Retrotonsillar abscess
| Classification according to ICD-10 | |
|---|---|
| J36 | Peritonsillar abscess |
| ICD-10 online (WHO version 2019) | |
A retrotonsillar abscess is an inflammatory mass in the area of the palatine tonsil ( tonsilla palatina ). It is a form of the peritonsillar abscess (syn .: paratonsillar abscess).
Etiology / pathogenesis
The abscess develops between the tonsil capsule and the posterior palatal arch (arcus palatopharyngeus). The cause is usually an aerobic-anaerobic mixed infection with group A streptococci . The inflammation ultimately leads to edema of the larynx (edema of the lateral hypopharyngeal wall and the ary region).
clinic
It is characterized by severe reddening and bulging of the posterior palatal arch . Edema is found on the lateral wall of the hypopharynx and the ary region . The uvula is pushed to the opposite side. There are also swallowing difficulties with severe unilateral pain, lumpy speech, possibly bad breath and, as a result of an infiltration of the medial pterygoid muscle, possibly a jaw clamp .
Diagnosis
Diagnosis is more difficult due to its hidden location than with peritonsillar abscesses further forward. In addition to anamnesis, inspection and palpation, the nasopharynx can be examined with the help of an endoscope. To verify the exact extent of the abscess, computed tomography (CT) or an examination using an ultrasound B-scan are suitable .
therapy
In addition to an antibiotic cover, an operative abscess tonsillectomy - the so-called “hot” tonsillectomy - is recommended for manifest abscesses . If necessary, the abscess can also be emptied by clearing and spreading it and a tonsillectomy can be performed in a second session.
Complications
Due to its location, the abscess can sink towards the larynx, obscuring the larynx and causing shortness of breath and suffocation. The abscess can also sink into the mediastinum .
