Peritonsillar Abscess (Quinsy): Hot-Potato Gbe, Uvula Deviation, Trismus, kple Aŋe ƒe Ʋuʋu vs Retropharyngeal Abscess¶

Peritonsillar abscess (si woyɔna le atikewɔnyawo me be quinsy) nye kɔ goglo me dɔlékui si bɔ wu le ƒewuiviwo kple ame tsitsiwo me, si dzɔna ne dɔlékui ƒe dɔléle kaka wu palatine tonsil ƒe capsule yi ɖe areolar tissue si le gbadzaa si le tonsillar capsule kple superior pharyngeal constrictor muscle dome. Togbɔ be dɔlékui alo streptococcal tonsillitis si nu sẽ nana ŋɔti biãna eye wòsea veve le akpa eveawo hã la, peritonsillar abscess naa kotoku si me ʋuʋudedi le si le axa ɖeka dzi si me ʋuʋudedi le le tonsil ɖeka tame kple eƒe axadzi (zi geɖe wu le atikpo si le etame). Nuƒoƒoƒu sia si le kekem ɖe enu la tua aɖu falɛfalɛa yia ŋgɔ kple anyime esime wòle titina fli uvula la tum ɖe akpa si tsi tre ɖe eŋu (si le lãmesẽ me), eʋãa medial pterygoid jaw muscle si te ɖe eŋu la ƒe ʋuʋu vevesesetɔe (trismus, ŋutetemanɔamesi be wòaʋu nu si keke wu sentimeta 2 [inch 0.8]), muffles ƒoa nu wòzua a classic "hot-potato" voice, eye wòxea mɔ na dɔnɔa be wòagami woawo ŋutɔ ƒe aɖuɖɔ (drooling). Nusi hiã kpata wu la, ele be woade vovototo amesiame si ƒe gbe me mekɔ o, eƒe ŋɔti le ʋuʋum, alo eƒe ŋɔti me vevesese sesẽ la dome kabakaba tso Retropharyngeal Abscess (si ƒe dzesi enye vevesese sesẽ le kɔ ƒe kekeme kple megbeƒu ƒe gli si le dodom le ɖevi suewo me) kple Acute Epiglottitis (afisi ŋɔti dze abe ɖe wòsɔ le aɖe dzi le mɔ si ble ame nu ene ŋkuléle ɖe eŋu esime supraglottic yaƒoƒomɔ̃a le ɣeyiɣi kpui aɖewo tso sealing shut). Ne ame aɖe si ƒe ŋɔti le veve sem vevie la ƒe ŋɔti le dodom, stridor, tripod posture, trismus, alo tsi siwo mate ŋu ami o la, ƒo ka na miaƒe nutoa me tɔwo xexlẽdzesi siwo wozãna kpata enumake. Dzro mía nɔviwo ŋuti mɔfiamegbalẽ siwo ku ɖe... epiglottitis, croup, stridor, kple yaƒoƒomɔ̃ si le etame ƒe xexe kpata, . Ludwig ƒe angina kple submandibular yaƒoƒomɔ̃ ƒe vuvu, kple sepsis kple septic shock ƒe ʋuʋu.

Nusi nàtsɔ aɖo nɔƒe gbãtɔ enumake enye be nàna dɔnɔa ƒe bɔbɔ nɔ tsitrenu nanɔ woƒe akɔfafa ƒe nɔnɔme me ale be ʋuʋudedi kple aɖuɖɔ nagaxe mɔ na yaƒoƒomɔ̃a o, nàtsɔ akaɖi alé ŋku ɖe nu si le ʋuʋu ɖi ŋu ne stridor zero mele eme o ko (ne èle asymmetric soft-palate bulging kple contralateral uvula deviation dim), nàkpɔ asibidɛ ƒe kekeme nenie aɖua ate ŋu aʋu (trismus test), eye nàyi edzi aɖo a kɔdzi ƒe dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ na dexamethasone si wodona ɖe ʋuka me, dɔlékuiwutike siwo wodona ɖe ʋuka me siwo ƒe dɔwɔwɔ keke ta (ampicillin-sulbactam alo clindamycin), kple aŋe si wotsɔa ultrasound fiaa mɔe be woatsɔ aŋe alo atsoe ahaɖe tsi.

