Peritonsillar cellulitis and abscess
- Ellen R Wald, MD
Ellen R Wald, MD
- Professor of Pediatrics
- University of Wisconsin School of Medicine and Public Health
- Section Editors
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Department of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The clinical features, evaluation, and management of peritonsillar cellulitis (also called peritonsillitis) and abscess will be discussed here. Cervical lymphadenitis, retropharyngeal cellulitis and abscess, and other deep neck space infections are discussed separately. (See "Cervical lymphadenitis in children: Etiology and clinical manifestations" and "Retropharyngeal infections in children" and "Deep neck space infections".)
Suppurative infections of the neck are uncommon. However, they are potentially very serious. Suppurative cervical lymphadenitis is the most common superficial neck infection. Peritonsillar abscess (PTA, quinsy) is the most common deep neck infection [1,2]. Other deep neck infections include retropharyngeal abscess and parapharyngeal space abscess (also known as pharyngomaxillary or lateral pharyngeal space abscess). Pharyngeal space infection most often arises via contiguous spread of infection from a peritonsillar or retropharyngeal abscess.
Two terms are used to describe infection of the peritonsillar region:
●Peritonsillar cellulitis – Peritonsillar cellulitis is an inflammatory reaction of the tissue between the capsule of the palatine tonsil and the pharyngeal muscles that is caused by infection, but not associated with a discrete collection of pus. An alternate term for cellulitis is phlegmon.
●Peritonsillar abscess – Peritonsillar abscess is a collection of pus located between the capsule of the palatine tonsil and the pharyngeal muscles.
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- ANATOMY AND PATHOGENESIS
- Assess airway
- Typical presentation
- Laboratory evaluation
- DIFFERENTIAL DIAGNOSIS
- Overview of approach
- - Probable PTA
- - Probable cellulitis
- - Suspected PTA
- Antibiotic therapy
- - Parenteral
- - Oral
- - Needle aspiration
- - Incision and drainage
- - Tonsillectomy
- Discharge instructions
- Response to treatment
- SUMMARY AND RECOMMENDATIONS