Ithumba Le-Peritonsillar (Quinsy): I-Hot-Potato Voice, Ukuphambuka kwe-Uvula, i-Trismus, ne-Needle Aspiration vs Retropharyngeal Abscess¶

Ithumba le-peritonsillar (ngokomtholampilo elaziwa ngokuthi quinsy) liwukutheleleka kwentamo ejulile evame kakhulu entsheni nakubantu abadala, okwenzeka lapho ukutheleleka kwebhaktheriya kusabalala ngale kwekhephuseli le-palatine tonsil ku-areolar tissue evulekile phakathi kwe-tonsillar capsule kanye ne-superior pharyngeal constrictor muscle*. Nakuba i-acute virus noma i-streptococcal tonsillitis ibangela ukubomvu komphimbo nobuhlungu obulinganayo nhlangothi zombili, ithumba le-peritonsillar lidala iphakethe elishubile, elihlangene le-purulent pus ngenhla nangaseceleni kwethoni eyodwa (**imvamisa ku-pole ephakeme *). Leli qoqo elandayo liphusha ulwanga oluthambile luye phambili naphansi kuyilapho lushova umugqa omaphakathi uvula ngokucijile uwele ohlangothini oluphambene (olunempilo), kubangela ukugobhoza okubuhlungu kwemisipha yomhlathi eseduze (trismus, ukungakwazi ukuvula umlomo ube banzi kuno-2 centimeters ube yinkulumo engu-0.8" ye-potapota engamasentimitha angu-0.8 izwi, futhi livimbele isiguli ekugwinyeni amathe aso (ukuvuza). Okuphuthuma nakakhulu, noma ubani onezwi elinyakazayo, eliconsisa amathe, noma ubuhlungu bomphimbo obunzima kufanele ahlukaniswe ngokushesha ne-Retropharyngeal Abscess (ebonakala ngobuhlungu obunzima ku isandiso sentamo kanye nodonga lwangemuva oluqhumayo lwepharyngeal ezinganeni ezincane) kanye ne-Acute Epiglottitis (lapho umphimbo ubukeka ngendlela ekhohlisayo lapho uphuma emoyeni ngokukhohlisayo. ukuvala uphawu). Uma noma ubani onomphimbo obuhlungu kakhulu eba namathe, i-stridor, ukuma kwe-tripod, i-trismus, noma ukungakwazi ukugwinya uketshezi, shayela indawo yangakini. izinombolo eziphuthumayo ngokushesha. Futhi buyekeza imihlahlandlela yethu yezelamani ku i-epiglottitis, i-croup, i-stridor, kanye nokuvinjwa kwendlela yokuphefumula ephezulu, I-angina ka-Ludwig kanye nokuvuvukala kwe-submandibular airway, futhi i-sepsis kanye nokushaqeka kwe-septic.

Okubalulekile kuwe ngokushesha ukugcina isiguli esihlezi ibhawodi siqondile sisesimweni saso sokunethezeka ukuze ubomvu namathe kungavimbeli indlela yokuphefumula, hlola umlomo ovulekile ngethoshi kuphela uma kukhona i-zero stridor (ufuna ukuqhuma kwe-asymmetric palate ethambile kanye nokuphambuka kwe-uvula ephikisanayo), hlola ukuthi mingaki imisele yeminwe* evulekile* esibhedlela* ukuze uhlole* umnyango wezimo eziphuthumayo nge-intravenous dexamethasone, ama-antibiotic e-intravenous ebanzi (i-ampicillin-sulbactam noma i-clindamycin), kanye ne-ultrasound-guided inaliti aspiration noma ukusika nokukhipha amanzi.