Wɔ esia fifia¶

1. Kpɔ enumake be Critical Airway Obstruction ƒe aflaga dzĩwo le eme eye nàƒo wò nutoa me ƒe xexlẽdzesi kpata ne ele afima. Ƒo ka na 911 le United States kple Canada, 999 le United Kingdom, 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 000 le Australia, alo kpɔ míaƒe nyatakakadzraɖoƒe si nye xexlẽdzesi siwo wozãna kpata ne dɔnɔa ƒe gbɔgbɔ ƒe stridor (ɣlidodo alo ɣlidodo sesĩe ne ele gbɔgbɔm), anyinɔƒe dzɔdzɔe tsɔ bɔbɔ ɖe ŋgɔ le asi siwo wodo ɖa dzi (tripod position), aɖuɖɔ si le dodom atraɖii, mete ŋu mlɔ anyi gbadzaa gbɔgbɔ manɔmee, alo eƒe dzodzro kple vuvu kaka ɖe kɔ ƒe ŋgɔgbe alo axadzi.
2. Na dɔnɔa nanɔ anyi ɖe tsitrenu eye wòabɔbɔ ɖe ŋgɔ vie; MÈgazi wo dzi GBEÐE be woamlɔ anyi ɖe woƒe akɔta o. Mlɔ anyi gbadzaa nana be peritonsillar alo retropharyngeal abscess gã aɖe, uvula si vuvu, kple aɖuɖɔ si ƒo ƒu la gena ɖe megbe le epiglottis kple gbeɖiɖikawo dzi, si wɔnɛ be yaƒoƒomɔ̃a xena keŋkeŋ kpata.
3. Wɔ asibidɛ 3 ƒe Trismus Check kple Flashlight Palate Check (ne stridor mele dɔnɔa ŋu o eye menye ɖevi si tsi dzimaɖi si wosusu be epiglottitis le o KO):
4. Asibidɛ Etɔ̃ ƒe Trismus Dodokpɔ: Bia dɔnɔa be wòaʋu eƒe nu wòakeke alesi wòate ŋui. Ame tsitsi alo ɖevi si le lãmesẽ me ate ŋu atsɔ woawo ŋutɔ ƒe asibidɛ 3 siwo woƒo ƒu ɖe wo nɔewo dzi la ade woƒe ŋgɔgbe aɖu siwo le etame kple esiwo le ete dome (milimeta 35 va ɖo 50 / sentimeta 1.4 va ɖo 2.0)**. Ne aɖu ƒe vevesese xe mɔ na ʋuʋu si keke wu asibidɛ 1 va ɖo 2 (si mede milimeta 20 / inch 0.8 o) la, trismus le eme, si ɖo kpe edzi be dɔlékuia ge ɖe tonsil godo ɖe medial pterygoid masticator muscle me.
5. Soft-Palate Bulge kple Uvula Deviation Check: Klẽ telefon ƒe akaɖi ɖe nu me. Le peritonsillar abscess me la, aɖu falɛfalɛ si le aɖuɖɔtoea tame ƒe akpa ɖeka doa go yia anyime kple ŋgɔ abe plum dzĩ si vuvu ene, si ƒoa uvula si le ƒoƒom la sesĩe to titina fli la dzi yia akpa si tsi tre ɖe eŋu, si mevuvu o la gbɔ.
6. Screen for Retropharyngeal Abscess by checking gentle Neck Extension vs. Flexion: Ne dɔnɔa nye ɖevi sue (vevietɔ si xɔ tso ɣleti 6 va ɖo ƒe 6) alo ame tsitsi le tɔmelã ƒe ƒu alo koklozi ƒe ƒu mimi vɔ megbe si lé woƒe kɔ sesĩe le torticollis me eye wòfa avi alo se veve sesẽ aɖe le ŋɔti/kɔ me ne ele agbagba dzem be yeawɔe woatrɔ woƒe ta ɖe megbe be woakpɔ dzisasrãa (kɔ kekeɖenudɔwɔwɔ), woasusu be Retropharyngeal Abscess aɖe le prevertebral afɔku teƒe eye nàƒo ka na EMS enumake.
7. Na dɔnɔa nanɔ NPO (Naneke to Nu me: nuɖuɖu zero, ahanono zero, atikekui siwo woano zero) hafi nàɖo ta Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ. Esi wònye be trismus sesẽ alo kɔ ƒe kekeme goglo ate ŋu abia be woaɖe tsi si fa akɔ na ame alo atike si naa alɔ̃dɔdɔ le amekoko me le Amekokoxɔa me ta la, dɔgbo ƒuƒlu xea mɔ na yaƒoƒo le yaƒoƒomɔ̃a dzi kpɔkpɔ me.
8. Mègate kpɔ GBEÐE be yeatsɔ asibidɛ, gavi, aŋe, alo kotoklobo aƒo ŋɔti me ʋuʋudedi aɖe le aƒeme, aƒoe, alo azi edzi o. ememe carotid ʋuka zɔa mɔ tẽe yia megbe kple axadzi yia tonsillar fossa (ɣeaɖewoɣi le milimeta 10 va ɖo 20 [inch 0.4 va ɖo 0.8] tso abscess gli gbɔ); blind home lancing ate ŋu ato carotid ʋuka si le eme (si ana ʋu nado le lãme na ame si wua ame le sɛkɛnd 60 me) alo agbã ʋu si me ʋuʋudedi le ƒe tsiɖɔɖɔ tẽe le yaƒoƒoa me (acute aspiration asphyxiation).

Nyametsotsoti: ŋɔti me veve sesẽ, gbe si me mekɔ o, trismus, kple kɔ ƒe teƒe goglo ƒe vovototodedeameme¶

flowchart TD
    A["Kɔmeve Sesẽ + Odynophagia (Vevesese Mimi) + Asrã"] --> B{"Ðe Yameʋuɖoɖo ƒe Afɔku ƒe Dzesiwo Li Enumakea? (Inspiratory stridor, afɔti etɔ̃ ƒe nɔnɔme, cyanosis, alo ŋutete manɔamesi be wòamlɔ anyi)"}
    B -->|YES: Imminent Airway Obstruction| C["Ƒo ka na EMS (911/999/112) Enumake: Yi edzi nànɔ anyi ɖe bolt dzi wòanɔ tsitrenu; MÈGADE naneke nu me o; dzra ɖo ɖe Awake Fiberoptic alo Amekokoxɔ me Intubation ŋu"]
    B -->|NO stridor or respiratory distress| D{"Check Mouth Opening (Trismus), Kɔ ƒe Ʋuʋu, kple Soft Palate Anatomy"}
    D -->|Unilateral soft-palate bulge pushing uvula to opposite side + Trismus (< 2 cm jaw opening) + Hot-Potato voice + ipsilateral ear pain| E["PERITONSILLAR ABSCESS (QUINSY): Peritonsillar ƒe Yamenutome Nuƒoƒoƒu"]
    D -->|Stiff neck / torticollis + severe pain on NECK EXTENSION (looking up) + midline/paramedian posterior pharyngeal wall bulge (often child < 6 yrs or post-fishbone)| F["RETROPHARYNGEAL ABSCESS: Afɔku ƒe Yamenutome Kpata (Afɔku si Le Mediastinitis Ŋu) ."]
    D -->|Bilateral woody, rock-hard submandibular swelling under chin + elevated floor of mouth pushing tongue against roof of mouth after lower molar toothache| G["LUDWIG ƑE ANGINA: Akpa eve ƒe Submandibular/Sublingual Yamenutome Kpata"]
    D -->|Symmetrical bilateral red swollen tonsils with white exudates, midline uvula, normal 3-finger mouth opening, NO voice muffling or drooling| H["Tonsillitis / Pharyngitis si mesẽ o (Strep, EBV Mononucleosis, alo Dɔlékui) ."]
    E --> I["Kɔdzi ƒe ED ƒe dodokpɔ kpata (Dzra NPO ɖo): Tsidede le ʋuka me + Dexamethasone si wodona ɖe ʋuka me (10 mg) + Ampicillin-Sulbactam alo Clindamycin si wodona ɖe ʋuka me"]
    I --> J["Intraoral High-Frequency Ultrasound (alo Contrast CT ne trismus sesẽ): Eɖo kpe tsi ƒe ʋuʋudedi dzi vs peritonsillar cellulitis dzi"]
    J --> K["ENT Abatidzi Ultrasound-Guided Needle Aspiration (le Superior Pole titina vaseɖe molar fli) alo Incision & Drainage"]
    F --> L["Kɔdzi ED Enumake: Vovototo CT of Neck & Chest + IV Broad-Spectrum Antibiotics + Amekokoxɔ me Transoral Surgical Drainage"]
    G --> M["Kɔdzi ED Enumake: Nyɔ Nasotracheal Intubation + IV Dɔlékuiwutikewo + Amekoko ƒe Decompression"]
    H --> N["Strep Dodokpɔ Kabakaba / Kɔ ƒe Dekɔnu + Nu me Vevesesenutsitike + Tsidede (Amoxicillin si woano ne Ƒuƒoƒo A Strep le ame ŋu; ƒo asa na Amoxicillin ne esusu be EBV Mono)"]

