Peritonsillar Abscess (Quinsy): Te Reo Riwai wera, Te Uvula Deviation, Trismus, me te Needle Aspiration vs Retropharyngeal Abscess¶

Ko te puku peritonsillar (e mohiotia ana ko quinsy) te mate mokowhiti kaki hohonu i roto i nga taiohi me nga pakeke, ka puta i te wa ka horapa atu te mate kitakita ki tua atu o te kapopa o te tone palatine ki roto i te kiko areolar e matara ana i waenga i te kopa tonsillar me te ** uaua whakakaha pharyngeal teitei**. Ahakoa ka puta te mumura o te korokoro me te mamae i nga taha e rua, ka puta mai he pute puku o te peritonsillar i te pute o te purulent i runga ake me te taha o tetahi tone (te nuinga kei te pou teitei). Ko tenei kohinga e whakawhanui ana ka turaki i te ngutu ngohe ki mua me te whakararo i te wa e panaia ana te raina waenga uvula ki te taha o te taha (hauora), ka puta te mamae mamae o te uaua o te taha medial pterygoid kauae ** (trismus, te kore e taea te puaki i te waha kia whanui atu i te 2 henimita [0.8 inihi], ka aukati i te reo o te manawanui ki roto i te kopa wera, te reo o te manawanui ki roto i te kohao wera, te reo o te manawanui. ka horomia o ratou ake huware (drooling). Ko te mea nui ake, ko te tangata he reo maru, he tohe, he mamae korokoro nui me tere te wehe mai i te Retropharyngeal Abscess (e tohuhia ana e te mamae nui i runga ** te toronga kaki me te pakitara pharyngeal o muri i roto i nga tamariki nohinohi) me te ** Epiglottitis Acute** (kei te ahua o te korokoro i te wa e rere ana te rere o te arero i te wa e rere ana te arero. kati). Mena ka mate te korokoro nui o te korokoro, ka tohe, te stridor, te tuutuu, te trismus, te kore ranei e kaha ki te horomi wai, waea atu ki to rohe. tau ohorere tonu. Ka arotake ano i o maatau kaiarahi teina i runga epiglottitis, croup, stridor, me te aukati i te ara o runga, Ko te angina a Ludwig me te pupuhi o te ara rererangi, a sepsis me te ru septic.

Ko to kaupapa matua tonu ko te pupuri i te manawanui te noho tika ki te noho humarie kia kore te nana me te huware e arai i te huarahi hau, tirohia te waha tuwhera me te rama rama ** mena karekau he stridor** (te rapu mo te pupuhi o te ngutu ngawari me te rereke o te uvula contralateral), tirohia e hia nga whaanui o nga maihao ka taea e te tari ohotata (**) dexamethasone whakaroto, nga patu paturopi whaanui-a-whare (ampicillin-sulbactam, clindamycin ranei), me te awhi ngira e arahina ana e te ultrasound, te werohanga me te whakaheke wai.

