Peritonsillar, retropharyngeal, and parapharyngeal
abscesses are the most common deep cervical fascial space
infections. Most develop secondary to an oropharyngeal or dental
infection. Additional factors such as smoking and
periodontal disease may also contribute to the formation of a
peritonsillar abscess. The CT scan is used to confirm the presence of deep neck
abscesses, but its accuracy has some limitations. Adequate drainage with accompanying antimicrobial
therapy and hydration are the cornerstones of management.
Catheter or needle drainage of these
abscesses may provide an alternative to open procedures and is the drainage method of choice for
peritonsillar abscesses. However, in selected cases, medical
therapy alone, especially in children, can resolve parapharyngeal and hypopharyngeal
abscesses. Ancillary use of
steroids reduces morbidity in patients with a
peritonsillar abscess and there is a limited but useful place for immediate
tonsillectomy in the treatment of this disease.