Anatomical blueprint: alesi tonsillitis toa atikekui la me yia peritonsillar space me¶

Gotagome lãkusi si me ka le (tonsillar capsule) si ma tonsil ƒe ʋumenugbagbevi dzĩwo kple ŋɔti ƒe lãmekawo ƒe gli (the superior pharyngeal constrictor muscle) ƒo xlã palatine tonsil. Le fibrous tonsillar capsule si le eme kple superior pharyngeal constrictor muscle si le egodo dome la, teƒe gbadza aɖe si ate ŋu adzɔ si yɔ fũ kple kadodoŋusẽ si me mekɔ o si woyɔna be peritonsillar space:

INTRAORAL VIEW OF A LEFT PERITONSILLAR ABSCESS (QUINSY)
=======================================================================
          [Upper Incisor Teeth - Trismus Limits Opening < 2 cm]
     ---------------------------------------------------------------
              Right Side (Normal)   |   Left Side (QUINSY ABSCESS)
                                    |
                                    |     ( * * * * * * * )
                                    |   (  TENSE BULGING   )
                Normal Arch         |  (  LEFT SOFT PALATE  )
                  _______           |   (  [Superior Pole] )
                 /       \    <---  |     ( * * * * * * * )
                |         |  Uvula  |            \
                |  (R)    | Pushed  |             \  [Left Tonsil Pushed
                | Tonsil  |  Right  |              |  Downward & Medially]
     ---------------------------------------------------------------
          [Tongue]                               [Medial Pterygoid Muscle
                                                  in Spasm --> TRISMUS]
     * CRITICAL DANGER ZONE: Internal Carotid Artery lies 1.5 to 2.5 cm
       posterolateral to the lower/lateral tonsillar pillar.
=======================================================================

Nusitae peritonsillar abscesses ƒe alafa memama 75 dzɔna le Superior Pole (Weber ƒe Glands) .¶

Le ŋutinya me la, atikewɔlawo tsɔe be streptococcal tonsillitis si womewɔ atike na o si le tutum to atikekui la me koe peritonsillar abscesses katã nye. Egbegbe ŋutilã ƒe wɔwɔme ŋuti numekuku ɖe mɔ vevi evelia fia: Weber ƒe lãkusiwo, si nye aɖuɖɔtoe suesuesue 20 va ɖo 25 ƒe ƒuƒoƒo si le supratonsillar space si le tonsil ƒe akpa si le etame tame tẽ, ɖoa mɔ suesuesuewo ɖe tonsillar crypts me be woaklɔ nuɖuɖu ƒe gbeɖuɖɔwo ɖa. Ne dɔdzẽ sesẽ alo abi xɔ Weber ƒe lãkusiwo ƒe mɔ̃wo la, aɖuɖɔ kple dɔlékuiwo léna ɖe supratonsillar space la me, eye wowɔa superior-pole peritonsillar abscess si kekena kabakaba si ƒoa aɖu falɛfalɛa yia ŋgɔ kple anyime esime wòɖea uvula la yia akpa si tsi tre ɖe eŋu.

Dɔlékuiwo ŋuti nunya: nusita Penicillin ɖeɖe mesɔ gbɔ o¶

To vovo na strep throat bɔbɔe la, ɣesiaɣi kloe la, peritonsillar abscess nyea polymicrobial infection si ƒoa aerobic kple anaerobic nu me dɔlékuiwo nu ƒu (siwo dometɔ geɖe wɔa beta-lactamase enzymes siwo gblẽa penicillin gbadzaa): - Aerobic Dɔlékui Gbãtɔwo: Streptococcus pyogenes (Ƒuƒoƒo A beta-hemolytic Streptococcus / GAS), Streptococcus anginosus (milleri) ƒuƒoƒo (si xɔ ŋkɔ le ʋuʋudedi goglo siwo me ʋuʋudedi le wɔwɔ me), Staphylococcus aureus (MRSA hã le eme), kple Haemophilus influenzae ƒe dɔléle. - Dɔlékui Gbãtɔ Siwo Mewɔa Ya O si Wobia: Fusobacterium necrophorum (nusi gbɔ Lemierre ƒe dɔlélea tsona), Prevotella melaninogenica, Porphyromonas, Bacteroides, kple Peptostreptococcus si me ya mele o.