Mahia tenei inaianei¶

1. Tirohia inamata mo nga haki whero Whakararu Rererangi Rererangi, waea atu ki to nama whawhati tata ki te mea kei reira. Waea atu ki a 911 i Amerika me Kanata, 999 i te United Kingdom, 112 puta noa i te Kotahitanga o Europi, 000 i Ahitereiria, tirohia mai ranei ki ta maatau rarangi ingoa o tau ohorere ki te mea he he stridor whakahihiko te tangata manawanui (te tangi nui, te whiowhio ranei i te wa e manawa ana ki roto), te noho tika me te anga whakamua ki runga i nga ringa totoro (te tuunga tripod), te tohe haere tonu o te huware, te kore e taea te takoto papa me te kore e hau, ka horapa te whero me te pupuhi i mua, taha taha ranei o te kaki.
2. Kia noho tika te manawanui me te okioki paku ki mua; KAUA rawa e akina kia takoto tapapa ki runga. Ma te takoto papatahi ka taea e te peritonsillar, te retropharyngeal abscess nui, te uvula tetere, me te huware huihui ki te taka whakamuri ki runga i te epiglottis me nga taura oro, ka paopao ohorere te ara rererangi.
3. Mahia te Tirohanga 3-Finger Trismus me te Tirohanga Panui Maama Rarama (ANAKE mena karekau he stridor te manawanui, a, ehara hoki ia i te tamaiti ohorere e whakapaetia ana he epiglottitis):
4. Tirohanga Trismus Toru-Mamati: Tonoa te manawanui ki te whakatuwhera i tona waha kia whanui rawa atu. Ka taea e te pakeke, te tamaiti ora ranei te uru 3 o ona maihao kua tapae poutū ki waenga i o ratou niho o runga me raro o mua (35 ki te 50 mitamano / 1.4 ki te 2.0 inihi). Mena ka aukati te mamae o te kauae ki te tuwhera whanui ake i te 1 ki te 2 maihao (i raro iho i te 20 mitamano / 0.8 inihi), kei reira a trismus, e tohu ana kua uru te mate ki waho o te tone ki roto i te medial pterygoid masticator muscle.
5. Soft-Palate Bulge and Uvula Deviation Check: Tiaho he rama waea ki roto i te waha. I roto i te puku peritonsillar, ko tetahi taha o te ngutu ngohe kei runga ake i te tonene ka pupuhi whakararo me te anga whakamua ano he paramu whero tetere, e pana ana te uvula e tarewa ana puta noa i te raina waenga ki tera taha, kaore i te pupuhi.
6. Mata mo te Retropharyngeal Abscess ma te tirotiro i te Neck Extension me te Flexion ngawari: Mena he tamaiti nohinohi te turoro (ina koa he 6 marama ki te 6 tau) he pakeke ranei i muri i te horomia i te wheua ika, i te wheua heihei ranei e mau ana tona ** kaki i roto i te torticollis** ka tangi, ka wheako ranei i te mamae nui o te mahunga ki te tuara o te kaki. toronga)**, whakapae he Retropharyngeal Abscess kei roto i te waahi morearea prevertebral ka waea atu ki a EMS tonu.
7. Kia mau tonu te NPO ki te manawanui (Kaore he mea ma te waha: kore kai, kore inu, kore pire waha) i mua i te haerenga ki te Tari Ohotata. Na te mea ka nui te mate o te trismus, te toronga kaki hohonu ranei, ka hiahiatia he wai whakamomori, whaanui-a-whanui ranei i roto i te Whare Whakahaere, na te puku kau ka aukati i te wawata i te wa e whakahaere ana te ara rererangi.
8. ** KAUA rawa e ngana ki te pupuhi, ki te wero, ki te pehi ranei i te korokoro i te kainga me te maihao, te koko, te ngira, te miro ranei.** Ka haere tika te arawa karoti o roto ki muri me te taha taha ki te kohanga tone (i etahi wa kei roto i te 10 ki te 20 mirimita [0.4 ki te 0.8 inihi] o te pakitara puku); Ka taea e te kapo i te kainga ka werohia te arai karoti o roto (ka mate te mate i roto i te 60 hēkona) ka pakaru ranei te waipuke o te nana matotoru tika ki raro i te pukoro (acute aspiration asphyxiation).

Rakau whakatau: te mamae nui o te korokoro, te reo maru, te trismus, me te whakamatautau mokowhiti kaki hohonu¶

flowchart TD
    A["Te Korokoro Nui + Te Odynophagia (Ka horomia te mamae) + Te kirika"] --> B{"Kei te waatea nga tohu morearea o te Rererererangi? (Ko te hikoi whakahiato, ko te tuunga hikoi, ko te cyanosis, ko te kore e taea te takoto papa)"}
    B -->|YES: Imminent Airway Obstruction| C["Waea atu ki a EMS (911/999/112) Inamata tonu: Kia mau ki te noho tika; KAUA e maka tetahi mea ki te waha; whakareri mo te Aranga Fiberoptic, mo te Roopu Whakahaere ranei"]
    B -->|NO stridor or respiratory distress| D{"Tirohia te Tuwheratanga o te Mangai (Trismus), Te Neck Neck, me te Aanatomi Ngakau Ngohe"}
    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 Space Collection"]
    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: Mokowā Mokowā ohorere (Mōrearea o Mediastinitis)"]
    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'S ANGINA: Bilateral Submandibular/Sulingual Space Emergency"]
    D -->|Symmetrical bilateral red swollen tonsils with white exudates, midline uvula, normal 3-finger mouth opening, NO voice muffling or drooling| H["Te Tonosillitis Acute / Pharyngitis (Strep, EBV Mononucleosis, Viral ranei)"]
    E --> I["Te Aromātai ED Hospital Tere (Pupuri NPO): IV Hydration + IV Dexamethasone (10 mg) + IV Ampicillin-Sulbactam or Clindamycin"]
    I --> J["Te Irarangi Whakanui-a-waha (te Whakataurite CT ranei mena he nui te mate o te mate): Ka whakau i te kopu wai me te cellulitis peritonsillar"]
    J --> K["ENT Te Taha Moenga Iratuki-Arahi Aspiration Needle (kei te Pou teitei i waenganui ki te raina molar) ranei te Werohanga me te Whakaheke"]
    F --> L["Hohipera Tere ED: He rereke te CT o te kaki me te uma + IV Paturopi Awhiowhio-a-whanui + Te Rua Mahi Whakawhiti Whakawhiti Whakawhiti"]
    G --> M["Hohipera Tere ED: Oho Nasotracheal Intubation + IV Antibiotic + Surgical Decompression"]
    H --> N["Whakamātautau Rapid Strep / Tikanga korokoro + Whakawhanake-a-waha + Whakahau (Amoxicillin-waha mena he pai te Rōpū A Strep; karohia te Amoxicillin mena ka whakapaehia te EBV Mono)"]