Yenza lokhu manje¶

1. Hlola ngokushesha amafulegi abomvu we-Critical Airway Obstruction futhi ushayele inombolo yakho yasendaweni yezimo eziphuthumayo uma ikhona. Shayela ku-911 e-United States nase-Canada, 999 e-United Kingdom, 112 ku-European Union yonkana, 000 e-Australia, noma uhlole uhla lwemibhalo yethu izinombolo eziphuthumayo uma isiguli sine-inspiratory stridor (ukukhala phezulu noma ukushaya ikhwela uma siphefumula), sihlezi siqondile sincike phambili ezandleni ezeluliwe (i-tripod position), ukuconsa okuqhubekayo kwamathe, ukungakwazi ukulala phansi ngaphandle kokuhefuzela, noma ukusabalalisa ububomvu nokuvuvukala phansi ngaphambili noma ohlangothini lwentamo*.
2. Gcina isiguli sihlezi siqondile futhi sincike kancane phambili; UNGALOKOTHI ubaphoqe ukuthi balale phansi ngomhlane. Ukulala okuyisicaba kuvumela ithumba elikhulu le-peritonsillar noma i-retropharyngeal, i-uvula evuvukele, namathe ahlanganisayo ukuthi awe emuva phezu kwe-epiglottis nezintambo zezwi, kubangele ukuvaleka komzila womoya kungazelelwe.
3. Hlola I-Trismus Yeminwe emi-3 kanye Nokuhlola Ukulunywa Kwe-Flashlight (KUPHELA uma isiguli singenayo i-stridor futhi kungeyona ingane ethukuthele ene-epiglottitis esolwayo):
4. Ukuhlola I-Trismus Yeminwe Emithathu: Cela isiguli ukuthi sivule umlomo waso banzi ngangokunokwenzeka. Umuntu omdala ophile kahle noma ingane ingalingana emithathu yeminwe yayo estakiwe iqonde phakathi kwamazinyo ayo angaphezulu nangaphansi (amamilimitha angu-35 kuya kwangu-50 / amayintshi angu-1.4 kuya kwangu-2.0). Uma ubuhlungu bomhlathi buvimbela ukuvuleka okubanzi kuno-1 kuya kwemibili iminwe (ngaphansi kwamamilimitha angu-20 / amayintshi angu-0.8), i-trismus ikhona, okufakazela ukuthi ukutheleleka kungene ngaphandle kwethoni ku-medial pterygoid masticator muscle.
5. I-Soft-Palate Bulge kanye ne-Uvula Deviation Check: Khanyisa isibani sefoni emlonyeni. Ethumbani le-peritonsillar, uhlangothi olulodwa lolwanga oluthambile ngenhla kwethoni luqhuma luye phansi naphambili njengepulamu elibomvu elivuvukele, lisunduza okulenga uvula ngokucijile uwele umugqa omaphakathi kuya ngakolunye uhlangothi, olungavuvukalanga.
6. Isikrini se-Retropharyngeal Abscess ngokuhlola i-Neck Neck Extension vs. Flexion: Uma isiguli siyingane encane (ikakhulukazi eneminyaka eyizinyanga eziyisi-6 kuya kweyisi-6) noma umuntu omdala ngemva kokugwinya ithambo lenhlanzi noma ithambo lenkukhu elibambe intamo yalo lukhuni ku-torticollis futhi likhale noma lizwe ubuhlungu obuhlabayo lapho libheka umgogodla ojulile emhlane/ (isandiso sentamo) **, sola i- **Retropharyngeal Abscess ** endaweni yengozi ye-prevertebral bese ubiza i-EMS ngokushesha.
7. Gcina isiguli ngokuqinile i-NPO (Nothing by Mouth: zero food, zero drinks, zero oral pills) ngaphambi kokuya Emnyangweni Wezimo Eziphuthumayo. Ngenxa yokuthi i-trismus eqinile noma i-deep neck extension ingase idinge ukugeleza kwamanzi okuhlinza okuthulisiwe noma okujwayelekile kwe-anesthesia eGumbini Lokuhlinza, isisu esingenalutho sivimbela ukulangazelela ngesikhathi sokulawulwa kwendlela yokuphefumula.
8. **UNGALINGE uzame ukubhoboza, ukuklabalasa, noma ukucindezela ithumba lomphimbo ekhaya ngomunwe, ukhezo, inaliti, noma iswabhu kakotini.Umthambo we-carotid wangaphakathi uhamba uqonde ngemuva futhi ubheke ngaseceleni kwe-tonsillar fossa (ngezinye izikhathi ngaphakathi 10 kuya ku-20 amamilimitha [0.4 kuya ku-0.8 amayintshi] wodonga lwamathumba ukubhoboza kwasekhaya okungaboni kungabhoboza umthambo wangaphakathi we-carotid (okubangele ukuphuma okubulalayo emizuzwaneni engu-60) noma kuqhume ubomvu obugqinsi obuqonde phansi kuqhoqhoqho (i-acute aspiration asphyxiation).

