Kemudian dapat terjadi penjalaran ke mediastinum menimbulkan mediastinitis. Bila terjadi penjalaran ke daerah intracranial, dapat mengakibatkan thrombus sinus kavernosus, meningitis, dan abses otak. Pada stadium infiltrasi, diberikan antibiotika dosis tinggi dan obat simtomatik. Juga perlu kumur-kumur dengan air hangat dan kompres dingin pada leher. Antibiotik yang diberikan ialah penisilin Bila telah terbentuk abses, dilakukan pungsi pada daerah abses, kemudian diinsisi untuk mengeluarkan nanah.
Tempat insisi ialah di daerah yang paling menonjol dan lunak, atau pada pertengahan garis yang menghubungkan dasar uvula dengan geraham atas terakhir. Intraoral incision dan drainase dilakukan dengan mengiris mukosa overlying abses, biasanya diletakkan di lipatan supratonsillar. Drainase atau aspirate yang sukses menyebabkan perbaikan segera gejala-gejala pasien. Bila terdapat trismus, maka untuk mengatasi nyeri, diberikan analgesia lokal di ganglion sfenopalatum. Kemudian pasien dinjurkan untuk operasi tonsilektomi a chaud.
Bila tonsilektomi dilakukan hari setelah drainase abses disebut tonsilektomi a tiede, dan bila tonsilektomi minggu sesudah drainase abses disebut tonsilektomi a froid. Pada umumnya tonsilektomi dilakukan sesudah infeksi tenang, yaitu minggu sesudah drainase abses2. Tonsilektomi merupakan indikasi absolut pada orang yang menderita abses peritonsilaris berulang atau abses yang meluas pada ruang jaringan sekitarnya.
Abses peritonsil mempunyai kecenderungan besar untuk kambuh. Sampai saat ini belum ada kesepakatan kapan tonsilektomi dilakukan pada abses peritonsil.
Sebagian penulis menganjurkan tonsilektomi 6 8 minggu kemudian mengingat kemungkinan terjadi perdarahan atau sepsis, sedangkan sebagian lagi menganjurkan tonsilektomi segera. Gambar 3. Pada saat tersebut peradangan telah mereda, biasanya terdapat jaringan fibrosa dan granulasi pada saat operasi. Telinga, Hidung dan Tenggorokan. Jakarta: FKUl, 2.
Mehta, Ninfa. Peritonsillar Abscess. Available from. Accessed at Juni 3. Caparas, Lim. Basic Otolaryngology. Filipina: university of the Philippines. Buka menu navigasi. Tutup saran Cari Cari. Pengaturan Pengguna. Lewati carousel. Karusel Sebelumnya. Karusel Berikutnya. Apa itu Scribd? Jelajahi eBook. Terlaris Pilihan Editor Semua eBook. Jelajahi Buku audio. Terlaris Pilihan Editor Semua buku audio. Jelajahi Majalah. Pilihan Editor Semua majalah. Jelajahi Podcast Semua podcast.
Kesulitan Pemula Menengah Lanjutan. Jelajahi Dokumen. Abses Peritonsiler 2. Diunggah oleh happyvillagers. Informasi Dokumen klik untuk memperluas informasi dokumen Judul Asli abses peritonsiler 2. Apakah menurut Anda dokumen ini bermanfaat? Apakah konten ini tidak pantas? Laporkan Dokumen Ini. Tandai sebagai konten tidak pantas. Unduh sekarang. Simpan Simpan abses peritonsiler 2 Untuk Nanti. Judul Asli: abses peritonsiler 2. Judul terkait.
Karusel Sebelumnya Karusel Berikutnya. Lompat ke Halaman. Cari di dalam dokumen. Medikamentosa Antibiotik yang diberikan ialah penisilin A, Iskandar, H. Dokumen Serupa dengan abses peritonsiler 2. Taufik Abidin. Septia Nindi F. Rani Tiyas Budiyanti. Riska ULy. Arung Widyaswara. Miya Elmira. Ika Ayu Dewi Satiti. Cininta Anisa Savitri. Quamila Fahrizani Afdi. Rizka Dana Prastiwi. Yudis Diana. Putry Roro. Zarah Alifani Dzulhijjah. Andriawan Bram. Bumi Zulheri Herman.
Aiq Qia. Brian Eka Putera. Harief Seamaladi. Anonymous WjXMw0. Lainnya Dari happyvillagers. Dacxa Groham. Nuzulut Fiana. Inez Hanindra Halim. It is more common among the adolescent population although it can occur in any group.
There is no sexual or racial predilection. In the United States, the incidence is 30 per , among patients who are 5 to 59 years of age. Peritonsillar abscess is rare below five years of age. The exact pathophysiology of peritonsillar abscess formation remains unknown to date.
The most accepted theory is that an infection develops in crypta magna that then spreads beyond the confines of the tonsillar capsule, initially causing peritonsillitis and then developing into a peritonsillar abscess. Another proposed mechanism is necrosis and pus formation in the capsular area which then obstructs the webers glands, resulting in abscess formation.
These are minor salivary glands in peritonsillar space which are responsible for clearing debris from the tonsillar area. The occurrence of peritonsillar abscess in patients who have undergone tonsillectomy further support this theory. The patient mainly complains of progressively increasing pain in the throat which is usually unilateral. There may be referred earache on the same side. Associated odynophagia painful swallowing is present, which in certain cases becomes so severe that the patient cannot swallow his or her saliva.