Mahinga Anatomical: pehea te pakaru o te tonsillitis i roto i te kapene ki te waahi peritonsillar¶

E karapotia ana te tonsil palatine e te anga o waho (te tonsillar capsule) e wehe ana i te kiko lymphoid o te tonsil mai i te pakitara uaua o te korokoro (te uaua o te pharyngeal constrictor uaua). I waenganui i te kapopa tonsillar fibrous i roto me te uaua o te pharyngeal constrictor ki waho ka takoto he mokowhiti whaiti e ki ana i te kopa honohono e kiia nei ko te 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.
=======================================================================

He aha te 75 paihēneti o te puku o te peritonsillar ka puta ki te Pou Kairangi (Weber's Glands)¶

I nga wa o mua, i kii nga taakuta ko nga puku katoa o te peritonsillar he streptococcal tonsillitis kaore i rongoatia e pana ana i roto i te kapene. E whakaatu ana te rangahau anatomical hou i te huarahi nui tuarua: Weber's glands, he tautau o te 20 ki te 25 mucous salivary glands iti kei roto i te supratonsillar space kei runga noa ake i te pou o runga o te tonsil, tuku ngongo ngongo ki roto i nga crypts tonsillar ki te horoi i nga otaota kai. I te wa e puruhia ana e te mumura, te marumaru ranei nga ngongo o te repe o Weber, ka mahanga te huware me te huakita ki roto i te waahi supratonsillar, ka puta he tere tere ** te toronga o te pou o te peritonsillar abscess** e turaki ana i te ngutu ngohe ki mua i raro i te wa e nekehia ana te uvula ki tera taha.

Polymicrobial bacteriology: he aha i kore ai e ranea te Penicillin anake¶

Kaore i rite ki te korokoro strep simple, he tata tonu he mate polymicrobial e whakakotahi ana i te huakita aerobic me te anaerobic waha (ko te nuinga o enei e whakaputa ana i nga enzyme beta-lactamase e whakangaro ana i te penicillin noa): - Prima Aerobic Pathogens: Streptococcus pyogenes (Rōpū A beta-hemolytic Streptococcus / GAS), Streptococcus anginosus (milleri) rōpū (he rongonui mo te hanga puku purulent hohonu), Staphylococcus aureus (tae atu ki te rewharewha MRSA), me te *Haemophilus rewharewha. - Primary Obligate Anaerobic Pathogens: Fusobacterium necrophorum (te take o Lemierre's syndrome), Prevotella melaninogenica, Porphyromonas, Bacteroides, me te anaerobic Peptostreptococcus.

Te tātaritanga rerekee taha-taha: Peritonsillar Abscess vs Retropharyngeal Abscess vs Epiglottitis vs Acute Tonsillitis¶

Ma te wehewehe i enei ahuatanga e wha i te taha o te moenga ka whakatau mena ka hiahia te manawanui ki te whakahaunga paturopi-a-waha, ki te wawata ngira i te taha o te moenga, ki te huarahi hau ruuma whakahaere ohorere ranei:

He aha te Retropharyngeal Abscess me te Parapharyngeal Extension he ohorere whakamate¶

Ahakoa ka herea te puku o te peritonsillar i te tuatahi e te uaua o te uaua, ko te whakaroa i te rerenga wai ka pakaru te nana ki roto i te pakitara uaua ki nga huarahi nui o te kaki e tata ana:

1. Retropharyngeal Abscess me te "Alar Danger Space" ki te Uma¶

Kei muri i te pakitara o muri o te korokoro (muri pharyngeal wall) kei te retropharyngeal space, ka rere mai i te take o te angaanga ki raro ki te uma o runga (T1 ki T2), ka wehea e te alar fascia angiangi mai i Space 4 (te "Te Mokowā Mokowā"), he kauhanga poutū kore e rere totika ki te diaphraginummmst muri. - I roto i nga Tamariki (I raro iho i te 6 tau): E rua nga mekameka poutū o retropharyngeal lymph nodes (Nodes of Rouviere) kei roto i nga tamariki nohinohi ka whakaheke i nga mate mai i te ihu, te sinuses, te adenoids, me nga taringa waenga. Ina he taringa, he mate sinus ranei ka pupuhi tetahi o enei ngongo rewharewha ka pakaru, ka whakakiia e te nana te waahi retropharyngeal. (I te 5 ki te 6 tau, ka iti haere, ka ngaro noa atu enei ngongo ngongo, na reira ko te retropharyngeal abscess he ohorere mo nga tamariki ki te kura ki te kore e werohia e te pakeke te tuara o tona korokoro ki te wheua ika, wheua heihei, rakau popsicle ranei.) - Descending Necrotizing Mediastinitis: Ki te pakaru te retropharyngeal abscess i roto i te angiangi alar fascia ki roto i te Mokowā Danger, te kaha me te pehanga o te uma kino i te wa e ngotea ana ka ngotea te nana purulent ki raro ki roto i te kohanga o te uma huri noa i te ngakau me nga oko nui (acute descending necrotizing mediastinitis.), e mau ana i te **25% o te mate mate ki te 4horacic he pokanga **25 ki te 4hora.

2. Te Mokowā Parapharyngeal Lateral Rupture and Lemierre's Syndrome¶

Mēnā ka pakaru te puku o te peritonsillar i te taha o te uaua o te pharyngeal constrictor ki roto i te parapharyngeal space (carotid sheath), e rua nga aitua toto ka puta: - Lemierre's Syndrome (Internal Jugular Vein Septic Thrombophlebitis): Na te huakita anaerobic te nuinga o te peia Fusobacterium necrophorum, ka uru te mate ki te pakitara o te aa jugular o roto, ka puta he kohu toto pangia (septic thrombuswell) ka puta te mamae o waho o te taha o waho. te uaua sternocleidomastoid i roto i te kaki me te uwhiuwhiu emboli septic ki roto i te pūkahukahu (cavitary septic pulmonary emboli, te mamae o te uma, me te ohorere septic). - ** Carotid Artery Mycotic Pseudoaneurysm and Blowout:** Ko te whakangaromanga o te pakitara o te arawa karoti o roto ka hanga he aneurysm teka pakarukaru ka pakaru ki roto i te pharynx, ka rere te toto o te ihu/waha i muri i te whakaheke toto mate.

Ko nga whakaahua taatai ​​hohipera me te whakahaere hauora¶

1. Intraoral Point-of-Care Ultrasound (POCUS) vs. Contrast-Enhanced CT of the Neck¶

Tata ki te 20 ki te 30 paiheneti o nga turoro e pupuhi ana i te ngutu-ngohengohe o tetahi taha he peritonsillar cellulitis (phlegmon), he mumura o te kiko me te kore he kohao nana wai, ka whakatauhia ma te paturopi me te steroids me te kore e hiahiatia he rakau ngira. - Te Irarangi Roto-a-waha, Raina-Tuatahi mo Quinsy): Ka tuu marie nga taote ohorere me nga tohunga ENT he tere-tere ** te tirotiro ultrasound endocavitary** (kua hipokina ki roto i te pukoro me te rehu anesthetic) ki runga i te waha tetere o te ngutu o raro**, kei raro ranei te whao ** kei raro i te ngutu o raro** kiki rawa ki te uru ki roto i te waha. Ka kitea e te ultrasound te puke pute wai hypoechoic (abscess) mai i te cellulitis totoka me te mapi i te hohonutanga i roto i te mitamano ki te paheketanga arii carotid roto ma te whakamahi i te Tae Doppler i mua i te pa o te ngira ki te ngutu. - IV Matawai CT Whakanui-Whakanuia o te Neck: Me whakahau i nga wa katoa ka whakapaehia te retropharyngeal abscess, te toronga parapharyngeal, te mate trismus nui e aukati ana i te waha, te mate Lemierre's syndrome ranei ka whakapaehia, me nga tamariki nohinohi. He rereke ki te CT, ka puta mai he kohungahunga pono hei kohinga wai iti ** iti-attenuation e karapotia ana e te rii "whakarei whakakai" kanapa**, engari ko te thrombosis vein jugular o roto e whakaatu ana i te koha whakakii i roto i te jugular lumen.

