Unusual Parapharyngeal Extension of Peritonsillar Abscess to the Masticator Space: Successfully Drained by Extraoral and Intraoral Endoscopic Approaches

• Published in: Annals of otology, rhinology & laryngology rhinology & laryngology, 2014-05, Vol.123 (5), p.333-337
• Main Authors: Hidaka, Hiroshi, Ishida, Eiichi, Suzuki, Takahiro, Matsutani, Sachiko, Kobayashi, Toshimitsu, Takahashi, Shoki
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Diabetes Complications; Drainage - methods; Endoscopy; Facial Nerve; Female; Humans; Immunosuppressive Agents - adverse effects; Male; Masticatory Muscles - pathology; Mouth Mucosa - surgery; Peritonsillar Abscess - diagnostic imaging; Peritonsillar Abscess - pathology; Peritonsillar Abscess - surgery; Tomography, X-Ray Computed
• ISSN: 0003-4894; 1943-572X
• DOI: 10.1177/0003489414526360

Objective: The object was to describe 2 novel cases of peritonsillar abscess showing peculiar extension to the masticator space. Methods: The methods included clinical case records, including computed tomography and surgical approaches. Results: Both patients we encountered were suffering from systematic diseases, with case 1 involving a 75-year-old man with diabetes mellitus and case 2 involving a 90-year-old woman taking immunosuppressive medications. The abscesses were peritonsillar in origin, extending primarily to the parapharyngeal space, with unusual secondary extension to the masticator space. Extraoral drainage conducted in case 1 was useful for assessing the masticator space and surrounding spaces, but endoscopy-assisted intraoral drainage in case 2 was less invasive, obviating the need for identifying the facial nerve. Conclusions: It is important to bear in mind that patients suffering from systemic diseases may display unusual extension of deep head and neck infections, and enhanced computed tomography is a useful modality for evaluating such extensions.