THE PHARYNX AND NASOPHARYNX
may be diagnosed on palpation. The ipsilateral ear must be examined for
evidence of tuberculosis. The abscess is opened through an incision over the
posterior border of the sternomastoid muscle, and the abscess is sought for by
dissection between the carotid sheath and the prevertebral muscles, and is
drained from the neck. Full antituberculous therapy must be ordered.
This is an uncommon condition, usually arising after removal of the tonsils
when there has been a tear of the pharyngeal wall, but it may accompany a
severe tonsillar infection. There is a rapid spread of infection into the
mediastinum along the tissue planes, and air in the parapharyngeal tissues
produces surgical emphysema of the neck. Trismus makes inspection difficult,
and the abscess may be mistaken for a quinsy. Treatment is by free incision
either through the pharynx or through the neck if a course of antibiotics does
not improve the condition. Tracheostomy may be necessary on account of
an extension involving the larynx.