2. Te Hauora Hauora Tonu (Wai, Steroid, me nga Paturopi Awhiowhio)¶

I te mea karekau e taea e nga turoro me te mate peritonsillar me te retropharyngeal abscess te horomia wai mo te 24 ki te 72 haora na te mamae o te odynophagia, ka hiahia nga turoro katoa kia toru nga wawaotanga a-roto i te taenga mai:

1. Ko te Rehydration Crystalloid Intravenous: Ko te 1,000 mL bolus o te 0.9% saline noa, te Ringer's lactated ranei (ranei 20 mL/kg i roto i nga tamariki) ka whakahoki i te rōrahi intravascular me te whakatika i te ketosis matewai.
2. Kotahi Tirohanga Tirohanga Roopu Rorohiko (Dexamethasone): Ko nga whakamatautau haumanu matapōkeretia (i whakamanahia e te American Academy of Otolaryngology-Head and Neck Surgery) e whakaatu ana ko te whakahaere i te horopeta urunga kotahi o Dexamethasone 10 mg IV i roto i nga pakeke (ranei **0.3 ki te 0.6 mg/kg i te taha o nga tamariki i te taha o ** ki te 0.3 ki te 0.6 mg/kg IV, tae atu ki te 0.6 mg/kg IV. te edema pharyngeal, ka tapahia nga tohu mamae ki te haurua i roto i te 4 haora, ** ka whakakorikori i te waenganui pterygoid trismus kia tuwhera te waha o te manawanui **, ka whakahoki ano i te kaha ki te horomia wai 12 ki te 24 haora tere ake.
3. ** Nga Paturopi Paiora Intravenous Polymicrobial (Ka hipoki i te GAS, Strep anginosus, me te Beta-Lactamase Anaerobes):**
4. Raina Raina Tuatahi A: IV Ampicillin-Sulbactam (Unasyn) 3 karamu IV ia 6 haora i roto i nga pakeke (ranei ** 50 mg / kg / horopeta o te waahanga ampicillin** IV ia 6 haora i roto i nga tamariki), OR IV Amoxicillin-Clavulanate (i Uropi/UK/Australia **)
5. Raina Raina Tuatahi B (Penicillin-Allergic or MRSA Coverage): IV Clindamycin 600 ki te 900 mg IV ia 8 haora (ranei 10 ki te 13 mg/kg/ horopeta IV ia 8 haora i roto i nga tamariki), OR IV Ceftriaxone (1 ki te 2 g IV0dazole ia ra) PLUS **IV0 mg IV ia ra) PLUS ** IV Vancomycin or Linezolid ki te whakapaehia he sepsis nui, he MRSA ranei.
6. Te whakawhiti ki te rongoa waha i muri i te whakaheke wai: Ina kua whakahekehia te kopu, kua mate te turoro me te kaha ki te horomia wai ma te pai me te kore e tohe, ka whakawhiti ki te 10 ki te 14 ra o te akoranga Amoxicillin-Clavulanate waha (Augmentin, 875/125 mg ki te wha nga wa i ia ra) ki te 300 mg ki te wha nga wa i ia ra. ia rā).

Te whakahekenga o te pokanga tino: Aspiration Needle vs. Incision and Drainage vs. Interval Tonsillectomy¶

1. He pehea te mahi a nga Kairorohiko Haumaru i te Hiinga o te Ngira Kairangi (90% ki te 95% Reanga Whakaora)¶

Mo nga taiohi mahi tahi me nga pakeke e pa ana ki te puku peritonsillar kore uaua, ko te wawata o te ngira i te taha o te moenga, i te ultrasound-arahina ranei te mea iti rawa te mamae, te tere tere me te whakatau i te 90 ki te 95 paihēneti o te puku me te kore e tika kia werohia te ruma poka:

