Hyphalic abscess: causes, symptoms, diagnosis, treatment

Hyperal abscess (retropharyngeal abscess, posterior pharyngeal abscess) - purulent inflammation of the lymph nodes and loose fiber between the fascia of the pharyngeal musculature and the pre-invertebrate fascia.

ICD-10 code

D39.0 Retropharyngeal abscess.

Epidemiology of the abscess abscess

The disease occurs almost exclusively in childhood due to the fact that lymph nodes and loose fiber in this area are well developed up to 4-5 years of age, and then undergo involute changes

In adults, retropharyngeal abscess is extremely rare and usually of a secondary nature; is of a severe type in tuberculosis and with syphilitic spondylitis of the upper cervical vertebrae, with their trauma.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]

Causes of a pharyngeal abscess

The etiology of the abscess is the same as in paratonsillitis.

[14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25]

Pathogenesis of the retropharyngeal abscess

In children, the retrograde abscess occurs as a result of the spread of infection to the lymph nodes in acute rhinopharyngitis, angina, acute infectious diseases (measles, diphtheria, scarlet fever); the disease can be associated with trauma of the posterior pharyngeal wall, adenotomy. The cause of infection of the pharyngeal space can be a purulent process in the auditory tube and the tympanum. Deep swollen lymph nodes represent the first barrier and play the role of regional lymph nodes for the posterior sections of the nasal cavity, nasopharynx, auditory tube and middle ear. Infection spreads through the venous or lymphatic pathways or by a contact route.

The disease is predisposed to metabolic disorders, weakened immunity, reduced nutrition. Weakened children are more likely to have a pharyngeal abscess. A certain role in the infection of the zasopharyngeal space in infants is played by cracks in the mother's nipple and the initial forms of mastitis.

Symptoms of retropharyngeal abscess

The most frequent is the acute course of the retrofaringueal abscess, less often subacute and chronic. The disease is severe, characterized by a significant increase in temperature (up to 38-39 ° C). There are signs of intoxication, weakness, sweating. Head position forced, with inclination to the sore and behind; there is a moderate stiff neck, hypersalization, painful and limited opening of the mouth.

Symptomatology depends on the localization of the pharyngeal abscess: in the upper, middle or lower parts of the pharynx. When it is located in the upper part, there is difficulty in nasal breathing, accompanied by nasal, and in infants - a violation of the act of sucking. With the localization of the pharyngeal abscess in the oral part of the pharynx, swallowing is disturbed, a pharyngeal stridor appears. With an abscess of the lower part of the pharynx, compression of the entrance to the esophagus and trachea occurs - there is a difficulty in breathing, especially pronounced in the horizontal position of the child. Breathing becomes wheezing and resembles the sound of a working saw, sometimes the voice acquires a hoarse hue.

A constant symptom of the retropharyngeal abscess is the swelling, painfulness of the lymph nodes of the medulla and the posterior cervical lymph nodes, due to which the involuntary position of the head appears (inclination and the patient side).

Screening

An otorhinolaryngologist examines children with cervical lymphadenitis, difficulty swallowing, breathing, nasal, forced head position.

Diagnosis of pharyngeal abscess

When pharyngoscopy is defined as hyperemic, round or oval, asymmetrically located protrusion of the mucous membrane of the posterior pharyngeal wall, often fluctuating upon palpation. With the location of the pharyngeal abscess in the upper pharynx, this protrusion is seen in posterior rhinoscopy, with localization and the laryngopharynx with hypopharyngeal obstruction. In young children, palpation is often the only possible way of research; while under the finger feel an elastic, mostly fluctuating, usually a little lateral from the middle line swelling.

The palpation of the protrusion is sharply painful, and with a pharyngeal abscess of otogenic origin, due to palpation, pus appears in the external auditory cause of the corresponding side.

The chronic course of the retropharyngeal abscess occurs more often in adults with spondylitis of tubercular or syphilitic etiology, proceeds for a long time, the symptoms are not pronounced.

[26], [27], [28], [29], [30], [31], [32]

Laboratory research

Usually, an inflammatory reaction of the blood is detected: leukocytosis up to 10-15x10 ⁹ / l, shift of the leukocyte formula to the left, an increase in ESR to 40-50 mm / h.