Vovototodedeameme le axadzi kple axadzi: Peritonsillar Abscess vs Retropharyngeal Abscess vs Epiglottitis vs Acute Tonsillitis¶

Vovototodede nɔnɔme ene siawo me le aba gbɔe afia nenye be ehiã be woaŋlɔ dɔlékuiwutike si woano na dɔnɔa, aŋe si woatsɔ agbɔ aba dzi, alo amekokoxɔ me yaƒoƒomɔ̃ si wozãna kpata:

Nusita Retropharyngeal Abscess kple Parapharyngeal Extension nye nudzɔdzɔ kpata siwo wua ame¶

Togbɔ be lãmeka si nye superior constrictor la xea mɔ na peritonsillar abscess le gɔmedzedzea me hã la, tsi ƒe sisi hehe ɖe megbe nana be ʋuʋudedi te ŋu toa lãmekaa ƒe gli me yia kɔ ƒe mɔ goglo siwo te ɖe wo nɔewo ŋu dzi:

1. Retropharyngeal Abscess kple "Alar Afɔku Teƒe" yi Akɔta¶

Le kɔ ƒe megbegli megbe (akɔta ƒe gli si le megbe) la, retropharyngeal space, si tso tagbɔ ƒe gɔme yi anyime va ɖo akɔta si le etame (T1 va ɖo T2), si alar fascia tsɛ la koe ma tso Teƒe 4 ("Afɔku ƒe Teƒe"), si nye mɔ si le tsitrenu si me ʋuʋudedi mele o si zɔna yia anyime tẽ va ɖoa ** akɔta kple megbe mediastinum** ƒe ƒuƒoƒo. - Le Ðevi Suewo (Mexɔ ƒe 6 haɖe o): retropharyngeal lymph nodes (Nodes of Rouviere) ƒe kɔsɔkɔsɔ eve siwo le tsitrenu le ɖevi suewo si siwo ɖea dɔlékuiwo ɖa le ŋɔti, ŋɔti, adenoid, kple titinato me. Ne to alo ʋuka me dɔlékui aɖe na ʋuka siawo dometɔ ɖeka ʋuʋu eye wòvuvu la, ʋuʋudedi yɔa megbeƒu ƒe teƒea. (Kaka woaxɔ ƒe 5 va ɖo ƒe 6 la, ʋuka siawo dzi ɖena kpɔtɔna le dzɔdzɔme nu eye wobuna, si tae ɖeviwo ƒe do ŋgɔ na sukudede koŋue nyea akɔta ƒe ʋuʋu kpata negbe ɖe ame tsitsi aɖe tsɔ tɔmelã ƒe ƒu, koklozi ƒe ƒu, alo popsicle-ti ƒo woƒe ŋɔti ƒe megbe hafi.) - Descending Necrotizing Mediastinitis: Ne retropharyngeal abscess aɖe gbã to alar fascia tsɛa me yi Afɔku Teƒea la, nuheŋusẽ kple akɔta ƒe nyaƒoɖeamenu manyomanyo le gbɔgbɔ me noa ʋuʋudedi si me ʋuʋudedi le tẽe yia akɔta ƒe do si ƒo xlã dzia kple ʋuka gãwo me (acute descending necrotizing mediastinitis), si tsɔa 25 va ɖo 40 le alafa me ku ƒe agbɔsɔsɔme ne wowɔ dɔ na ame le dzitodzito me gɔ̃ hã.

2. Axadzi Parapharyngeal Space Rupture kple Lemierre ƒe Dɔléle¶

Ne peritonsillar abscess aɖe vuvu le axadzi to superior pharyngeal constrictor muscle me yi ɖe parapharyngeal space (carotid sheath) la, ʋukawo ƒe afɔku eve ate ŋu adzɔ: - Lemierre ƒe Dɔléle (Internal Jugular Vein Septic Thrombophlebitis): Dɔlékui si me ya mele o si nye Fusobacterium necrophorum ye ʋãnɛ wu, dɔlékuia gena ɖe ememe jugular vein ƒe gli ŋu, eye wòwɔa ʋu ƒe sisi si me dɔlékui le (septic thrombus) si nana wòvivina ŋutɔ eye wòvua along sternocleidomastoid lãmeka ƒe ŋgɔgbe liƒo le kɔ me eye wòɖea septic emboli ɖe lãkusi me (cavitary septic pulmonary emboli, akɔtave, kple septic shock). - Carotid Artery Mycotic Pseudoaneurysm and Blowout: Enzyme ƒe tsɔtsrɔ̃ le carotid artery ememetɔ ƒe gli ŋu naa alakpa ʋuka si mebɔbɔ o si ate ŋu agbã ɖe ŋɔti me, si ana ʋu si dona le ŋɔti/nu me si nye sentinel eye ʋuka me ʋu si wua ame la nakplɔe ɖo.

