Peritonsillar Abscess

imagesClinical suspicion

   imagesSwollen/red peritonsillar region causing uvular shift

   imagesFluctuance of area

imagesInterim treatment for peritonsillar closed space infection until tonsillectomy


imagesExtension into the deep neck tissue

imagesSepticemia/toxic appearance

imagesAirway obstruction

imagesSevere trismus


imagesGeneral Basic Steps

   imagesPatient preparation



   imagesNeedle aspiration/incision and drainage (I&D)


imagesSuperior lateral border of affected tonsil, or area of most fluctuance

imagesAspirate peritonsillar abscess’ (PTA’s) superior pole first, then middle pole, and finally the inferior pole (FIGURE 76.1)


imagesPatient Preparation

   imagesCooperative patient sitting upright in a chair with occipital support

   imagesConsider intravenous analgesia or sedation

   imagesDigital exam key: Must feel abscess!

   imagesUse ultrasound (endocavitary probe) to assess volume, location, and relationship to the carotid artery (FIGURE 76.2)

imagesNeedle Aspiration

   imagesAnesthetize with benzocaine spray or have patient gargle viscous lidocaine

   imagesHave patient depress own tongue by holding laryngoscope, insert as you would for intubation. Patient will be less likely to trigger own gag reflex while pulling down on blade (FIGURE 76.3)

   imagesAnesthetize locally with 1 to 2 mL of 1% lidocaine via 27-gauge needle

   imagesUse a long spinal needle so visualization is not obscured by syringe

   imagesCut the distal 1 cm off of the needle cover and recap the needle, thereby preventing the needle from penetrating >1 cm (FIGURE 76.4)

   imagesInsert spinal needle at area of greatest fluctuance (usually the superior pole) and aspirate the pus


FIGURE 76.1 A: Peritonsillar abscess. The tonsil is displaced forward and inferomedial, the uvula is deviated toward the unaffected tonsil, and the soft palate is edematous and ruborous. B: Recommended sites for three-point needle aspiration of a peritonsillar abscess. (From Saladino RA. Pharyngeal procedures. In: Henretig FM, King C, eds. Textbook of Pediatric Emergency Procedures. Philadelphia, PA: Williams & Wilkins; 1997:692, 696, with permission.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Peritonsillar Abscess
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