Peritonsillar Abscess (Quinsy): Liwu la Mbatata Yotentha, Kupatuka kwa Uvula, Trismus, ndi Needle Aspiration vs Retropharyngeal Abscess¶

Abscess ya peritonsillar (yodziwika bwino kuti ** quinsy **) ndi matenda omwe amapezeka kwambiri m'khosi mwa achinyamata ndi akuluakulu, omwe amapezeka pamene matenda a bakiteriya amafalikira kupyola kapisozi wa palatine tonsil mu minofu yotayirira pakati pa tonsillar capsule ndi pamwamba pharyngeal constrictor muscle . Ngakhale tizilombo toyambitsa matenda kapena streptococcal tonsillitis imayambitsa kufiira kwapakhosi ndi kupweteka kumbali zonse ziwiri, chiphuphu cha peritonsillar chimapanga thumba lokhazikika la purulent mafinya pamwamba ndi pambali pa tonsil imodzi ( nthawi zambiri pamtengo wapamwamba ). Kusonkhanitsa kumeneku kumakankhira mkamwa wofewa kutsogolo ndi pansi kwinaku akukankhira mzere wapakati kuvundukula mwamphamvu kudutsa mbali ina (yathanzi), kumayambitsa kupweteka kowawa kwa pafupi pakatikati pterygoid nsagwada minofu (trismus, kulephera kutsegula pakamwa mokulirapo kuposa 2 centimita mu "potaziyamu" 0.8 mainchesi mawu, ndikuletsa wodwalayo kumeza malovu awo (kudontha). Kuphatikiza apo, aliyense amene ali ndi mawu osamveka, akudontha, kapena kupweteka kwapakhosi ayenera kusiyanitsidwa mwachangu ndi ** Retropharyngeal Abscess ** (yomwe imadziwika ndi kupweteka kwambiri ** kukulitsa khosi ** ndi khoma lakumbuyo kwa pharyngeal mwa ana ang'onoang'ono) ndi ** Acute Epiglottitis (pomwe khosi limawoneka mopanda pake pomwe lilime likuwoneka mopanda pake. kusindikiza kutseka). Ngati wina aliyense amene ali ndi zilonda zapakhosi ayamba kutuluka thukuta, stridor, kaimidwe katatu, trismus, kapena kulephera kumeza zamadzimadzi, imbani foni kwanuko. manambala angozi nthawi yomweyo. Onaninso maupangiri a abale athu pa epiglottitis, croup, stridor, ndi kutsekeka kwapamwamba kwa mpweya, Ludwig angina ndi kutupa kwa submandibular airway,ndi sepsis ndi septic shock.

Chofunikira chanu chachikulu ndikusunga wodwalayo kukhala bawuti molunjika pamalo ake otonthoza kuti mafinya ndi malovu asatseke njira yodutsa mpweya, yang'anani pakamwa potsegula ndi tochi pokhapo ngati pali zero stridor ** (kuyang'ana kuphulika kwa mkamwa wofewa komanso kupatuka kwa uvula), onani kuchuluka kwa zala zala ndikutsegula chipatala* dipatimenti yadzidzidzi ya mtsempha wa dexamethasone, maantibayotiki olowa m'mitsempha yotakata (ampicillin-sulbactam kapena clindamycin), komanso kutulutsa singano motsogozedwa ndi ultrasound kapena kudula ndi kutulutsa madzi.