Kɔdzi ƒe nɔnɔmetata siwo wotsɔ dia dɔlélewoe kple atikewɔwɔ me dzikpɔkpɔ¶

1. Intraoral Point-of-Care Ultrasound (POCUS) tsɔtsɔ sɔ kple Kɔ ƒe CT si me woɖea vovototo le¶

Dɔnɔ siwo ade 20 va ɖo 30 le alafa me siwo va kple akpa ɖeka ƒe aɖu falɛfalɛ ƒe vuvu la le nyateƒe me la, peritonsillar cellulitis (phlegmon), si nye lãmenugbagbeviwo ƒe dɔdzẽ si kaka si me tsi me ʋuʋudedi mele o haɖe o, si nu yina to dɔlékuiwutikewo kple steroid siwo wodona ɖe ʋuka me me evɔ mehiã be woatsɔ aŋe aƒoe o. - High-Frequency Intraoral or Submandibular Ultrasound (First-Line for Quinsy): Atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ kple ENT eŋutinunyalawo tsɔa endocavitary ultrasound probe (si wotsɔ tsyɔ nu kotoku si me dɔlékui mele o me kple atike si wotsɔna fa alɔ̃e si wotsɔna tsia lãme na ame) blewuu ɖe aɖu falɛfalɛ si vuvu la dzi, alo scan le gota le aɖu te (transcervical submandibular view ne trismus sesẽ akpa be wòate ŋu asɔ na probe la le nu me). Ultrasound dea vovototo hypoechoic liquid pus pocket (abscess) kple solid cellulitis dome enumake eye wòwɔa eƒe goglome tututu le milimeta me yia internal carotid artery si le ʋuʋum la gbɔ to Color Doppler zazã me hafi aŋe naka asi aɖu ŋu gbeɖe. - IV Contrast-Enhanced CT Scan of the Neck: Sedziwɔwɔ ɣesiaɣi si wosusu be retropharyngeal abscess, parapharyngeal extension, trismus sesẽ si xea mɔ na nu me dodokpɔ, alo Lemierre ƒe dɔléle, kpakple le ɖevi suewo hã gome. To vovo na ema la, CT, abscess vavãtɔ dzena abe tsi si mebɔ o ƒe nuƒoƒoƒu si woɖe nyuie si ƒo xlã "ring-enhancing" rim si klẽna ene, gake ememe jugular vein thrombosis ɖea yɔyɔ ƒe gbɔdzɔgbɔdzɔ le jugular lumen fiana.

.¶

Esi wònye be dɔnɔ siwo ŋu peritonsillar alo retropharyngeal abscess le mete ŋu mi tsi gaƒoƒo 24 va ɖo 72 o le odynophagia si le veve sem ta la, dɔnɔ ɖesiaɖe hiã be woade ʋuka me zi etɔ̃ enumake ne eva ɖo:

1. Aggressive Intravenous Crystalloid Rehydration: 1,000 mL bolus si me 0.9% normal saline alo lactated Ringer's (alo 20 mL/kg le ɖeviwo me) gbugbɔa ʋukawo me ƒe lolome ɖoa anyi eye wòɖɔa tsikuɖiɖi ƒe ketosis ɖo.
2. Corticosteroid (Dexamethasone) si wodona ɖe ʋuka me zi ɖeka: Dɔdamɔnu dodokpɔ siwo wowɔ le vome (si dzi Amerikatɔwo ƒe Tome kple Kɔ ƒe Amekoko Habɔbɔ da asi ɖo) ɖo kpe edzi be Dexamethasone 10 mg IV ƒe agbɔsɔsɔ ɖeka dodo ɖe ʋuka me na ame tsitsiwo (alo 0.3 va ɖo 0.6 mg/kg IV, va ɖo 10 mg le ɖeviwo me) kpe ɖe dɔlékuiwutikewo ŋu la, eɖea akɔta ƒe ʋuʋu dzi kpɔtɔna kabakaba, eɖea vevesese ƒe dzesiwo dzi kpɔtɔna ɖe afã me le gaƒoƒo 4 me, eɖea medial pterygoid trismus dzi kpɔtɔna ale be dɔnɔa nate ŋu aʋu woƒe nu, eye wògagbugbɔa ŋutete si le esi be wòami tsi gaƒoƒo 12 va ɖo 24 kabakaba wu.
3. Dɔlékuiwutike siwo wodona ɖe ʋuka me si wokpɔna le nuteƒekpɔkpɔ me (siwo tsyɔa GAS, Strep anginosus, kple Beta-Lactamase Anaerobes dzi):
4. Atikewɔwɔ Gbãtɔ A: IV Ampicillin-Sulbactam (Unasyn) gram 3 IV gaƒoƒo 6 ɖesiaɖe le ame tsitsiwo me (alo 50 mg/kg/ampicillin ƒe akpaa ƒe agbɔsɔsɔme IV gaƒoƒo 6 ɖesiaɖe le ɖeviwo me), ALOO IV Amoxicillin-Clavulanate (le Europa/UK/Australia, alo IV Benzylpenicillin + IV Metronidazole ƒe atike.
5. Atikewɔwɔ Gbãtɔ B (Penicillin-Allergic alo MRSA ƒe Kpekpeɖeŋu): IV Clindamycin 600 va ɖo 900 mg IV gaƒoƒo 8 ɖesiaɖe (alo 10 va ɖo 13 mg/kg/dose IV gaƒoƒo 8 ɖesiaɖe le ɖeviwo me), ALOO IV Ceftriaxone (1 va ɖo 2 g IV gbesiagbe) PLUS IV Metronidazole (500 mg IV gaƒoƒo 8 ɖesiaɖe), tsɔa IV Vancomycin alo Linezolid kpena ɖe eŋu ne wosusu be dɔlékuiwutike sesẽ alo MRSA le eŋu.
6. Tɔtrɔ yi Nu me Atikewɔwɔ me le Tsiɖeɖe vɔ megbe: Ne woɖe tsi le abi la me eye dɔnɔa ƒe dzoxɔxɔ le fu ɖem nɛ eye wòte ŋu mia tsiwo bɔbɔe evɔ tsi meɖea wo o la, wotrɔna yia Ŋkeke 10 va ɖo 14 ƒe Amoxicillin-Clavulanate (Augmentin, 875/125 mg zi eve gbesiagbe) alo Clindamycin si woano (300 va ɖo 450 mg zi etɔ̃ va ɖo ene gbesiagbe).