This results in poor oral hygiene and oral sepsis-causing halitosis foul breath. As the abscess size progresses, it may result in muffled speech or "hot potato" voice. Neck pain develops secondary to inflamed cervical lymph nodes. Trismus inability to open mouth of varying severity occurs in almost every case due to inflammation of the pterygoid muscles, which lie near the superior constrictor muscles. Other accompanying features include fever with rigors and chills, malaise, body aches, headache, nausea, and constipation.
As the inflammation proceeds, an abscess may extend to the parapharyngeal and prevertebral space, causing respiratory distress. On examination, the patient is usually ill-looking and febrile. On local examination, there is trismus of varying degree. The tonsil is found pushed downward and medially; it blanches on applying slight pressure. The uvula is swollen and edematous and pushed to the opposite side.
There is a bulge on the soft palate and anterior tonsillar pillar. Mucous may be seen overlying the tonsillar region. Cervical lymphadenopathy is seen, usually in the jugulodigastric lymph nodes. Torticollis may be seen as the patient keeps the neck tilted on the affected side.
The patient is hospitalized. Intravenous fluids are started, as the patient is usually dehydrated. A suitable intravenous antibiotic is started. The antibacterial spectrum should include gram-positive, gram-negative, and anaerobes.
Ideally, antibiotic therapy should be started as per culture sensitivity reports. A patient is shifted to oral antibiotics once he improves and can tolerate orally. The role of steroids is controversial. A study shows that a single dose of intravenous IV dexamethasone reduces the hospital stay and severity of symptoms. These conservative measures can cure peritonsillitis; however, for peritonsillar abscess, drainage is a must along with medical management.
Aspiration with a wide-bore needle serves both diagnostic and therapeutic purposes. The aspirated pus can be sent for culture sensitivity, and in some cases, further incision and drainage may not be required. Intraoral incision and drainage are carried out in a sitting position to prevent aspiration of pus. The incision is given at the point of the maximum bulge above the upper pole of the tonsil. Another alternative site for incision is lateral to the point of junction of the anterior pillar with a line drawn through the base of the uvula.
Quinsy forceps or No. The opening created is left open to drain, and the patient is asked to gargle with sodium chloride solution. This helps in self-drainage of accumulated material. In uncooperative, young patients or those affected in an unusual location, the procedure might have to be done under general anesthesia.
The prognosis in most patients is excellent. However, if there are airway compromise and delay in treatment, death can occur. Peritonsillar abscess is usually managed by a team of healthcare professionals which include an ENT surgeon, primary care physician, emergency department physician, nurse, and pharmacist. Following treatment, followup is necessary to ensure recovery and the ability to consume an oral diet. The peritonsillar area must be examined at the clinic visit to ensure that there is no more abscess or reaccumulation of an abscess.
In addition, the head and neck should be examined to ensure that the cervical adenopathy is resolving. Any patient with signs of recurrence should be referred back to the ENT surgeon for a formal tonsillectomy.
The majority of patients with peritonsillar abscess who undergo prompt drainage and are treated with antibiotics recover within days. The risk of recurrence is highest in young people who have experienced five or more episodes of tonsillitis.
After treatment, there is usually no residual sequelae. Complications like bleeding have been reported in less than 0. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Affiliations 1 IGMC. Continuing Education Activity Peritonsillar abscesses are localized collections of pus in peritonsillar space between the tonsillar capsule and superior constrictor muscle.
Introduction Peritonsillar abscess, also known as quinsy, is the localized collection of pus in peritonsillar space between the tonsillar capsule and superior constrictor muscle. Clinical Anatomy Peritonsillar space consists of loose connective tissue between the fibrous capsule of palatine tonsils medially and superior constrictor muscle laterally. Etiology Peritonsillar abscess usually occurs following acute tonsillitis.
Epidemiology Peritonsillar abscess is a common infection of the head and neck region. Pathophysiology The exact pathophysiology of peritonsillar abscess formation remains unknown to date.
History and Physical The patient mainly complains of progressively increasing pain in the throat which is usually unilateral. Evaluation Diagnosis and Work Up Diagnosis of peritonsillar abscess is usually made clinically by any of the following features: Unilateral swelling of the peritonsillar area. C-reactive protein blood culture might be required in patients presenting with features of sepsis. Contrast-enhanced CT is required in a very young patient where clinical diagnosis or in cases with other complications like the development of parapharyngeal or retropharyngeal abscess is not feasible.
Intraoral ultrasonography is a simple, non-invasive imaging modality proposed to differentiate peritonsillitis from a peritonsillar abscess. Another important use is in the exact localization of site for abscess drainage. Analgesics and antipyretics are given to relieve pain and fever. Surgical Management Aspiration with a wide-bore needle serves both diagnostic and therapeutic purposes.
Differential Diagnosis Dental infections. Complications Rare complications of peritonsillar abscess include: Parapharyngeal abscess.
Pearls and Other Issues The prognosis in most patients is excellent. Enhancing Healthcare Team Outcomes Peritonsillar abscess is usually managed by a team of healthcare professionals which include an ENT surgeon, primary care physician, emergency department physician, nurse, and pharmacist. Review Questions Access free multiple choice questions on this topic. Comment on this article.
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