Chitani izi tsopano¶

1. Yang'anani mwachangu mbendera zofiira za Critical Airway Obstruction ndikuimbira nambala yanu yadzidzidzi yapafupi ngati ilipo. Imbani 911 ku United States ndi Canada, 999 ku United Kingdom, 112 kudutsa European Union, 000 ku Australia, kapena fufuzani chikwatu chathu cha manambala angozi ngati wodwalayo ali ndi ** inspire stridor (kukweza kwambiri kapena kuimba mluzu pamene akupuma), kukhala mowongoka ndikutsamira patsogolo pa manja otambasulidwa (magawo atatu), kuloza kosalekeza kwa malovu, kulephera kugona mosapumira, kapena kufalitsa kufiira ndi kutupa kutsogolo kapena mbali ya khosi **.
2. Sungani wodwalayo kukhala mowongoka ndikutsamira patsogolo pang'ono; MUSAMAkakamize kugona chagada chagada. Kugona mopanda fulati kumapangitsa kuti chiphuphu chachikulu chotuluka m'mimba, chotupa, ndi malovu olumikizana kuti zigwe chagada pamwamba pa epiglottis ndi zingwe zotulutsa mawu, zomwe zimapangitsa kuti mwadzidzidzi msewu wa mpweya uzitsekeke.
3. Yengani 3-Finger Trismus Check ndi Tochi Palate Palate (POKHALA ngati wodwala alibe stridor ndipo si mwana wokhumudwa yemwe akuganiziridwa kuti epiglottitis):
4. Fufuzani za Trismus za Zala zitatu: Funsani wodwalayo kuti atsegule pakamwa pake momwe angathere. Wachikulire kapena mwana wathanzi amatha kukwana 3 zala zake zopindika molunjika pakati pa mano awo akutsogolo ndi akumunsi (mamilimita 35 mpaka 50 / mainchesi 1.4 mpaka 2.0). Ngati kupweteka kwa nsagwada kumalepheretsa kutsegula kwambiri kuposa ** 1 mpaka zala za 2 (pansi pa 20 millimeters / 0.8 mainchesi) **, ** trismus ** ilipo, kutsimikizira kuti matendawa alowa kunja kwa tonsil mu ** medial pterygoid masticator muscle **.
5. Chongani Chofewa cha Palate ndi Kupatuka kwa Uvula: Wanitsani tochi ya foni mkamwa. Mu chiphuphu cha peritonsillar, mbali imodzi ya mkamwa wofewa pamwamba pa tonsil imatuluka pansi ndi kutsogolo ngati maula ofiira otupa, kukankhira lendewende **uvula mwamphamvu kudutsa pakati pa mzere ku mbali ina, yosatupa **.
6. Screen for Retropharyngeal Abscess poona kufatsa kwa Neck Extension vs. Flexion: Ngati wodwala ali mwana wamng'ono (makamaka wazaka 6 mpaka zaka 6) kapena wachikulire atameza fupa la nsomba kapena fupa la nkhuku yemwe wagwira khosi mowuma mu torticollis ndipo akulira kapena kumva kupweteka kwa khosi kumutu mpaka padenga* (kukulitsa khosi) **, ganizirani ** Retropharyngeal Abscess ** mu malo oopsa a prevertebral ndikuyitana EMS mwamsanga.
7. Sungani wodwalayo mosamalitsa NPO (Palibe Pakamwa: chakudya cha zero, zakumwa za zero, mapiritsi akumwa a zero) musanapite ku Dipatimenti Yowopsa. Chifukwa chakuti trismus yoopsa kapena kutambasula kwa khosi lakuya kungafunike kutulutsa madzi opangira opaleshoni kapena opaleshoni ya opaleshoni mu Chipinda Chothandizira, m'mimba yopanda kanthu imalepheretsa kukhumba panthawi yoyendetsa ndege.
8. **MUSAMAyese kutulutsa chiphuphu chapakhosi kunyumba ndi chala, supuni, singano, kapena swab ya thonje.*Mtsempha wamkati wa carotid umayenda molunjika kumbuyo ndi kutsogolo mpaka ku tonsillar fossa (nthawi zina mkati mwa 10 mpaka 20 mamilimita [0.4 mpaka 0.8 mainchesi]); Kuboola kunyumba kwakhungu kumatha kuboola mtsempha wamkati wa carotid (kuyambitsa kufa kwa masekondi 60) kapena kutulutsa mafinya okhuthala molunjika ku trachea (acute aspiration asphyxiation).

Mtengo wosankha: zilonda zapakhosi, mawu osamveka, trismus, ndi kuzama kwapakhosi kwapakhosi¶

flowchart TD
    A["Kupweteka Kwambiri Pakhosi + Odynophagia (Kumeza Ululu) + Kutentha thupi"] --> B{"Kodi Zizindikiro Zowopsa za Airway Zilipo? (Kulimbikitsa stridor, kaimidwe katatu, cyanosis, kapena kulephera kugona pansi)"}
    B -->|YES: Imminent Airway Obstruction| C["Imbani EMS (911/999/112) Nthawi yomweyo: Khalani pansi mowongoka; MUSAMAike kalikonse mkamwa; konzekerani Awake Fiberoptic kapena Operating Room Intubation"]
    B -->|NO stridor or respiratory distress| D{"Onani Kutsegula Pakamwa (Trismus), Neck Motion, ndi 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 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: Danger Space Emergency (Ngozi ya 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["ANGINA YA LUDWIG: Bilateral Submandibular/Sublingual Space Emergency"]
    D -->|Symmetrical bilateral red swollen tonsils with white exudates, midline uvula, normal 3-finger mouth opening, NO voice muffling or drooling| H["Osavuta Acute Tonsillitis / Pharyngitis (Strep, EBV Mononucleosis, kapena Viral)"]
    E --> I["Urgent Hospital ED Evaluation (Sungani NPO): IV Hydration + IV Dexamethasone (10 mg) + IV Ampicillin-Sulbactam kapena Clindamycin"]
    I --> J["Intraoral High-Frequency Ultrasound (kapena Contrast CT ngati trismus yoopsa): Imatsimikizira abscess yamadzimadzi vs peritonsillar cellulitis"]
    J --> K["ENT Bedside Ultrasound-Guided Needle Aspiration (pa Superior Pole medial mpaka molar line) kapena Incision & Drainage"]
    F --> L["Chipatala Chapafupi ED: Kusiyanitsa CT ya Neck & Chest + IV Broad-Spectrum Antibiotics + Malo Opangira Opaleshoni Transoral Opaleshoni Drainage"]
    G --> M["Chipatala Chapafupi ED: Galamukani Nasotracheal Intubation + IV Antibiotics + Opaleshoni Decompression"]
    H --> N["Rapid Strep Test / Throat Culture + Oral Analgesics + Hydration (Oral Amoxicillin ngati Gulu A Strep positive; pewani Amoxicillin ngati EBV Mono akukayikira)"]

