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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 21
ABSCESSES OF THE PHARYNX

ACUTE RETROPHARYNGEAL ABSCESS

The prevertebral fascia stretching across the midline separates the visceral
compartment of the pharynx and neck from the prevertebral muscles and
cervical vertebrae. Between the pharynx and the prevertebral muscles, on
either side of the midline, is a potential space, the space of Gilette, which
contains the retropharyngeal lymph glands. These glands are present in
infancy but gradually disappear as the child gets older. Infection of the deep
cervical glands may readily pass to the retropharyngeal group to give rise to
abscess formation {Plate VI, 1). The most frequent cause is the haemolytic
streptococcus. The acute abscess occurs only in infants under 1 year.

SYMPTOMS. The infant is irritable and may refuse feeds while the abscess is
developing. At this stage localizing signs are few. When the abscess has
developed there is pyrexia and the infant is obviously in considerable pain.
Because of the proximity of the abscess to the cervical vertebrae any movement
of the head causes agony, and the baby lies with the head stiff and often
extended, sometimes in opisthotonos. Any extension downwards of the abscess
impairs the airway so that there is stridor and a muffled cry and croupy cough.

CLINICAL FEATURES. The swelling of the posterior pharyngeal wall, to one
side of the midline, is apparent on inspection. Should there be a downwards
extension there will be inspiratory stridor and suprasternal indrawing.
Palpation may demonstrate fluctuation, and lateral radiography will show the
size and extent of the abscess in the prevertebral region.

TREATMENT. The abscess is not usually seen until it has fully developed, and
at this stage the only treatment is incision and drainage. General anaesthetic
is dangerous because of the impaired airway. The infant is wrapped in a
binder and held upright by a nurse. The abscess is opened with sinus forceps
which are plunged into the swelling closed and then opened to release a
copious flow of pus which is under considerable tension. The baby is turned
upside down to allow the pus to escape. This results in an immediate cure.
Feeding becomes easy, the temperature drops and movement of the head is
once again possible. Antibiotics are not usually necessary.

CHRONIC RETROPHARYNGEAL ABSCESS

The chronic abscess is secondary to tuberculous involvement of the cervical
spine, the deep cervical glands or the middle ear cavity. It occurs in the older
child or young adult. It is of slow onset and gives rise to pharyngeal dis-
comfort, rather than pain, and to some degree of dysphagia. The lesion in the
cervical spine will be seen on radiography, and the tuberculous cervical glands

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