Amekoko ƒe tsi si woɖena ɖa keŋkeŋ: Needle Aspiration vs. Incision kple Drainage vs. Interval Tonsillectomy¶

1. Alesi Atikewɔlawo Wɔa Superior-Pole Needle Aspiration Dedie (90% va ɖo 95% ƒe Atikewɔwɔ ƒe Agbɔsɔsɔ) .¶

Le ƒewuivi kple ame tsitsi siwo wɔa nu aduadu kple peritonsillar abscess si mesesẽ o gome la, abadzivɔ alo ultrasound-guided needle aspiration ye nye dɔ si me vevesese boo aɖeke mele o, kabakaba wu eye wòɖea abi 90 va ɖo 95 le alafa me ɖa evɔ mehiã be woatso amekokoxɔ me o:

1. Topical and Submucosal Anesthesia: Atikewɔla tsɔa topical benzocaine/lidocaine spray (si léa ŋku ɖe agbɔsɔsɔme bliboa ŋu be woaƒo asa na methemoglobinemia) ƒua gbe ɖe aɖu falɛfalɛa dzi eye wòdoa 1% alo 2% lidocaine 1 va ɖo 2 mL si me epinephrine 1:100,000 le ɖe aɖuɖɔtoea me wu alesi wòdonae wu ati si le etame si le ŋgɔgbe ƒe tonsillar sɔti la me.
2. Mɔ̃ɖaŋununya ƒe Goglome Dzɔla (Carotid Ʋuka Takpɔkpɔ): Wotsɔa 18-gauge spinal alo didi aspiration needle blaa 10 mL syringe. Be woaka ɖe edzi be aŋea mate ŋu age ɖe eme goglo wu milimeta 10 va ɖo 15 (inch 0.4 va ɖo 0.6) gbeɖe o ɖo ta carotid ʋuka si le eme gbɔ la, atikewɔla la tsoa aŋea ƒe nugbɔ si wotsɔ aŋe wɔe ale be ga aŋea ƒe nugbɔ si didi sentimeta 1.0 va ɖo 1.5 koe dona toa plastic dzɔla la ŋu.
3. Strict Sagittal Trajectory at the Superior Pole: Ne èɖo tae sesĩe a megbe dzɔdzɔe (sagittal plane, parallel to the floor of the mouth) le fli si le tsia dzi ƒe nutome le uvula ƒe gɔme kple fli si le tsitrenu le ŋgɔgbe tonsillar pillar (megawɔa dzogoe ɖe axadzi gbeɖe o ɖo ta to/carotid ʋuka la gbɔ o) la, aŋea yia ŋgɔ 0.5 va ɖo 1.0 cm yi ɖe atikpo si le etame la me esime wòle hehem ɖe megbe le plunger la ŋu, zi geɖe la, woɖea 2 va ɖo 10 mL ƒe ʋuʋudedi ɣi-fu si ʋẽna lilili** eye wònaa nyaƒoɖeamenu kple vevesese dzi ɖena kpɔtɔna enumake. (Ne ati si le etame la meɖe ʋuʋudedi aɖeke o eye womezã ultrasound o la, woate ŋu awɔ aspiration evelia le titina pole la gbɔ, gake woƒoa asa na ati si le ete la le esi wòte ɖe carotid artery ŋu ta.)

2. Nu me Lãɖeɖe Kple Tsidzɔƒe (I&D) Kple Ne Wokafui be Woaɖe Tonsillectomy le Dome¶

• Tɔɖeɖe Kple Tsidzɔƒe (Quinsy Drainage): Ne ʋuʋudedia lolo akpa (le teƒe aɖe) be wòate ŋu ahe to aŋe si ƒe didime nye gauge 18 me alo agaƒo ƒu ake le gbɔgbɔtsixe megbe la, eŋutinunyala la tsɔa 5 va ɖo 8 milimeta ƒe lãkusi si le etame ɖea atikpo si le etame la dzi kple #11 scalpel blade si wodzɔ (afisi tape tsyɔa nusianu dzi negbe akplɔa ƒe nugbɔ ko), dea Kelly hemostat forceps si wotu ɖe doa me, ekekea aɖuawo ɖe enu blewuu wòʋuna be wogbãa loculations, noa ʋuʋudedi la, eye wònana dɔnɔa tsɔa saline kple hydrogen peroxide ƒoa ƒui.
• Hot ("Quinsy") Tonsillectomy vs. Interval Tonsillectomy: Ðevi sue siwo hiã na atike si naa alɔ̃dɔdɔ bliboe hena tsi si dona, alo dɔnɔ siwo ŋu peritonsillar abscesses si gbugbɔna (si wu ɣeyiɣi 2) alo tonsillitis sesẽ si nɔa anyi didi la ate ŋu awɔ acute tonsillectomy enumake le amekokoxɔ me alo elective interval tonsillectomy 4 to Kwasiɖa 6 megbe ne dɔdzẽ sesẽ kple ʋukawo ƒe dɔwɔwɔ dzi ɖe kpɔtɔ ko.

Nutome ƒe xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu kple dɔwɔƒea ƒe ɖoɖowo¶

• United States kple Canada: Ƒo 911 enumake ne ŋɔti me veve ɖesiaɖe si kpe ɖe aɖuɖɔɖɔɖɔ, stridor, afɔti etɔ̃ ƒe nɔnɔme, kɔ kekeɖenudɔ, alo aɖuɖɔ mimi ƒe ŋutetemanɔamesi ŋu. Ne wosusu be peritonsillar abscess (trismus, uvula deviation, hot-potato voice) la, yi Kɔdzi Kpata Dɔwɔƒe si si ENT ƒe kpekpeɖeŋu le (menye dɔnɔdzikpɔƒe si wokpɔa dɔnɔwo gbɔ kpata o, si mate ŋu awɔ ultrasound-guided drainage alo CT imaging o), le American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) ƒe mɔfiamewo dzi wɔwɔ me.
• United Kingdom: Ƒo 999 hena stridor alo yaƒoƒomɔ̃ ƒe nugbegblẽ. Le ENT UK kple NICE ƒe mɔfiamewo nu la, dɔnɔ ɖesiaɖe si wosusu be quinsy (peritonsillar abscess) le eŋu, si wokpɔ to akpa ɖeka ƒe peritonsillar ƒe vuvu, uvula ƒe tete ɖa, trismus, alo ŋutete manɔamesi be wòami tsi me la, bia be gbe ma ke ƒe kɔdzi kpata ɖoɖo ɖe ENT ƒuƒoƒo si le yɔyɔ me hena IV tsiwo, IV dexamethasone, IV benzylpenicillin + metronidazole (alo co-amoxiclav), kple aŋetutu.
• Europa Dukɔwo ƒe Habɔbɔ: Ƒo 112 le EU dukɔwo katã me hena kɔ goglo yamenutome nɔnɔme kpatawo alo stridor. Kɔdzi ƒe ORL dɔwɔƒewo zãa ultrasound to nu me kple aŋe ƒe tsi si woɖena alo lãɖeɖe kple tsi si woɖena kple dɔlékuiwutike si wodona ɖe ʋuka me enumake.
• Australia kple New Zealand: Ƒo ka na 000 le Australia alo 111 le New Zealand hena yameʋuɖoɖo ƒe nɔnɔme kpatawo. Wɔ ɖe Atikewɔwɔ ƒe Mɔfiamewo (Australia) dzi na peritonsillar abscess: kɔdzi ƒe dodokpɔ kpata hena amekoko ƒe tsiɖeɖe kpe ɖe IV benzylpenicillin + IV metronidazole (alo IV clindamycin le penicillin ƒe nulɔdɔ me) kple IV dexamethasone ƒe agbɔsɔsɔme ɖeka.
• Asia-Pacific: Ƒo ka na 119 le Japan kple South Korea, 995 le Singapore, 999 le Malaysia kple Hong Kong, alo 112 / 108 le India be nàtsɔe ayi kɔdzi si me woawɔ ENT ƒe amekoko kple yaƒoƒomɔ̃ ƒe kpekpeɖeŋu le gaƒoƒo 24 sɔŋ.