Ndondomeko ya anatomical: momwe matonsillitis amathyola kapisozi kupita kumalo a peritonsillar¶

Palatine tonsil imazunguliridwa ndi chipolopolo chakunja chamtundu (** kapisozi wa tonsillar **) chomwe chimalekanitsa minofu ya lymphoid ya tonsil kuchokera ku khoma la mitsempha ya mmero (**pamwamba kwambiri pharyngeal constrictor muscle **). Pakati pa fibrous tonsillar capsule mkati ndi pamwamba pa pharyngeal constrictor minofu kunja pali malo opapatiza odzaza ndi minofu yotayirira yotchedwa 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.
=======================================================================

Chifukwa chiyani 75 peresenti ya abscesses a peritonsillar amapanga ku Superior Pole (Weber's Glands)¶

M'mbuyomu, asing'anga ankaganiza kuti zilonda zonse za peritonsillar zinali chabe streptococcal tonsillitis yosachiritsika yomwe imadutsa mu kapisozi. Kafukufuku wamakono wa anatomical akuwonetsa njira yayikulu yachiwiri: ** Tizilombo ta Weber **, gulu la 20 mpaka 25 ting'onoting'ono ting'onoting'ono ta mucous salivary tomwe timakhala molunjika mu supratonsillar danga pamwamba pa mtengo wapamwamba wa tonsil, kutumiza tinjira tating'onoting'ono mu tonsillar crypts kutsuka zinyalala za chakudya. Pamene kutupa kwakukulu kapena kuphulika kumatseketsa ma ducts a glands za Weber, malovu ndi mabakiteriya amatsekera mkati mwa danga la supratonsillar, kupanga kukula kofulumira **pamwamba-pole peritonsillar abscess ** yomwe imakankhira mkamwa lofewa patsogolo ndi pansi pamene ikuchotsa uvula kumbali ina.

Polymicrobial bacteriology: chifukwa chiyani Penicillin yekha sikokwanira¶

Mosiyana ndi strep throat, chiphuphu cha peritonsillar pafupifupi nthawi zonse chimakhala *matenda a polymicrobial ophatikiza mabakiteriya a aerobic ndi anaerobic oral ** (ambiri mwa iwo amapanga michere ya beta-lactamase yomwe imawononga plain penicillin): - Matenda Oyamba a Aerobic: Streptococcus pyogenes (Gulu A beta-hemolytic Streptococcus / GAS), Streptococcus anginosus (milleri) gulu (lotchuka chifukwa chopanga zithupsa zakuya), Staphylococcus(incphilus RS) fuluwenza*. - **Matenda Ofunika Kmbiri a Anaerobic:***Fusobacterium necropho* (choyambitsa cha Lemierre's syndrome*), *Prevotella melaninognica, *Porphyromoas, *Bacteroies, ndi anaerobic *Pptostreptococcus.

Kuzindikira kwa mbali ndi mbali: Peritonsillar Abscess vs Retropharyngeal Abscess vs Epiglottitis vs Acute Tonsillitis¶

Kusiyanitsa mikhalidwe inayi pambali ya bedi kumatsimikizira ngati wodwalayo akufunika kupatsidwa mankhwala oletsa kumwa mankhwala, kukhumba singano pabedi, kapena njira yopangira opaleshoni yadzidzidzi:

Chifukwa chiyani Retropharyngeal Abscess ndi Parapharyngeal Extension ndizochitika zadzidzidzi¶

Ngakhale kuti chiphuphu cha peritonsillar chimakhala chotsekeredwa ndi minofu yapamwamba kwambiri, kuchedwetsa ngalande kumapangitsa mafinya kudutsa khoma la minofu kupita kumisewu yakuya ya khosi:

1. Retropharyngeal Abscess ndi "Alar Danger Space" ku Chifuwa¶

Kumbuyo kwa khoma lakumbuyo la mmero (posterior pharyngeal wall) pali retropharyngeal space, yomwe imayenda kuchokera pansi pa chigaza mpaka pachifuwa chapamwamba (T1 mpaka T2), yolekanitsidwa ndi chiwopsezo chochepa kwambiri cha alar fascia kuchokera ku ** Space 4 ("Danger Space"), frictionless and postdiaphless frictionless mediastinum. - Mwa Ana Aang'ono (Osapitirira zaka 6): Ana aang'ono amakhala ndi maunyolo awiri ofukula a retropharyngeal lymph nodes (Nodes of Rouviere) omwe amachotsa matenda m'mphuno, m'mphuno, adenoids, ndi makutu apakati. Pamene khutu kapena sinus matenda amayambitsa imodzi mwa ma lymph nodes kuti iwonongeke ndi kuphulika, mafinya amadzaza danga la retropharyngeal. (Pokafika zaka 5 mpaka 6, ma lymph nodeswa amachepa ndi kutha, chifukwa chake abscess retropharyngeal makamaka ndi vuto lachibwana lachibwana pokhapokha ngati munthu wamkulu akuwombera kumbuyo kwa mmero ndi nsomba, fupa la nkhuku, kapena ndodo ya popsicle.) - ** Kutsika kwa Necrotizing Mediastinitis: ** Ngati chiphuphu cha retropharyngeal chikuphulika kupyolera mu malo owopsa a alar fascia, mphamvu yokoka ndi kupanikizika kwa chifuwa panthawi yopuma imayamwa purulent mafinya molunjika pansi pachifuwa chozungulira mtima ndi ziwiya zazikulu (**kutsika kwakukulu kwa necrotizing mediastinitis **), kunyamula 4025 peresenti ya imfa ya 4025 opaleshoni.

2. Lateral Parapharyngeal Space Rupture ndi Lemierre's Syndrome¶

Ngati chiphuphu cha peritonsillar chikuphwanyidwa mozungulira kudzera mumtsempha wapamwamba kwambiri wa pharyngeal kupita ku parapharyngeal space (carotid sheath), masoka awiri a mitsempha amatha kuchitika: - Lemierre's Syndrome (Internal Jugular Vein Septic Thrombophlebitis) Moyendetsedwa kwambiri ndi bakiteriya yotchedwa anaerobic Fusobacterium necrophorum, matendawa amalowera khoma la internal jugular vein, kupanga magazi omwe ali ndi kachilombo (septic thrombus) yomwe imayambitsa kuphulika kwamkati mkati mwake. Minofu ya sternocleidomastoid pakhosi ndikuthira septic emboli m'mapapo (** cavitary septic pulmonary emboli **, kupweteka pachifuwa, ndi septic shock). - Carotid Artery Mycotic Pseudoaneurysm and Blowout: Enzymatic kuwonongeka kwa khoma la internal carotid artery kumapanga mtsempha wonyezimira wosalimba womwe ungathe kusweka mu pharynx, kupangitsa mphuno / pakamwa kutulutsa magazi motsatiridwa ndi kupha kwa mtsempha wamagazi.

Kujambula kwachipatala ndi kasamalidwe kachipatala¶

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

Pafupifupi 20 mpaka 30 peresenti ya odwala omwe amabwera ndi kutupa m'kamwa kofewa kamodzi kokha amakhala ndi peritonsillar cellulitis (phlegmon), kutupa kwa minofu popanda mafinya amadzimadzi, komwe kumathetsa ndi mankhwala opha tizilombo ndi ma steroid popanda kufunikira ndodo ya singano. - High-Frequency Intraoral or Submandibular Ultrasound (Mzere Woyamba wa Quinsy): Madokotala azadzidzi ndi akatswiri a ENT amayika mozama kwambiri endocavitary ultrasound probe (yokutidwa m'chimake chosabala chokhala ndi mankhwala opha ululu) motsutsana ndi kutupa kwa mkamwa wofewa, kapena nsagwada yakunja* trismus ndi yothina kwambiri kuti isagwirizane ndi kafukufuku m'kamwa). Ultrasound nthawi yomweyo imasiyanitsa thumba la hypoechoic fluid pus (abscess) kuchokera ku cellulitis yolimba ndipo imayika kuzama kwenikweni kwa mamilimita mpaka kugunda ** mtsempha wamkati wa carotid ** pogwiritsa ntchito Colour Doppler singano isanakhudze mkamwa. - IV Contrast-Enhanced CT Scan of the Neck: Yovomerezeka nthawi iliyonse ** abscess retropharyngeal, parapharyngeal extension, trismus yovuta kwambiri yolepheretsa mayeso a m'kamwa, kapena Lemierre's syndrome** akukayikira, komanso ana aang'ono. Mosiyana ndi CT, chiphuphu chenicheni chimawoneka ngati chodziwika bwino ** chosonkhanitsira chamadzimadzi chochepa chozunguliridwa ndi "ring-enhancing" rim** yowala, pomwe thrombosis yamkati ya jugular vein thrombosis ikuwonetsa vuto lodzaza mu lumen ya jugular.

