Parapharyngeal space infection

Background

• The parapharyngeal space is one of three potential spaces that can cause deep neck space infections
  1. retrophanygeal space
  2. submandibular space
  3. parapharyngeal space

• Infections arise from foci in the mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes, middle ear, or sinuses.

• Polymicrobial

Clinical Features

• Sore throat
• Trismus
• Swelling below angle of mandible
• Lymphadenopathy
• Poor handling of oral secretions
• Asymetric pharyngeal swelling
• Fevers/chills

Differential Diagnosis

• Pharyngitis
• Ludwig's Angina
• Parotitis
• Tonsillitis
• Lemierre's syndrome

Diagnosis

• CT neck soft tissues with IV contrast
• MRI neck

Management

• ABC's
• ENT Consult for potential surgical drainage
• Antibiotics (amp-sulbactam, clindamycin, penicillin plus metronidazole)
• Analgesia

Disposition

• Admit to ICU

See Also

• Retropharyngeal abscess
• Ludwig's Angina