Isihlahla sesinqumo: umphimbo obuhlungu kakhulu, izwi elivalekile, i-trismus, kanye nokuzama kwesikhala esijulile sentamo¶

flowchart TD
    A["Umphimbo Obuhlungu Kakhulu + Odynophagia (Ukugwinya Ubuhlungu) + Umkhuhlane"] --> B{"Ingabe Izimpawu Zengozi Ye-Airway Esheshayo Zikhona? (I-stridor ekhuthazayo, ukuma kwe-tripod, i-cyanosis, noma ukungakwazi ukulala phansi)"}
    B -->|YES: Imminent Airway Obstruction| C["Shayela i-EMS (911/999/112) Ngokushesha: Qhubeka uhlezi uqondile; UNGAfaki lutho emlonyeni; lungiselela i-Awake Fiberoptic noma i-Operating Room Intubation"]
    B -->|NO stridor or respiratory distress| D{"Hlola Ukuvuleka Komlomo (i-Trismus), Ukunyakaza Kwentamo, ne-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["ITHUMBA LE-PERITONSILLAR (QUINSY): I-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["ITHUMBA LE-RETROPHARYNGEAL: I-Danger Space Emergency (Ingozi ye-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["I-ANGINA KA-LUDWIG: I-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["I-Acute Tonsillitis / Pharyngitis engavamile (Strep, EBV Mononucleosis, noma Viral)"]
    E --> I["Ukuhlola Okuphuthumayo Kwe-ED Yesibhedlela (Gcina i-NPO): I-IV Hydration + IV Dexamethasone (10 mg) + IV Ampicillin-Sulbactam noma i-Clindamycin"]
    I --> J["I-Intraoral High-Frequency Ultrasound (noma i-Contrast CT uma i-trismus enamandla): Iqinisekisa ithumba eliwuketshezi uma liqhathaniswa ne-peritonsillar cellulitis"]
    J --> K["I-ENT Bedside Ultrasound-Guided Needle Aspiration (ku-Superior Pole medial kuya kulayini we-molar) noma i-Incision & Drainage"]
    F --> L["Isibhedlela Esiphuthumayo ED: Qhathanisa i-CT Yentamo Nesifuba + IV Ama-antibiotics e-Broad-Spectrum + Igumbi Lokuhlinza I-Transoral Surgical Drainage"]
    G --> M["Isibhedlela Esiphuthumayo ED: I-Phaphama I-Nasotracheal Intubation + IV Antibiotics + Ukucindezeleka Kokuhlinzwa"]
    H --> N["Ukuhlolwa kwe-Rapid Strep / Usiko Lomphimbo + I-Oral Analgesics + Hydration (I-Amoxicillin yomlomo uma i-Strep positive; gwema i-Amoxicillin uma kusolwa i-EBV Mono)"]

Ipulani ye-anatomical: indlela i-tonsillitis enqamula ngayo i-capsule ingene endaweni ye-peritonsillar¶

I-palatine tonsil izungezwe igobolondo langaphandle eline-fibrous (i-tonsillar capsule) elihlukanisa izicubu ze-lymphoid zethoni kusukela odongeni lwemisipha yomphimbo (umsipha ophakeme we-pharyngeal constrictor). Phakathi kwe-fibrous tonsillar capsule ngaphakathi kanye nomsipha ophakeme we-pharyngeal constrictor ngaphandle kunesikhala esingaba khona esigcwele izicubu ezixhumene ezixegayo ezibizwa ngokuthi i-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.
=======================================================================