2. Immediate Intravenous Medical Therapy (Fluids, Steroids, ndi Broad-Spectrum Antibiotics)¶

Chifukwa odwala omwe ali ndi peritonsillar kapena retropharyngeal abscess sanathe kumeza zamadzimadzi kwa maola 24 mpaka 72 chifukwa cha odynophagia yowawa, wodwala aliyense amafunika kulowetsedwa katatu mwamsanga atangofika:

1. Aggressive Intravenous Crystalloid Rehydration: A 1,000 mL bolus ya 0.9% saline wamba kapena lactated Ringer's (kapena 20 mL/kg mwa ana) imabwezeretsa mphamvu ya m'mitsempha ndikuwongolera ketosis.
2. Single High-Dose Intravenous Corticosteroid (Dexamethasone): Mayesero achipatala osankhidwa mwachisawawa (ovomerezedwa ndi American Academy of Otolaryngology-Head and Neck Surgery) amatsimikizira kuti kupereka mtsempha umodzi wa Dexamethasone 10 mg IV mwa akulu (kapena 0.3 mg* 0 mpaka IV). Pamodzi ndi maantibayotiki amachepetsa msanga edema ya pharyngeal, amadula kuchuluka kwa zowawa pakati pa maola 4, **amachotsa medial pterygoid trismus kuti wodwalayo atsegule pakamwa **, ndikubwezeretsa mphamvu yakumeza zamadzimadzi maola 12 mpaka 24 mwachangu.
3. Empiric Polymicrobial Intravenous Antibiotics (Kuphimba GAS, Strep anginosus, ndi Beta-Lactamase Anaerobes):
4. Mzere Woyamba A: IV Ampicillin-Sulbactam (Unasyn) 3 magalamu IV maora 6 aliwonse mwa akulu akulu (kapena 50 mg/kg/mlingo wa chigawo cha ampicillin IV maola 6 aliwonse mwa ana), KAPENA IV Amoxicillin-Clavulanate (ku Europe +IV/Benzy) Metronidazole**).
5. Mzere Woyamba B (Penicillin-Alergic kapena MRSA Coverage): IV Clindamycin 600 mpaka 900 mg IV maora 8 aliwonse (kapena 10 mpaka 13 mg/kg/dozi IV maola 8 aliwonse mwa ana), KAPENA IV Ceftriaxone (tsiku ndi tsiku* 1 mpaka 50 mg* IV Ceftriaxone) IV maola 8 aliwonse), kuwonjezera IV Vancomycin kapena Linezolid ngati akukayikira sepsis kapena MRSA.
6. Kusintha Kuchiza Mkamwa Pambuyo Kuthira: Chiphuphu chikatsitsidwa ndipo wodwala wafooka ndipo amatha kumeza zamadzi bwinobwino popanda kudontha, amapita ku*10 mpaka 14 pakamwa Amoxicillin-Clavulanate (Augmentin, 875/125 mg wa 4 oral Clinda katatu patsiku) nthawi tsiku lililonse)**.

Ngalande yotsimikizirika yopangira opaleshoni: Kutayira kwa singano vs.¶

1. Momwe Achipatala Amagwirira Ntchito Yotetezeka Kwambiri-Nyengo ya Singano (90% mpaka 95% Kuchiza)¶

Kwa achinyamata ogwirizana komanso achikulire omwe ali ndi chiphuphu chosavuta cha peritonsillar, m'mbali mwa bedi kapena ultrasound-guided singano aspiration ndi njira yopweteka kwambiri, yofulumira kwambiri ndipo imathetsa 90 mpaka 95 peresenti ya zilonda popanda kudulidwa m'chipinda chopangira opaleshoni:

1. Topical and Submucosal Anesthesia: Dokotala amapopera mkamwa wofewa ndi topical benzocaine/lidocaine spray (kuyang'ana mlingo wonse kuti apewe methemoglobinemia) ndikubaya 1 mpaka 2 mL ya 1% kapena 2% lidocaine wa 1:100,000 epinephrine mu mtsempha wamkati wamkati* wam'mimba* tonsillar mzati.
2. Mechanical Depth Guard (Kuteteza Mitsempha ya Carotid): 18-gauge ya msana kapena singano yayitali* imalumikizidwa ku syringe ya 10 mL. Pofuna kutsimikizira kuti singanoyo singalowe mozama kuposa mamilimita 10 mpaka 15 (mainchesi 0.4 mpaka 0.6) kulowera mtsempha wamkati wa carotid, sing'anga amadula kapu ya singano ya pulasitiki kuti **masentimita 1.0 mpaka 1.5 okha a nsonga ya singano yachitsulo imadutsa mtsempha wa pulasitiki **.
3. Strict Sagittal Trajectory at Superior Pole: Kulunjika ndendende ** molunjika kumbuyo (ndege ya sagittal, yofanana ndi pansi pakamwa) pa mphambano ya mzere wopingasa m'munsi mwa uvula ndi mzere wowongoka motsatira chipilala chakumbuyo chakumbuyo** (osayang'ana mozungulira molunjika ku khutu la 01). masentimita mumtengo wapamwamba uku akukokeranso plunger, nthawi zambiri amalakalaka **2 mpaka 10 mL ya mafinya onunkhira achikasu-woyera ** ndikupereka mpumulo wanthawi yomweyo kupsinjika ndi kupweteka. (Ngati mtengo wapamwamba supereka mafinya ndi ma ultrasound sanagwiritsidwe ntchito, kulakalaka kwachiwiri pamtengo wapakati kungathe kuchitidwa, koma ** mzati wapansi umapewedwa chifukwa choyandikira mtsempha wa carotid **.)

2. Intraoral Incision and Drainage (I&D) ndi Pamene Interval Tonsillectomy Ikulangizidwa¶

• Kucheka ndi Kukhetsa (Quinsy Drainage): Ngati mafinyawo ndi okhuthala kwambiri (omwe ali) kuti alowe mu singano ya 18-gauge kapena kuunjikananso pambuyo polakalaka, katswiri amapanga 5 mpaka 8 millimeter pamwamba pa mucosal incision pamwamba pa chipolopolo chapamwamba chokhala ndi chotchinga chotchinga #11 pomwe zonse ( tsamba), amalowetsa zopindika zopindika Kelly hemostat forceps m'bowo, amatambasula nsagwada pang'onopang'ono kuti athyole malo, amayamwa mafinya, ndipo amamupangitsa kuti wodwala agunde saline ndi hydrogen peroxide.
• Hot ("Quinsy") Tonsillectomy vs. Interval Tonsillectomy: Ana ang'onoang'ono omwe amafunikira opaleshoni kuti athetse madzi, kapena odwala omwe ali ndi zilonda zam'mimba (zopitilira 2 episode) kapena tonsillitis yoopsa kwambiri, akhoza kuchitidwa opaleshoni yopweteka kwambiri m'chipinda chopangira opaleshoni kapena kusankha **interval tonsillectomy 6 pambuyo pa masabata asanu ndi awiri opweteka kwambiri *

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

• United States ndi Canada: Imbani 911 nthawi yomweyo kuti mumve zilonda zapakhosi zilizonse zomwe zimatsagana ndi kudontha, stridor, kaimidwe katatu, kupweteka kwa khosi, kapena kulephera kumeza malovu. Kwa abscess yokayikira ya peritonsillar (trismus, uvula deviation, hot-potato voice), pitani ku Hospital Emergency department with ENT coverage (osati chipatala chachangu, chomwe sichingapange madzi otsogozedwa ndi ultrasound kapena kujambula kwa CT), kutsatira **American Academy of Otolaryngology-Head and Neck Surgery)**AO-lines
• United Kingdom: Imbani 999 kuti mugwirizane ndi stridor kapena airway. Pansi pa ENT UK ndi NICE malangizo, wodwala aliyense amene akuganiziridwa kuti quinsy (peritonsillar abscess), wodziwika ndi kutupa kwa peritonsillar unilateral, uvula deviation, trismus, kapena kulephera kumeza madzi, amafunikira kutumiza kuchipatala kwadzidzidzi kwatsiku lomwelo ku gulu la ENT la IVxamenzso IV, IV mettharonizol, pennezolicillin (kapena co-amoxiclav), ndi singano aspiration.
• European Union: Imbani 112 m'maiko onse omwe ali m'bungwe la EU kuti mumve zadzidzidzi zapakhosi kapena stridor. Madipatimenti a Chipatala ORL amagwiritsa ntchito transoral ultrasound ndi ngalande za singano kapena kudula ndi ngalande ndi kuphimba ma antibiotic a IV.
• Australia ndi New Zealand: Imbani 000 ku Australia kapena 111 ku New Zealand pazadzidzidzi zaulendo wa pandege. Tsatirani Malangizo Ochizira (Australia) pa chiphuphu cha peritonsillar: kuunika kwachipatala kwadzidzidzi kuti muchotse madzi opangira opaleshoni kuphatikiza IV benzylpenicillin + IV metronidazole (kapena IV clindamycin mu penicillin ziwengo) ndi mlingo umodzi wa IV dexamethasone.
• Asia-Pacific: Imbani 119 ku Japan ndi South Korea, 995 ku Singapore, 999 ku Malaysia ndi Hong Kong, kapena 112 / 108 ku India kuti mupite ku chipatala ndi chithandizo cha opaleshoni ya ENT ya maola 24 ndi ndege.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi ndingadziwe bwanji kusiyana pakati pa strep throat (tonsillitis) ndi abscess peritonsillar (quinsy)?¶

