Paratonsillar abscess (paratonsillitis): treatment

The goals of the treatment of paratonzillar abscess (paratonzillita) - the coping of inflammatory phenomena at the stage of edema and infiltration, drainage of the purulent process, removal of the focus of infection.

Indications for hospitalization

Patients with signs of abscessing are subject to inpatient treatment. If in the initial stages of paratonsillitis, when there is edema and tissue infiltration, conservative treatment is justified, then in the presence of signs of abscessing, surgical intervention (abscess opening or, in the presence of indications, the implementation of tonsillitis abscess) is unconditionally indicated.

Non-drug treatment of paratonzillar abscess

It is possible to use various thermal procedures, UHF therapy at the onset of the disease (in the stage of edema and infiltration), and after achieving adequate drainage of the purulent process (in the stage of arresting inflammatory phenomena). However, at the stage of abscessing, thermal procedures are not shown. Apply rinsing of the throat with solutions of disinfectants, solutions of chamomile, sage, salt solution, etc.

Medicamentous treatment of paratonzillitis

The isolated pathogens show the greatest sensitivity to such drugs as amoxicillin in combination with clavulanic acid, ampicillin in combination with sulbactam, cephalosporin II-III generations (cefazolin, cefuroxm), lincosamides (clindamycin); effectively their combination with metronidazole, especially in cases where the participation of anaerobic flora

At the same time, detoxifying and anti-inflammatory therapy is prescribed antipyretic drugs and analgesics.

Taking into account the deficit of all links of the immune status revealed in patients with paratonzillitis, the use of drugs with immunomodulating effect (azoxime, sodium deoxyribonucleinate) is shown.

Surgery

When the abscess ripens, usually on the 4th-6th day, one should not wait for its self-opening and emptying. In such cases, it is advisable to open the abscess, especially since a spontaneously formed opening is often not enough for rapid and persistent emptying of the abscess.

Autopsy is performed after local anesthesia by lubricating or pulverizing the pharynx with a 10% solution of lidocaine, sometimes supplemented with infiltration of tissues with 1% procaine solution or 1-2% lidocaine solution. The incision is made on the site of greatest bulging. If there is no such reference point, then in a place where a spontaneous dissection usually occurs, at the intersection of two lines: a horizontal, soft palate along the lower edge of the healthy side through the base of the tongue, and a vertical line that extends upward from the lower end of the anterior arch of the diseased side.

An autopsy in this area is less dangerous in terms of injuring large blood vessels. The incision with a scalpel is performed in the sagittal direction to a depth of 1.5-2 cm and a length of 2-3 cm. Then through the incision, Hartmann's forceps are inserted into the wound cavity and dilate the aperture to 4 cm, simultaneously rupturing possible bridges in the abscess cavity.

Sometimes the opening of the paratonsillar abscess is performed only with the help of Hartmann forceps or Schneider's instrument specially designed for this purpose. The Schneider tool is used to open the paratonsillar abscess of the anterolateral localization through the supramaxel fossa. In the posterior paratonsillitis, the incision is made behind the palatine tonsil at the site of the largest protrusion (the depth of the incision is 0.5-1 cm), with the lower location of the abscess - the incision in the lower part of the anterior arch to a depth of 0.5-1 cm. The abscess of the outer localization (lateral) it is difficult, and spontaneous breakthrough here does not occur more often, therefore abscessesillectomy is shown. Sometimes the path formed for the outflow of pus is closed, so it is necessary to repeatedly open the wound and empty the abscess.

In recent decades, more and more widespread recognition and dissemination and clinics have received active surgical tactics in the treatment of paratonzillitis - the implementation of abscessesillisectomy. When a patient is treated with a paratonsillar abscess or paratonzillitis in the infiltration stage, the operation is performed in the first day or even hours (the "hot" period), or within the next 1-3 days ("warm" period). It should be noted that the postoperative period in this case is less severe and less painful than after opening the abscess or performing surgery in later periods.

Indications for the performance of abscessesilllectomy in a patient with abscessed or infiltrative forms of paratonzillitis are as follows:

• relapsing for a number of years of angina, which indicates the presence of a patient with chronic tonsillitis: an indication of a patient with paratonzillitis on the previously diagnosed tonsillitis diagnosed;
• repeated piratonsillitis and anamnesis;
• unfavorable localization of the abscess, for example, lateral, when it can not be effectively opened and drained;
• absence of changes in the patient's condition (heavy or heaviness increases) even after opening the abscess and getting pus;
• appearance of signs of complication of paratonzillitis - sepsis, parafaringitis, neck phlegmon, mediastinitis.

The question of whether the removal of the second amygdala with abscessesilllectomy is somewhat justified, on the opposite side to the abscess, is decided individually. However, studies conducted in recent studies show significant pathological changes in the tissue of the intact amygdala, similar to those with a pronounced (toxico-allergic form of grade II) chronic inflammatory process. This indicates the expediency of simultaneous removal of both tonsils. The operation should begin with a patient with tonsils, as this facilitates the intervention on the other side.

Further management

If patients have chronic tonsillitis I or II toxic-allergic degree, they are subject to follow-up, treatment courses. Patients with chronic tonsillitis II toxic-allergic degree are recommended bilateral tonsillectomy in a planned manner, not earlier than a month after the transferred paratonzillitis,

Forecast

The prognosis for paratonheillitis is generally favorable. Approximate terms of temporary incapacity for work are 10-14 days.