Parapharyngeal space infection
Background
- The parapharyngeal space is one of three potential spaces that can cause deep neck space infections
- retrophanygeal space
- submandibular space
- parapharyngeal space
- Infections arise from foci in the mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes, middle ear, or sinuses.
- Polymicrobial
- Proximity to the carotid sheath makes erosion into vasculature a possible complication
Clinical Features
- Sore throat
- Trismus
- Swelling below angle of mandible
- Lymphadenopathy
- Poor handling of oral secretions
- Asymetric pharyngeal swelling
- Fevers/chills
Differential Diagnosis
Bacterial infections
- Streptococcal pharyngitis (Strep Throat)
- Neisseria gonorrhoeae
- Diphtheria (C. diptheriae)
- Bacterial Tracheitis
Viral infections
- Infectious mononucleosis (EBV)
- Patients with peritonsillar abscess have a 20% incidence of mononucleosis [1]
- Laryngitis
- Acute Bronchitis
- Rhinovirus
- Coronavirus
- Adenovirus
- Herpesvirus
- Influenza virus
- Coxsackie virus
- HIV (Acute Retroviral Syndrome)
Other
- Deep neck space infection
- Peritonsillar Abscess (PTA)
- Epiglottitis
- Kawasaki disease
- Penetrating injury
- Caustic ingestion
- Lemierre's syndrome
- Peritonsillar cellulitis
- Lymphoma
- Internal carotid artery aneurysm
- Oral Thrush
- Parotitis
- Post-tonsillectomy hemorrhage
- Vincent's angina
- Acute necrotizing ulcerative gingivitis
Evaluation
- CT neck soft tissues with IV contrast
- MRI neck
Management
- ABC's
- ENT Consult for potential surgical drainage
- Antibiotics (ampicillin-sulbactam, clindamycin, penicillin plus metronidazole)
- Analgesia
Disposition
- Admit to ICU
See Also
References
- Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
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