1. Topical and Submucosal Anesthesia: Ka rehuhia e te taote te ngutu ngohe ki te benzocaine/lidocaine rehu mo runga (matakitakihia te horopeta katoa hei karo i te methemoglobinemia) ka werohia te 1 ki te 2 mL o **1%, 2% ranei te lidocaine me te 1:100,000 epinephrine ** ki roto i te mucosa mucosa o ** pou tonitara.
2. Kaitiaki Hohonu Miihini (Te Tiaki i te Carotid Artery): Ka piri he 18-mehua tuawhenua, ngira wawata roa ranei ki te syringe 10 mL. Hei whakapumau i te ngira kaore e taea te kuhu hohonu atu i te 10 ki te 15 mitamano (0.4 ki te 0.6 inihi) ki te arai karoti o roto, ka tapahia e te taote te potae ngira kirihou na 1.0 ki te 1.5 henemita anake o te pito ngira whakarewa ka puta ki mua i te kaitiaki kirihou.
3. Te Maamaa Sagittal Trajectory i te Pou Superior: Te whai tika ** ki muri tika (rererangi sagittal, whakarara ki te papa o te waha) i te kupenga o te raina whakapae puta noa i te take o te uvula me te raina poutū i te taha o te pou tonsillar o mua** (kaua rawa e anga taha taha ki te taringa, 5 cm te anga whakamua) te pou i te wa e toia ana ki runga i te pupuhi, te nuinga o te wa ka kohia te 2 ki te 10 mL o te nana kowhai-ma kakara noa me te whakaora tere i te pehanga me te mamae. (Mehemea karekau he nana i puta mai i te pou teitei, karekau hoki i whakamahia te ultrasound, ka mahia he wawata tuarua ki te pou o waenga, engari ka karohia te pou iti na te mea e tata ana ki te arai carotid.)

2. Ko te Wehenga Roo-waha me te Whakaheketanga (I&D) me te wa e taunakihia ana te Waatanga Tosillectomy¶

• Te Wehenga me te Paheketanga (Quinsy Drainage): Mena he matotoru rawa te nana (kua kitea) ka taea te kuhu mai i te ngira 18 ine, ka kohikohi ano ranei i muri i te wawata, ka mahia e te tohunga he iti 5 ki te 8 mirimita te werohanga mucosal superficial ki runga i te puku o te pou teitei me te maataki #11 ki te mata o te scalpel mata (kei te kati te mata o te scalpel mata katoa) Ka kuhu a Kelly hemostat ki roto i te kohao, ka horahia marietia nga kauae e tuwhera ana ki te wawahi i nga waahi, ka ngotea te nana, me te whakamaarama i te tote me te hydrogen peroxide.
• Hot ("Quinsy") Tonsillectomy vs. Interval Tonsillectomy: Ko nga tamariki nohinohi e hiahia ana ki te whakamohiotanga whanui mo te whakaheke wai, ki nga turoro ranei e mau tonu ana te mate peritonsillar abscesses (neke atu i te 2 nga wahanga) me te tonsillitis mau tonu ranei, ka pangia e te totonsillectomy whakapeka tonu i roto i te rūma whakahaere, i te waa whiriwhiri ** i muri mai i te 4 ki te 6 wiki o muri mai ka whai i te tonsillectomy vascular me te tonsillectomy. kua heke.

Nga nama ohorere a rohe me nga tikanga umanga¶

• Te Hononga o Amerika me Kanata: Waea wawetia te 911 mo nga korokoro mamae e haere tahi ana me te drooling, stridor, tripod posture, mamae toronga kaki, te kore ranei e horomia huware. Mo te whakapae he puku o te peritonsillar (trismus, uvula deviation, reo wera-potato), haere ki te Tari Ohotata Hōhipera me te kapinga ENT (ehara i te whare haumanu tiaki ohorere, e kore e taea te whakahaere i te whakaheke i te ultrasound-arahi, i te whakaahua CT ranei), whai muri i te ** American Academy of Otolaryngology-Head and Neck Surgery (AAOlines-HNS)**
• United Kingdom: Waea 999 mo te stridor, te ara rererangi ranei. I raro i nga aratohu ENT UK me NICE, ko nga turoro e whakapaehia ana he quinsy (peritonsillar abscess), ka kitea e te pupuhi o te peritonsillar unilateral, te rereke o te uvula, te trismus, te kore e kaha ki te horomia wai, me tono ** i te ra kotahi te tukunga atu i te hohipera whawhati tata ki te roopu ENT i runga waea** mo nga wai IV, IV dexamethasone, IV dexamethasone, IV dexamethasone, IV. me te wawata ngira.
• Uniana Pakeha: Waea 112 puta noa i nga whenua mema katoa o te EU mo nga ohorere mokowhiti kaki hohonu, stridor ranei. Ko nga tari ORL o te hohipera e whakamahi ana i te ultrasound transoral me te ngira ngira, te werohanga me te whakaheke me te whakamaaramatanga o te paturopi IV tonu.
• Ahitereiria me Aotearoa: Waea 000 i Ahitereiria, 111 ranei i Aotearoa mo nga aitua ohorere. A pee i te ** Aratohu Whakaora (Ahitereiria)** mo te mate peritonsillar: te aromatawai i te hōhipera ohorere mo te whakaheke toto me te IV benzylpenicillin + IV metronidazole (ranei IV clindamycin i te mate pāwera penicillin) me te horopeta kotahi o te IV dexamethasone.
• Ahia-Kiwa: Waea 119 i Hapani me Korea ki te Tonga, 995 i Singapore, 999 i Mareia me Hong Kong, 112 / 108 ranei i Inia mo te kawe ki te hohipera me te 24-haora ENT pokanga me te tautoko i te huarahi rererangi.