Nya siwo wobiaa amewo enuenu¶

Aleke mawɔ ade dzesi vovototo si le strep throat si wozãna edziedzi (tonsillitis) kple peritonsillar abscess (quinsy) dome?¶

Strep throat alo dɔlékui ƒe tonsillitis si mesesẽ o nana veve kple abi le ŋɔti ƒe akpa eveawo sɔsɔe, wò uvula (si nye punching-bag ƒe lãkusi sue si le ƒoƒom ɖe wò ŋɔti ƒe megbe titina) nɔa titina le titina, eye àte ŋu aʋu wò nu wòakeke ami tsi kokoko. Peritonsillar abscess (quinsy) dzɔna ne ʋuʋudedi ƒo ƒu ɖe tonsil ɖeka megbe, si hea dzesi vovovo ene vɛ: (1) Vevesese sesẽ si ƒo ƒu ɖe akpa ɖeka si klẽna ɖe to me le akpa ma ke; (2) Nu ƒe xɔta (aɖu falɛfalɛ) si vuvu le tonsil ɖeka tame si ƒoa uvula la sesĩe yia akpa si tsi tre ɖe eŋu; (3) Lockjaw (trismus), afisi lãmekawo ƒe ʋuʋu xea mɔ na wò be màʋu wò nu wòagbɔ asibidɛ 1 va ɖo 2 o; kple (4) "Hot-potato" ƒe gbe si me mekɔ o kple ʋuʋudedi.

Nukatae peritonsillar abscess nana be màte ŋu aʋu wò nu wòakeke o (trismus)?¶

Trismus (lockjaw) dzɔna elabena peritonsillar space si le wò ŋɔti ƒe axadzi la nɔa medial pterygoid muscle, si nye lãmeka sesẽ siwo ɖua nu siwo ƒe dɔe nye be woatu aɖu si le ete la dometɔ ɖeka la xa tututu. Ne dɔlékuiwo ƒe ʋuʋudedi do le tonsil capsule me eye wòdo dziku na fascia si ka asi medial pterygoid lãmeka ŋu la, lãmekaa yia vevesese si le eɖokui si, si kpɔa ame ta me. Ɣesiaɣi si dɔnɔ si ƒe ŋɔti le vevem mete ŋu tsɔ asibidɛ etɔ̃ siwo woƒo ƒu ɖe wo nɔewo dzi le tsitrenu le woƒe ŋgɔgbe aɖuwo dome o (alo woʋu wòkeke wu sentimeta 2 / inch 0.8) la, enye dɔlélea ƒe dzesi be dɔlékuia kaka ɖe aɖuɖɔtoea godo yi lãkusi gogloawo me.

Nukae nye "hot-potato gbe," eye nukatae wòdzɔna?¶

"Hot-potato voice" (si woyɔna le atikewɔnyawo me be muffled dysphonia alo rhinolalia clausa) ɖina abe amea le agbagba dzem be yeaƒo nu esime wòlé mɔli si woɖa ƒe ɖuɖu dzodzoe si le dzo dam ɖe woƒe nu ƒe megbe evɔ meʋãa eƒe aɖe alo eƒe aɖu falɛfalɛ o. Edzɔna elabena ʋuʋudedi si ƒoa ƒu ɖe aɖu falɛfalɛa me la nana aɖuɖɔtoe ƒe lãmekawo tsia dzodzodzoe eye wòxea ŋɔti si le etame ƒe xɔ si me woɖea gbeɖiɖi le, evɔ aɖe alo aɖu ƒe gɔme ʋuʋu nana ame sea veve vevie. Mɔli dzodzoe ƒe gbe ate ŋu ado mo ɖa le peritonsillar abscess, retropharyngeal abscess, alo acute epiglottitis me, eye wòhiãna ɣesiaɣi be woada dɔa kpɔ le dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ gbemagbe ke.

Aleke ɖɔktawo wɔa dea dzesi peritonsillar abscess to vovo na retropharyngeal abscess?¶

Peritonsillar abscess nɔa tonsil ɖeka ƒe axadzi le ƒewuiviwo kple ame tsitsiwo me, si wɔnɛ be aɖuwo tsia (trismus) eye wòtutua uvula la yia akpa si tsi tre ɖe eŋu ne èlé ŋku ɖe nu me. Retropharyngeal abscess dzɔna le ŋɔti ƒe megbegli tututu megbe (zi geɖe le ɖevi siwo mexɔ ƒe 6 haɖe o siwo ƒe megbeƒu ƒe ʋuka goglowo xɔa dɔ le ŋɔti alo to ƒe dɔléle vɔ megbe, alo le ame tsitsi siwo mi tɔmelã ƒe ƒu ɖaɖɛ aɖe gome). Le esi teƒe be dɔnɔ si ƒe akɔta ƒe ʋuʋu le megbe nanye lockjaw kple axadzi uvula la, eƒe kɔ léa eƒe kɔ sesĩe keŋkeŋ eye wòsea veve vevie ne ele agbagba dzem be yeakɔ ta ɖe megbe akpɔ dzisasrãa (kɔ keke), elabena ne keke kɔa ɖe enu la, ekekea akɔta ɖe kotoku si me ʋuʋudedi le ŋu.

