Most common cause of parapharyngeal abscess in adults?
Ans. is 'b' i.e., Tooth extraction Lateral pharyngeal abscess (parapharyngeal abscess) is either due to tonsillitis or due to tooth infection/extraction. In adults, tonsillitis does not occur usually (tonsillitis occurs usually in children). Thus, in adults it is due to tooth infection or extraction. Parapharvngeal abscess Parapharyngeal space As the name suggests, parapharyngeal space, it is the space on both side of the pharynx, i.e. lateral to the pharynx - lateral pharyngeal space. It is also known as pharyngomaxillary space. It is pyramidal in shape with base at the base of skull and apex at the hyoid bone. Relations Medial : Buccopharyngeal fascia covering the constrictor muscles. Posterior : Preveebral fascia covering preveebral muscles and transverse processes of cervical veebrae. Lateral : Medial pterygoid muscle, mandible and deep surface of parotid gland. Divisions of parapharyngeal space Styloid process and the muscles attached to it divide the parapharyngeal space into anterior and posterior compaments. Anterior compament is related to tonsillar fossa medially and medial pterygoid muscle laterally. Posterior compament is related to posterior pa of lateral pharyngeal wall medially and parotid gland laterally. Through the posterior compament pass the carotid aery, jugular vein, IV, Xth,XIth, XII" cranial nerves and sympathetic trunk. Clinical features of parapharyngeal abscess This is rare site to get infection. Sixty per cent of patients develop it as a complication of tonsillitis or tonsillectomy and 40 per cent as a result of either infection or extraction of lower third molar tooth. Mastoid infection can extend into the space on rare occasions. There is fever and marked trismus because of spasm in medial pterygoid muscle. The tonsil, if it is normal, is pushed medially. The most marked swelling is in the neck at the posterior pa of the middle third of the sternomastoid (behind the angle ofjaw). There may also be swelling in retromolar area. There is toicollis (due to spasm of preveebral muscles), sore throat, marked odynophagia and signs of toxemia. Fuher extension of disease may cause involvement of IX, X, XI, XII cranial nerve and sympathetic chain.
TB
Tooth extraction
Tonsillitis
Lymphadenitis