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October 2003
By Youn W. Park, MD, and Ted Tang, MD
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CASE:
A 22-year-old man is brought to the emergency department
with swelling, pain, and tenderness of the upper neck accompanied
by a high fever. He relates that his illness began with a
sore throat about 10 days before the swelling first appeared.
WHAT IS YOUR DIAGNOSIS?
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The patient has an abscess in the parapharyngeal space of the
deep soft tissue of the neck, which extends in an inverted pyramidal
shape from the base of the skull to the hyoid bone. Peritonsillar
infection is the most likely source, but these abscesses can
also develop secondary to dental caries, retropharyngeal or
parotid infection, or mastoiditis. The patient usually presents
with fever, dysphagia or odynophagia, trismus, swelling over
the parotid gland and the mandibular angle, and tonsillar displacement
anteromedially. Multiple cranial neuropathy, or Horner's syndrome,
may occur since the parapharyngeal space contains the internal
carotid artery, the internal jugular vein, cranial nerves IX,
X, and XII, and the cervical sympathetic trunk. Other possible
complications include airway obstruction, thrombophlebitis of
the jugular vein, bleeding, mediastinitis, and sepsis from septic
embolization. |
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Dr. Park is a clinical professor of otolaryngology
at Northeastern Ohio Universities College of Medicine and
section head of otolaryngology at Barberton Citizens Hospital
in Barberton, Ohio. Dr. Tang is an attending physician in
the department of family practice at Akron General Medical
Center in Akron, Ohio.
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