Kupweteka kwapakhosi kapena tizilombo toyambitsa matenda kumayambitsa kupweteka ndi kufiira kumbali zonse za mmero mofanana, uvula wanu (kachikwama kakang'ono kamene kamalendewera pakati pa mmero wanu) chimakhala pakati, ndipo mukhoza kutsegula pakamwa panu ndikumeza madzi. Chiphuphu cha peritonsillar (quinsy) chimachitika pamene mafinya asonkhanitsa kuseri kwa tonsil imodzi, kuchititsa zizindikiro zinayi zosiyana: (1) Kupweteka kwakukulu kokhazikika kumbali imodzi yomwe imatuluka m'khutu kumbali yomweyo; (2) Kutupa kotupa padenga la mkamwa (mkamwa wofewa) pamwamba pa tonsi imodzi yomwe imakankhira uvula mwamphamvu mbali ina; (3) Lockjaw (trismus), kumene kupindika kwa minofu kumakulepheretsani kutsegula pakamwa panu kuposa 1 mpaka 2 m’lifupi la chala; ndi (4) Mawu osamveka a “mbatata yotentha” ndi kumedzera.

Chifukwa chiyani chiphuphu cha peritonsillar chimakulepheretsani kutsegula pakamwa panu (trismus)?¶

Trismus (lockjaw) imapezeka chifukwa danga la peritonsillar kumbali ya mmero wanu limakhala pafupi ndi minofu yapakati ya pterygoid, imodzi mwa minofu yamphamvu yotafuna yomwe imayambitsa kutseka nsagwada zapansi. Pamene mafinya a bakiteriya akutuluka mu capsule ya tonsil ndikukwiyitsa fascia kukhudza minofu yapakatikati ya pterygoid, minofu imapita kumalo opweteka, otetezera opweteka. Nthawi iliyonse wodwala yemwe ali ndi zilonda zapakhosi sangafanane ndi zala zitatu zopindika pakati pa mano ake akutsogolo (kapena kutseguka mokulirapo kuposa 2 centimita / 0.8 mainchesi), ndichizindikiro chachipatala kuti matenda afalikira kunja kwa tonsil kulowa mkati mwakuya.

Kodi "mawu a mbatata yotentha" ndi chiyani, ndipo chifukwa chiyani zimachitika?¶

Mawu akuti "mbatata yotentha" (yomwe amatchedwa kuti muffled dysphonia kapena rhinolalia clausa) amamveka ngati munthuyo akuyesera kulankhula atagwira mbatata yowotcha kumbuyo kwa m'kamwa mwake popanda kusuntha lilime kapena mkamwa wofewa. Izi zimachitika chifukwa chosokonekera cha mafinya mu mkamwa wofewa chimalepheretsa minofu ya palatal ndikutsekereza chipinda chapamwamba chapakhosi, ndikusuntha m'munsi mwa lilime kapena mkamwa kumayambitsa kupweteka kwambiri. Mawu a mbatata amatha kuchitika pakhungu la peritonsillar, abscess retropharyngeal, kapena acute epiglottitis, ndipo nthawi zonse amafuna kuwunika kwadzidzidzi tsiku lomwelo.

