CT scans were reviewed for the presence of a rim enhancement, a presence of a definable wall, and fluid-fluid level and were correlated with the plain x-rays and US results and intraoperative findings. Eighteen patients with proven parapharyngeal infection were included: 10 with proven abscess and 8 with cellulitis. The sensitivity and specificity of lateral neck radiograph and US were low compared with a specificity of 87.5 while evaluating fluid-fluid level seen on the CT scan, sensitivity of 58.3% for the presence of a definable abscess wall, and a sensitivity of 100% for the presence of a prominent wall. Our study demonstrates good rates of accuracy of CT scan for diagnosing a parapharyngeal abscess. Our study suggest that it is appropriate to obtain a CT scan upon presentation in all children with suspected parapharyngeal abscess and that a CT scan is proven to be a useful diagnostic tool in establishing a treatment plan.

Two cases of parapharyngeal space infections after streptococcal infection

Two cases of parapharyngeal space infections after streptococcal infection

Hardwood-Nuss’ Clinical Practice of Emergency Medicine, Fifth Edition

Hardwood-Nuss’ Clinical Practice of Emergency Medicine, Fifth Edition

Non-Candida albicansCandidamediastinitis of odontogenic origin in a diabetic patient

Descending mediastinitis occurs as a complication of oropharyngeal or cervical infections and its delayed diagnosis and treatment are associated with high mortality. A rare case of an odontogenic infection in a diabetic patient, complicated by Candida parapsilosis and Candida krusei parapharyngeal space infection, descending mediastinitis and aspiration pneumonia is described. Isolate identification was based on colonial and microscopic morphological characteristics and carbohydrate assimilation test results. The patient was successfully treated with surgical drainage and debridement, broad spectrum antibacterials and liposomal amphotericin B followed by prolonged oral voriconazole therapy.

Ropowica przestrzeni przygardłowej

The abscess of parapharyngeal space is very dangerous health condition graving numerous complications such as: jugular vein thrombosis, mediastinitis, arterial bleeding. This state originates most frequent during the acute pharyngitis, and especially acute tonsillitis. The aim of our study was to review the clinical sings, computed tomography scans and outcome of parapharyngeal space infection. 3 patients treatment in our Department were underwent surgical drainage and aggressive antibiotic therapy. One patient was treated solely with intravenous antibiotic therapy. The average time of hospitalization was 16 days. No one complication was observed.

Parapharyngeal and Retropharyngeal Space Infection of Odontogenic Origin

This report is of a 64-year-old woman with insulin-dependent diabetes and hypertension with a parapharyngeal and retropharyngeal space infection of odontogenic origin. The patient presented with submandibular swelling. After treatment with antimicrobial agents and diabetes control measures, she had initial improvement. Progressive dysphagia, increasing neck pain, and mild dyspnoea occurred on day 8, and imaging revealed abscess formation in the parapharyngeal and retropharyngeal spaces requiring transcervical drainage. On day 15, the associated teeth were extracted. She recovered uneventfully and was discharged from hospital after 30 days.

Redefining Parapharyngeal Space Infections

Our intent was to review the clinical signs, computed tomography (CT) scans, treatment, and outcome of parapharyngeal space infections (PPIs), and to define 2 types of infections of the parapharyngeal space (PPS) according to the location of the infectious process. We performed a retrospective analysis of patients hospitalized in a tertiary university hospital with a diagnosis of PPI, abscess, or deep neck abscess between 1988 and 2004. Files and CT scans were reviewed after classification into 2 groups: 1) infection located in the posterior part of the PPS (PostPPI); and 2) infection located in the anterior part of the PPS (AntPPI). Twenty-two patients had a PostPPI; their ages ranged from 10 months to 24 years. Five patients underwent surgical drainage, and 17 others were treated solely with intravenous antibiotic therapy. No pus was found during surgery in 2 patients. The average time of hospitalization was 10 days. Only 1 complication (aspiration pneumonia) was observed. Seven patients had an AntPPI; their ages ranged from 1.5 years to 65 years. All patients underwent surgical drainage, and pus was detected in all cases. The average time of hospitalization was 35 days. Complications (septic shock, respiratory arrest, mediastinitis, pleural empyema, pericarditis) were observed in 4 patients. The term "parapharyngeal abscess" was assigned long before the CT scan era, and was based on physical examination and plain film radiology. In essence, the entity PPS "abscess" or "infection" is composed of 2 different disorders. Infection located in the posterior part of the PPS with no invasion into the parapharyngeal fat and with no extension into other cervical spaces except the adjacent retropharyngeal space may be termed posterior parapharyngeal infection or parapharyngeal lymphadenitis. This is a relatively benign condition, and nonsurgical treatment should be considered. Infection involving the parapharyngeal fat may be termed parapharyngeal abscess or deep neck abscess. Diffusion into the mediastinum and other severe complications are frequent. Urgent surgical drainage is therefore mandatory.

