1. Peritonsillar Abscess Drainage Kalpesh Patel, MD Department of Pediatric Emergency Medicine February 13, 2008

2. 2 Objectives  To review the clincial features of peritonsillar abscess.  To review the anatomy of the posterior pharynx  To learn the procedure for needle aspiration of peritonsillar abscess  To learn the procedure for incision and drainage of peritonsillar abscess  To review post surgical treatment

3. 3 Etiology  AKA quincy  Affects adolescents more often than young children  Most commonly due to Group A Streptococcus and occasionally Staphylococcus aureus.

4. 4 Signs and Symptoms  “Hot potato voice”  Trismus and difficulty speaking  Asymmetric tonsillar enlargement  Uvula pushed away from abscess  Fluctuant mass frequently palpable

5. 5 Anatomy  Avoid laterally directed aspiration or incision  Branches of facial artery  Carotid artery 2cm lateral to tonsillar fossa

6. 6 Procedure  Anesthesia: 20% Benzocaine spray 1% Lidocaine with epinephrine injected peripherally around site with 30 gauge needle

7. 7 Tool Prep

8. 8 Needle Aspiration  5 or 10 ml luer lock syringe  18 or 20 gauge needle, LONG  Custom tongue depressor  3 tries

9. 9 Incision and Drainage  Needed for incomplete needle aspiration  #11 or 12 scalpel blade  Scalpel taping  Vertical incision through mucosa  Curved hemostat to break up loculations  Swab inside of abscess for culture

10. 10 Gross Video  http://video.google.com/videoplay?docid=- 6675382015910424364&q=peritonsillar+abscess&t otal=3&start=0&num=10&so=0&type=search&plind ex=0 http://video.google.com/videoplay?docid=- 6675382015910424364&q=peritonsillar+abscess&t otal=3&start=0&num=10&so=0&type=search&plind ex=0

11. 11 Post Surgical Management  Clindamycin