In addition, puncture the infiltrate with subsequent microbiological examination of the contents, as well as a blood test with the Wasserman reaction.

Instrumental diagnostics

CT, X-ray of the pharynx.

In the X-ray examination of the pharynx in the lateral projection, the inflammatory process in the pharyngeal space is characterized by the widening of its shadow; The retropharyngeal abscess is revealed in the form of a limited shadow in a certain area.

Differential diagnosis of the abscess abscess

Most often, the pharyngeal abscess has to be differentiated from the paratonsillar abscess due to the displacement of the amygdala and arch on the side of the lesion. It should be borne in mind that with the gullet abscess the amygdala and the soft palate are not inflamed; in a doubtful case it is necessary to carefully examine the back wall of the pharynx, as well as soft palate and arches.

When the abscess is located in the laryngopharynx, its symptoms resemble signs of edematous laryngitis, lumbar lining, a clinical picture of the foreign body of the larynx.

In older children and in adults, the zygopharyngeal abscess must be differentiated from the "cold" silt of tuberculosis etiology. With tuberculosis, the process is chronic, prolonged, accompanied by general tuberculous intoxication, subfebrile temperature, mild general and local symptoms. With a tuberculous abscess, children complain of pain in the region of the suboccipitary fossa, which increase with the movements of the head, and try to keep the head still. Additional information is provided by the x-ray of the cervical spine, in which it is possible to detect lesions of the vertebral bodies.

In the differential diagnosis of the abscess of the pharyngeal abscess with neoplasms of the posterior pharynx and spine, the slow increase of the latter without a rise in temperature is taken into account. Mandatory finger examination and puncture biopsy.

In some cases, the retropharyngeal abscess is differentiated with retrofaringealnaya lymphadenopathy, vertebral osteomyelitis, an aneurysm of the ascending pharyngeal artery.

[33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45]

Indications for consultation of other specialists

• Phthisiatrician for suspected tuberculosis.
• Traumatologist for suspected osteomyelitis of cervical vertebrae.
• Oncologist with a suspected malignant tumor.

Treatment of the abscess abscess

Objectives of treatment

Kupirovanie inflammatory phenomena, drainage of a purulent focus.

Indications for hospitalization

Patients with this disease are subject to emergency hospitalization and inpatient treatment in the ENT department.

Non-drug treatment

The elder children are prescribed warm rinses with weak disinfectant solutions. Thermal procedures, UHF at the initial stage of the disease or at the stage of process abatement.

Medication

The appointment of broad-spectrum antibiotics, antihistamines.

Surgery

Spontaneous dissection of the retropharyngeal abscess occurs late, can lead to asphyxia; prolonged constriction in the pharynx disrupts nutrition and breathing, leads to exhaustion, anemia and cachexia. It is for these reasons that the revealed abscess is opened as early as possible. To prevent the aspiration of pus in the underlying airways, pre-puncture the abscess with a thick needle and aspirate the pus with a syringe. Autopsy is performed through the mouth under local anesthesia or under anesthesia. A narrow scalpel is wrapped with cotton wool or a band-aid, leaving only its end (0.5-1.0 cm) free.

Opening is best done in the position of a child lying down with a head bent backwards. Under the eyesight control squeegee the tongue and make a cut at the place of greatest bulging, but not further than 3-4 mm from the midline. It is advisable at the same time to aspirate pus with suction. After opening and sucking off the pus, for complete evacuation of it from the abscess, the edges of the incision are diluted with Hartmann's forceps. After opening, continue to rinse the throat and antibiotic.

Specific "cold" filaments do not open in order to avoid secondary infection, and against a background of anti-tuberculosis or anti-syphilitic treatment, repeated punctures are performed with suction of pus and subsequent administration of specific medicinal solutions.

Further management

Increase in the level of nonspecific resistance of the body.

How to prevent the abscess of the abscess?

Carrying out in children activities aimed at increasing the overall resistance of the body.

What prognosis does the pharyngeal abscess have?

With a timely recognition and surgical treatment of the abscess, the prognosis is usually favorable. Approximate terms of incapacity for work are 7-14 days.