Imaging findings and significance of deep neck space infection

Objective To study the imaging appearance of deep neck space cellulitis and abscess and to evaluate the diagnostic criteria of deep neck space infection.Methods CT and MRI findings of 28 cases with deep neck space infection proved by clinical manifestation and pathology were analyzed, including 11 cases of retropharyngeal space, 5 cases of parapharyngeal space infection, 4 cases of masticator space infection, and 8 cases of multi-space infection. Results CT and MRI could display the swelling of the soft tissues and displacement, reduction, or disappearance of lipoid space in the cellulitis. In inflammatory tissues, MRI imaging demonstrated hypointense or isointense signal on T_1WI, and hyperintense signal changes on T_2WI. In abscess, CT could display hypodensity in the center and boundary enhancement of the abscess. MRI could display obvious hyperintense signal on T_2WI and boundary enhancement.Conclusion CT and MRI could provide useful information for deep neck space cellulitis and abscess.

副咽頭間隙感染後に続発した外頚動脈りゅう例

Mycotic aneurysms of the extracranial carotid artery are rare lesions. We describe a case of mycotic extracranial carotid aneurysms developing after a parapharyngeal space infection in a 65-year-old-man. The patient had a high fever because of tonsillitis, and it spread to the parapharyngeal space. After the inflammation had passed, a pulsatile mass appeared around the pharynx. Extracranial aneurysms are diagnosed by MRI and DSA (angiography), and are treated with intravascular techniques using mechanical detachable coil (MDC).

Head and neck space infections in infants and children

A retrospective study was performed in 117 children with head and neck space infections treated at the Children's Hospital of Pittsburgh from January 1986 through June 1992. Peritonsillar space infections were the most common (49%), followed by retropharyngeal (22%), submandibular (14%), buccal (11%), parapharyngeal (2%), and canine (2%) space infections. The most common pathogens isolated ( N = 78) were the aerobes β-hemolytic streptococcus (18%) and Staphylococcus aureus (18%), the anaerobes Bacteroides melaninogenicus (17%) and Veillonella (14%), and the gram-negative organism Haemophilus parainfluenzae (14%). β-Lactamase production by aerobic pathogens was detected in 22% of cultures. Computed tomography scans ( N = 16) were reviewed in blinded fashion and compared with operative findings. The sensitivity of computed tomography scan in detecting the presence of an abscess vs. cellulitis was high (91%), whereas the specificity was rather low (60%). Treatment of head and neck space infections in children should consist of accurate physical diagnosis aided by imaging studies, empiric antibiotic therapy that covers gram-negative and β-lactamase–producing organisms as well as gram-positive organisms and anaerobes, and timely surgical intervention, when indicated. (OTOLARYNGOL HEAD NECK SURG 1995;112:375-82.)

Parapharyngeal abscesses

Fifty-five patients with deep neck infections treated consecutively over a period of six and a half years between January 1983 and July 1989 were reviewed. Nine of these patients had abscesses localized to the pharapharyngeal space and form the basis of this study. The aetiology of the parapharyngeal abscess was odontogenic in two patients and remained unknown in the other seven. Five patients had associated systemic disease; four were diabetics and one patient had non-Hodgkin's Lymphoma. High dosage intravenous antibiotics directed towards the causative micro-organisms, airway control and early surgical intervention was the mainstay of treatment. All patients underwent open surgical drainage of the parapharyngeal abscess within 24 h of admission. Bacteriology results showed Klebsiella sp. to be the dominant micro-organism cultured in four patients. Morbidity was low; seven patients had no post-operative complications and were discharged from the hospital between 7-24 d (mean 12.9 d). There were two deaths. Early open surgical drainage remains the most appropriate method of treating parapharyngeal space infections; it avoids life threatening complications with rapid recovery.

Role of Anaerobic Bacteria in Perimandibular Space Infections

This review includes 44 patients with perimandibular space infections admitted to Johns Hopkins Hospital during a 5-year period. The most frequent spaces involved were the submandibular, peritonsillar, and parapharyngeal spaces. As expected, 1) peritonsillar abscesses were invariably associated with pharyngitis, 2) submandibular and buccal space infections generally represented complications of dental infections, and 3) parapharyngeal space infections were associated with both portals of entry. Most patients were treated with drainage procedures, and all received antimicrobial agents, the most common being penicillin. Serious complications included potential airway obstruction requiring tracheostomy in six patients with Fusobacterium bacteremia and two patients with septic emboli to the lung. All patients survived, and most had a relatively brief hospitalization with no sequelae.