Kodi madotolo amauza bwanji abscess ya peritonsillar kupatula abscess ya retropharyngeal?¶

Chiphuphu cha peritonsillar chimakhala pambali pa tonsil imodzi mwa achinyamata ndi akuluakulu, zomwe zimayambitsa nsagwada (trismus) ndikukankhira uvula kumbali ina pamene muyang'ana pakamwa. Chiphuphu cha retropharyngeal chimapanga kuseri kwa khoma lakumbuyo kwa mmero (nthawi zambiri mwa ana osakwana zaka 6 omwe ma lymph nodes akuya a retropharyngeal amadwala pambuyo pa mphuno kapena khutu, kapena akuluakulu omwe amameza fupa lakuthwa la nsomba). M'malo lockjaw ndi m'mbali uvula, wodwala ndi retropharyngeal abscess akugwira khosi kwathunthu ouma ndi kumva ululu woopsa poyesa kupendekera mutu wawo chammbuyo kuyang'ana pa denga (khosi kutambasuka), chifukwa kutambasula khosi kutambasula msana ndi thumba mafinya.

Kodi kukhetsa chiphuphu cha peritonsillar m'chipinda chadzidzidzi chimapweteka, ndipo zimatheka bwanji?¶

Asanakhudze chiphuphu, dokotala wadzidzidzi kapena katswiri wa ENT amapereka mankhwala opweteka m'mitsempha ndi mtsempha wa dexamethasone (mankhwala amphamvu oletsa kutupa omwe amachepetsa msanga nsagwada ndi kutupa), kenako amathira denga la kamwa ndi kupopera kwa dzanzi ndi jekeseni yaing'ono ya m'deralo. Pogwiritsa ntchito makina opangira mafinya omwe ali pafupi ndi bedi kuti aone thumba lenileni la mafinya komanso kupewa mitsempha yapafupi ya magazi, adokotala amalowetsa singano yotetezedwa ya 1 centimita kumtunda kwa mkamwa wofewa ndikutulutsa mafinya amadzimadzi omwe atsekeredwa mu syringe. Odwala ambiri amamva pompopompo, mpumulo wodabwitsa wa kugunda kwamphamvu ndi kupweteka kwa khutu pomwe mafinya akufuna, ndipo 90 peresenti amatha kupita kunyumba kukamwa maantibayotiki m'maola ochepa.

Nchifukwa chiyani ndimamva kupweteka kwambiri m'khutu kumbali imodzi ndi tonsil yanga yotupa ngati khutu langa lilibe kachilombo?¶

Tonsil, mkamwa wofewa, ndi khutu lapakati zonse zimagawana nthambi yamtundu womwewo, wotchedwa glossopharyngeal nerve (Cranial Nerve IX, makamaka nthambi ya Jacobson ya tympanic). Pamene chiphuphu cha peritonsillar chikutambasula kapisozi ndi mkamwa wofewa kumanzere kwa mmero wanu, mitsempha ya glossopharyngeal imayaka zizindikiro zowawa kwambiri ku ubongo wanu, zomwe sizingathe kusiyanitsa ngati chizindikirocho chinachokera ku mmero kapena khutu. Chodabwitsa ichi chimatchedwa otalgia; mwamsanga pamene abscess pakhosi chatsanulidwa, khutu ululu kutha.

Magwero ndi malangizo ovomerezeka¶

• American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS, United States): Malangizo Othandizira Zachipatala ndi Ndemanga Zogwirizana pa Peritonsillar Abscess (Quinsy), Intraoral Ultrasound Triage, Corticosteroid Adjunct Therapy, ndi Needle Aspiration vs. Incision and Drainage.
• ENT UK ndi National Institute for Health and Care Excellence (NICE, United Kingdom): Acute Sore Throat and Peritonsillar Abscess (Quinsy) Emergency Referral, Intravenous Antibiotic, and Drainage Guidelines.
• Infectious Diseases Society of America (IDSA) ndi American Academy of Pediatrics (AAP): *Kusamalira Matenda a Deep Neck Space mwa Ana ndi Akuluakulu: Retropharyngeal, Parapharyngeal, ndi Peritonsillar Abscesses *.
• American College of Emergency Physicians (ACEP): Clinical Policy on Point-of-Care Intraoral and Submandibular Ultrasound for Differentiation of Peritonsillar Abscess vs. Peritonsillar Cellulitis.
• Malangizo Ochizira (Australia): Malangizo a Antibiotic for Acute Peritonsillar Abscess (Quinsy) ndi Deep Neck Space Infections.

Maupangiri ogwirizana¶

• Epiglottitis, croup, stridor, ndi kutsekeka kwapamwamba kwa mpweya
• Ludwig angina, chiphuphu cha mano, ndi kutupa kwa submandibular airway
• Post-tonsillectomy Second hemorrhage: Tsiku 5 mpaka 10 eschar sloughing ndi airway triage
• Mwala wotsekeka wa gland ya salivary (sialolithiasis) vs suppurative parotitis
• Nambala zadzidzidzi malinga ndi dziko