Pātai auau¶

Me pehea e mohio ai ahau ki te rereketanga o te korokoro strep (tonsillitis) me te puku peritonsillar (quinsy)?¶

He rite tonu te mamae me te whero o nga taha e rua o te korokoro na te korokoro strep or tonsillitis viral, ko to uvula (te kopa paku paku e tarewa ana i waenganui o muri o to korokoro) ka noho ki waenganui, ka taea tonu e koe te puaki i to waha ka horomia te wai. Ka puta te puku o te peritonsillar (quinsy) ina kohi ana te nana ki muri i tetahi tone, ka puta nga tohu e wha: (1) Ka kaha te mamae ki tetahi taha ka puta ki roto i te taringa ki tera taha; (2) He pupuhi pupuhi i te tuanui o te waha (ngao ngohe) i runga ake i tetahi tone e pana ana te uvula ki tera taha; (3) Lockjaw (trismus), ka kore koe e puaki i to waha neke atu i te 1 ki te 2 maihao-whanui; me te (4) He reo "hot-potato" maru me te drooling.

He aha te take i kore ai e taea e te kopu o te peritonsillar te whakatuwhera whanui o to waha (trismus)?¶

Trismus (lockjaw) ka puta na te mea ko te waahi peritonsillar i te taha o to korokoro e noho ana i te taha tonu o te uaua pterygoid waenga, tetahi o nga uaua ngaungau kaha ki te kati i te kauae o raro. Ka pakaru mai te nana huakita i roto i te kapene tonsil me te whakapataritari i te fascia e pa ana ki te uaua pterygoid waenga, ka uru te uaua ki roto i te mokowhiti, he whakamarumaru mamae. I nga wa katoa e kore e taea e te turoro he korokoro mamae te whakauru kia toru nga maihao tapae poutū ki waenga i o ratou niho o mua (ka tuwhera ranei te whanui atu i te 2 henimita / 0.8 inihi), he tohu haumanu kua horapa te mate ki waho o te tone ki roto ki nga kiko hohonu.

He aha te "reo wera-potato," me te aha i tupu ai?¶

He "reo wera-potato" (e kiia ana ko te muffled dysphonia, rhinolalia clausa ranei) te ahua e ngana ana te tangata ki te korero i a ia e pupuri ana i te ngau wera-wera o te rīwai tunua ki muri o tona waha me te kore e nekehia tona arero me te ngutu ngohe. Ka tupu na te mea ko te kohikohinga o te nana i roto i te ngutu ngawari ka pararutiki nga uaua o te parata me te aukati i te ruuma resonance o te korokoro o runga, i te wa e nekehia ana te take o te arero, o te ngutu ranei ka nui te mamae. Ka puta te reo riwai wera i roto i te kopu peritonsillar, te retropharyngeal abscess, te epiglottitis whakapeka ranei, me te aro turuki i te tari whawhati tata mo te ra kotahi.

