1. GOOD MORNING!!! AM Report July 7, 2011

2. CT Neck 1.7x1.1x2.7 cm abscess within the left parapharyngeal space with mild impression on the airway; moderate LAD throughout the neck

3. Deep Neck Space Infections Not common, but definitely worth knowing about!!

4. Facial Spaces Submandibular Parapharyngeal* Retropharyngeal* “Danger” Prevertebral Peritonsillar* Parotid Masticator

5. Peritonsillar and Parapharyngreal Spaces

6. Retropharyngeal Space

7. Abscess Location Peritonsillar Parapharyngeal Retropharyngeal Patient Characteristics Ages 15-30Older children and adults Adults and children (3-5 yo) CausesTonsillitis Dental infxns, peritonsillar abscess (parotitis, otitis, mastoiditis) URI, FB/trauma, pharyngitis Microbiology Polymicrobial; Group A Strep, oral anaerobes Polymicrobial; Group A Strep, Strep viridans, S. epidermidis, oral anaerobes Polymicrobial; Group A Strep, Strep viridans, S. aureus, resp. anaerobes Symptoms High fever, odynophagia, unilateral sore throat, otalgia High fever, rigors, dyspnea, dysphagia/ odynophagia

8. Abscess Location Peritonsillar Parapharyngeal Retropharyngeal Signs/PE Unilateral deviation of uvula (unaffected side) Swelling/induration below angle of mandible, medial bulging of pharyngeal wall, resp. distress, neuro signs# Anterior bulging of the pharyngeal wall neck swelling or torticollis, stridor, tachypnea Evaluation CTABCs, CTABCs, ?lateral neck XR, CT Treatment Drainage; Clinda +/- Vanc Drainage; Vanc/Clinda, (Metronidazole), Ceftriaxone Complications ~Extension into the parapharyngeal space ~Carotid sheath involvement ~Supurrative jugular thrombophlebitis ~Airway compromise ~Acute necrotizing mediastinitis  abscess in pleural cavity, pleural/ pericardial effusion ~Airway compromise

9. CT; Clinda/Rocephin 4 yo M with h/o recent BOM presents with a 2d h/o fever, sore throat and decreased PO intake. On PE, he appears ill but non-toxic. His posterior pharynx appears clear, but it’s difficult to appreciate since he won’t open his mouth very wide. You notice he keeps his head turned to the right, and he doesn’t want you to palpate his neck. You get a lateral neck XR…

10. Group A Strep, S.aureus, anaerobes 16 yo female presents with a several day h/o fever and sore throat now with significant pain with swallowing. She does note that it hurts less to swallow on her right side. She woke up this AM with significant left-sided ear pain. On PE…

11. Parapharyngeal abscess 18 yo M with a 2 day h/o fever, and difficulty with swallowing. Symptom onset was after trip to the dentist early this week. Today, he presented secondary to some swelling on the L side of jaw. On PE…

12. Have a great day! Noon Conference: Dr. Velez, Heme/Onc Emergencies