Ðe tsi si dona le peritonsillar abscess me le xɔ si me wowɔa dɔ kpata le me vea amea, eye aleke wowɔa esiae?¶

Hafi ɖɔkta si kpɔa nu kpata alo ENT ŋuti nunyala bibi la naa vevesesenutsitike si wodona ɖe ʋuka me kple dexamethasone (atike sesẽ aɖe si tsia abi nu si ɖea aɖuɖɔtoe ƒe ʋuʋu kple vuvu dzi kpɔtɔna kabakaba) dea ʋuka me, emegbe wòtsɔa atike si naa ame ƒe lãme gbãna kple atike sue aɖe si doa alɔ̃dɔdɔ le teƒea tsɔa atike si naa nu me tsia dzodzodzoe la naa nu me ʋuʋu. Ðɔkta zãa abadzivɔ ƒe ultrasound-nukpɔmɔ̃ tsɔ kpɔa kotoku si tututu me ʋuʋudedi le eye wòƒoa asa na ʋuka siwo te ɖe eŋu la, etsɔa aŋe si wodzɔna si didi sentimeta 1 pɛ ko dea aɖu falɛfalɛa ƒe akpa si le etame la me eye wòhea aɖuɖɔtoe si tsi la doa goe wòzua atikekui. Dɔnɔ akpa gãtɔ sena le wo ɖokui me be yewokpɔ gbɔdzɔe enumake, le ƒoƒo ƒe nyaƒoɖeamenu kple to ƒe vevesese me le ɣeyiɣi si me woɖe aɖuɖɔa, eye wo dometɔ 90 le alafa me ate ŋu ayi aƒeme axɔ dɔlékuiwutike siwo woano le gaƒoƒo ʋɛ aɖewo ko me.

Nukatae nye to me vevesese sesẽ le axa ɖeka kple nye to si vuvu la nenye be dɔlékui mele nye to ŋu o?¶

Tonsil, aɖu falɛfalɛ, kple titinato katã ƒe seselelãme ƒe lãmeka ƒe alɔ ɖeka pɛpɛpɛ, si woyɔna be glossopharyngeal nerve (Cranial Nerve IX, vevietɔ Jacobson ƒe tympanic alɔdze). Ne peritonsillar abscess keke capsule kple aɖu falɛfalɛ si le wò ŋɔti ƒe miame la, glossopharyngeal nerve la doa vevesese sesẽ ƒe dzesiwo ɖe wò ahɔhɔ̃meka, si mate ŋu ade vovototo nenye be dzesia tso ŋɔti me alo to me o. Woyɔa nudzɔdzɔ sia be referred otalgia; ne wonya ɖe tsi le ŋɔti me ʋuʋudedia me ko la, to ƒe vevesesea nu yina.

Dzɔtsoƒewo kple dziɖuɖumegãwo ƒe mɔfiame¶

• Amerikatɔwo ƒe Tomeŋutinunya ƒe Suku-Ta kple Kɔ Amekoko (AAO-HNS, United States): Dɔdaƒe ƒe Dɔwɔwɔ Ŋuti Mɔfiamewo Kple Nya siwo Dzi Woda Ðe Edzi le Peritonsillar Abscess (Quinsy), Intraoral Ultrasound Triage, Corticosteroid Adjunct Therapy, kple Needle Aspiration vs. Incision and Drainage.
• ENT UK kple Dukɔa ƒe Lãmesẽnyawo Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE, United Kingdom): Acute Sore Throat and Peritonsillar Abscess (Quinsy) Kpata ƒe Mɔfiamewo, Dɔlékuiwutike Siwo Dona Ðe Ʋuka Me, Kple Tsi Siwo Dona Ðe Ame Ŋu ƒe Mɔfiamewo.
• Dɔléle siwo xɔa ame me ƒe habɔbɔ si le Amerika (IDSA) kple Amerika Ðeviwo ƒe Dɔlélewo Ŋuti Nusrɔ̃ƒe (AAP): Kɔ Goglo ƒe Dɔlékuiwo Dzikpɔkpɔ le Ðeviwo Kple Ame Tsitsiwo Me: Retropharyngeal, Parapharyngeal, kple Peritonsillar Abscesses.
• Amerikatɔwo ƒe Atikewɔla Kpatawo ƒe Kɔledzi (ACEP): Dɔwɔƒe ƒe Ðoɖo si ku ɖe Point-of-Care Intraoral kple Submandibular Ultrasound ŋu hena vovototodedeameme le Peritonsillar Abscess kple Peritonsillar Cellulitis dome.
• Atikewɔwɔ ƒe Mɔfiamewo (Australia): Dɔlékuiwutikewo ƒe Mɔfiamewo na Acute Peritonsillar Abscess (Quinsy) kple Deep Neck Space Infections.

Mɔfiame siwo do ƒome kplii¶

• Epiglottitis, croup, stridor, kple yaƒoƒomɔ̃ si le etame ƒe xexe kpata
• Ludwig ƒe angina, aɖu ƒe ʋuʋudedi, kple yaƒoƒomɔ̃ si le eƒe aɖu te ƒe vuvu
• Ʋudodo evelia si dona le tonsillectomy megbe: Ŋkeke 5 va ɖo 10 eschar sloughing kple yaƒoƒomɔ̃wo ɖeɖe
• Kpe si xe mɔ na aɖuɖɔtoe (sialolithiasis) vs suppurative parotitis
• Xexlẽdzesi siwo woxɔna kpata le dukɔwo nu