The Efficacy of Needle aspiration along with antibiotics and short dose of steroid in the treatment of Peritonsillar abscess (Quinsy).

Background: Quinsy (also known as Peritonsillar abscess) can be defined as pus collection in peritonsillar space (between superior constrictor muscle of pharynx and lateral surface of tonsil). It is a common complication of tonsillitis. Materials & Methods: This is a descriptive, prospective study. It was carried out on 27 consecutive patients which were treated for Quinsy from September 2016 to August 2018. All of the patients were hospitalized. Peritonsillar abscess was treated with aspiration of pus by wide bore needle followed by Antibiotics and short dose of steroid. Results: 74 % of patients were found to have previous history of recurrent tonsillitis. 56 percent of patients were already receiving antibiotics at the time of presentation. Mean hospital stay was two days. None of the patients required incision drainage. Recurrence was seen in only 3 patients. Conclusion: Needle-aspiration at the most prominent (bulging) part of the peritonsillar region followed by intravenous antibiotics and steroids is an effective treatment protocol. We also suggest further controlled studies on larger number of patients to establish its efficacy and safety.

Thorwaldt’s Cyst: Management by Combined Endoscopic Approach and Literature Review

Thornwaldt cysts occur in the midline bursa of the nasopharynx above the upper border of the superior constrictor muscle. They represent a communication between notochord remnants and the pharyngeal endoderm. It is usually asymptomatic unless an infection or obstruction occurs, then, a Thornwaldt's cyst might develop. It is relatively uncommon, with a prevalence rate of 0.2% to 4%. Due to its nonspecific symptoms, physician often misdiagnose thornwaldt cyst. It is usually diagnosed as an incidental finding on MRI. Surgical excision is the definitive treatment. This paper describes a case of thornwaldt cyst in a 39 years old gentleman presented with neck stiffness. It also includes a literature review that aids in the clinical suspicion, prevalence, diagnosis, and treatment of thornwald cyst.

Bilateral peritonsillar abscess: a case study and literature review

While peritonsillar abscesses are the most common deep neck infections, bilateral forms are rare. A peritonsillar abscess occurs when pus accumulates in the peritonsillar space, located between the tonsils and superior constrictor muscle, causing medial displacement of the uvula, trismus, odynophagia or even upper airway obstruction. High clinical suspicion is needed to diagnose bilateral peritonsillar abscess due to frequent history, computerized tomography scan of the neck with IV contrast facilitates accurate diagnose and a full assessment of the patient. Incision and drainage are needed to evacuate the pus along with systemic antibiotics to relieve patient symptoms followed by interval tonsillectomy, which usually done after 6 weeks.

Unusual symptoms of Thornwaldt’s cyst: a case report

<p>Thornwaldt’s cyst also known as bursa pharyngeal embryonalis which is formed by traction of notochord at the retropharyngeal wall at the site of contact. It is present in the midline, at the junction between nasopharyngeal vault and posterior pharyngeal wall. The bursa can extend upward and backward above the limit of superior constrictor muscle fibres. This bursa when infected becomes seat of inflammation and cyst formation occurred. The well-known Thornwaldt’s cyst occurs as a result of obstruction of orifice of the bursa and is different from cyst of Rathke’s pouch. Thornwaldt’s cyst is usually asymptomatic but more than 1-2 cm may become symptomatic. Symptoms that commonly seen are halitosis, nasal discharge, nasal obstruction, epistaxis, prevertebral spasm, and rarely occipital headache and obstruction of Eustachian tube can occur. The diagnosis usually incidental as a part of a nasal endoscopic examination or radiological and endoscopic examination which is used to diagnose the cyst. On examination it appears as smooth mass with a central dimple. In this case report young female present with difficulty in swallowing, occipital headache, halitosis and fever. Initially she was managed conservatively when the cyst was resolved then it was marspupizied by transoral approach, with uneventful postoperative period. Other approaches for excision or marsupialization in symptomatic cases are endoscopic or transpalatal using powdered instrumentation.</p>

Subcutaneous Emphysema Secondary to Tonsillectomy

ABSTRACT Background Tonsillectomy is one of the most common surgical procedures performed worldwide. However, it can potentially be associated with several complications. One of the very rare complications post-tonsillectomy in adults is subcutaneous emphysema, as in our case here. Although, most reported cases are resolved spontaneously, it may lead to fatal complications, like tension pneumothorax. Case report Tonsillectomy was performed on an adult patient with history of frequent tonsillitis. The patient developed facial subcutaneous emphysema 48 hours after the surgery (evident by clinical and radiological examination) that resolved within 2 days without further complications. Conclusion Tonsil should be removed along with tonsilar capsule. If tonsillectomy causes deeper than usual mucosal tear up to the level of the muscles, then air might pass into the subcutaneous tissue through the tonsillar fossa and superior constrictor muscle into fascial layers of neck. Emphysema can then spread to parapharyngeal, retropharyngeal spaces and mediastinum with its related morbidity. Though a rare complication, all otorhinolaryngologists must be aware of this complication and its management. How to cite this article Abraham SS, Stephen V, Deve L, Kurien M. Subcutaneous Emphysema Secondary to Tonsillectomy. Int J Otorhinolaryngol Clin 2015;7(2):78-80.