Me pehea te korero a nga taote mo te puku peritonsillar i tua atu i te retropharyngeal abscess?¶

Ka noho te puku ki te taha o tetahi tonsil i roto i nga taiohi me nga pakeke, ka kati te kauae (trismus) ka pana te uvula ki tera taha ina titiro koe ki te waha. Ka puta mai he whewhe retropharyngeal i muri i te pakitara o muri o te korokoro (te nuinga o nga tamariki kei raro iho i te 6 tau te pakeke ka pangia nga pona lymph retropharyngeal hohonu i muri i te pangia o te ihu, o te taringa ranei, i nga pakeke ka horomia he wheua ika koi). Engari i te lockjaw me te uvula taha taha, ko te tangata turoro he retropharyngeal abscess ka tino maro tona kaki, ka mamae te mamae i te wa e ngana ana ki te whakamuri i o ratou mahunga ki te titiro ki te tuanui (te toronga kaki), na te mea ka toro atu te kaki i te tuara ki te pukoro nana.

Kei te mamae te whakamakuku i te kopu o te peritonsillar i roto i te ruma ohorere, me pehea te mahi?¶

I mua i te pa atu ki te puku, ka hoatu e te taote ohorere, te tohunga ENT ranei he rongoa mo te mamae me te dexamethasone (he pūtaiaki anti-inflammatory kaha e whakangāwari ana i te mokowhiti kauae me te pupuhi), katahi ka whakangote i te tuanui o te waha ki te rehu ngongo me te werohanga whakamomori iti o te rohe. Ma te whakamahi i te tirotiro ultrasound i te taha o te moenga ki te kite i te pukoro tika o te nana me te karo i nga oko toto tata, ka kuhu e te taote he ngira kua tiakina kia 1 henemita noa iho ki te putunga o runga o te ngutu ngohe ka kumea mai te wai nana i mau ki roto i te syringe. Ko te nuinga o nga turoro ka rongo tonu i te mamae o te pupuhi me te mamae o te taringa i te wa e pupuhi ana te nana, a 90 paiheneti ka taea te hoki ki te kainga me te patu paturopi waha i roto i nga haora.

He aha te take e mamae nui ai taku taringa ki te taha o taku tonsil tetere ki te kore taku taringa i pangia?¶

Ko te tonsil, te ngutu ngohe, me te taringa waenganui he rite tonu te peka o te nakahi, e kiia nei ko te nerve glossopharyngeal (Cranial Nerve IX, ina koa ko te peka tympanic o Jacobson). I te wa e torohia ana e te puku o te peritonsillar te kapi me te ngutu ngohe ki te taha maui o to korokoro, ka tahuna e te nerve glossopharyngeal nga tohu mamae nui ki to roro, kaore e taea te tohu mena i ahu mai te tohu mai i te korokoro, i te puoro taringa ranei. Ko tenei ahuatanga ka kiia ko te otalgia; ka heke te puku o te korokoro, ka ngaro te mamae o te taringa.

Nga puna me nga aratohu whai mana¶

• American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS, United States): He Aratohu Mahi Hauora me nga Tauāki Whakaaetanga mo te Peritonsillar Abscess (Quinsy), Intraoral Ultrasound Triage, Corticosteroid Adjunct Therapy, and Needle Aspiration vs. Incision and Drainage.
• ENT UK and National Institute for Health and Care Excellence (NICE, United Kingdom): Acute Sore Throat and Peritonsillar Abscess (Quinsy) Emergency Referral, Intravenous Antibiotic, and Drainage Aratohu.
• ** Infectious Diseases Society of America (IDSA) me te American Academy of Pediatrics (AAP):** Te Whakahaerenga o nga Infections Mokowhiti Neck Deep i roto i nga Tamariki me nga Pakeke: Retropharyngeal, Parapharyngeal, me Peritonsillar Abscesses.
• ** American College of Emergency Physicians (ACEP):** He kaupapa here haumanu mo te Tohu-o-Tiaki i roto i te waha me te Irarangi Submandibular mo te Differentiation o Peritonsillar Abscess vs. Peritonsillar Cellulitis.
• Nga Aratohu Whakaora (Ahitereiria): Nga Aratohu Paturopi mo te Acute Peritonsillar Abscess (Quinsy) me nga Infections Mokowā Neck Hohonu.

Nga kaiarahi e pa ana¶

• Epiglottitis, croup, stridor, me te arai arai o runga
• Ko te angina a Ludwig, te pupuhi niho niho, me te pupuhi o te ara rererangi
• Te whakaheke toto tuarua i muri i te tonsillectomy: Ra 5 ki te 10 te whakahekenga o te eschar me te whakamatautau i te huarahi rererangi.
• Te kowhatu repe huware kua aukatia (sialolithiasis) me te parotitis suppurative
• Ko nga nama ohorere ma te whenua