Kungani amaphesenti angama-75 amathumba e-peritonsillar enza e-Superior Pole (Weber's Glands)¶

Ngokomlando, odokotela babecabanga ukuthi wonke amathumba e-peritonsillar ayemane nje engelashwa i-streptococcal tonsillitis ephusha ku-capsule. Ucwaningo lwesimanje lwe-anatomical lubonisa umzila wesibili omkhulu: Izindlala ze-Weber, iqoqo lezindlala zamathe ezincane ezingama-20 kuya kwezingu-25 ezitholakala ngqo ku sikhala se-supratonsillar ngenhla nje kwesigxobo esingenhla sethonsi, thumela imigudu emincane kuma-tonsillar crypts ukuze kugezwe imfucumfucu yokudla. Lapho ukuvuvukala okunamandla noma izibazi kuxhuma imigudu yezindlala ze-Weber, amathe namagciwane abamba ngaphakathi kwesikhala se-supratonsillar, enze ithumba elikhula ngokushesha i-superior-pole peritonsillar abscess eliphushela ulwanga oluthambile luye phambili naphansi kuyilapho ivula i-uvula iye kolunye uhlangothi.

I-Polymicrobial bacteriology: kungani i-Penicillin iyodwa ayanele¶

Ngokungafani nomphimbo olula, ithumba le-peritonsillar cishe lihlala liwu ukutheleleka kwe-polymicrobial okuhlanganisa amagciwane omlomo we-aerobic kanye ne-anaerobic (amaningi awo akhiqiza ama-enzyme e-beta-lactamase abhubhisa i-penicillin esobala): - Amagciwane Ayisisekelo E-Aerobic: I-Streptococcus pyogenes (Iqembu A beta-hemolytic Streptococcus / GAS), Streptococcus anginosus (milleri) iqembu (elidume kabi ngokwenza amathumba ajule ajule), *Staphylococcus (incphilus MRS) umkhuhlane. - I-Primary Obligate Anaerobic Pathogens: Fusobacterium necrophorum (imbangela ye-Lemierre's syndrome), Prevotella melaninogenica, Porphyromonas, Bacteroides, kanye ne-anaerobic Peptostreptococcus.

Ukuxilongwa komehluko ohlangothini ngalunye: I-Peritonsillar Abscess vs Retropharyngeal Abscess vs Epiglottitis vs Acute Tonsillitis¶

Ukwehlukanisa lezi zimo ezine eceleni kombhede kunquma ukuthi isiguli siyayidinga yini incwadi kadokotela enikezwa ama-antibiotic, i-aspiration yenaliti eseceleni kombhede, noma indlela yokuphefumula yegumbi lokuhlinza eliphuthumayo:

Kungani i-Retropharyngeal Abscess kanye ne-Parapharyngeal Extension kuyizimo eziphuthumayo ezibulalayo¶

Ngenkathi ithumba le-peritonsillar livalwe ekuqaleni yi-suior constrictor muscle, ukubambezeleka kokukhipha amanzi kuvumela ubomvu ukuthi buqhume odongeni lwemisipha bungene emigwaqweni emikhulu ejulile yentamo:

1. Ithumba Le-Retropharyngeal kanye "Nesikhala Sengozi Ye-Alar" esifubeni¶

Ngemuva kodonga olungemuva lomphimbo (i-posterior pharyngeal wall) kukhona retropharyngeal space, egijima isuka phansi yogebhezi yehle iye esifubeni esingaphezulu (T1 kuya ku-T2), ihlukaniswe kuphela i-alalar fascia ezacile ukusuka ku-Space 4 ("Isikhala Esiyingozi"), i-tunnelless ne-diaeriph egijima iqonde phezulu i-mediastinum**. - Ezinganeni Ezincane (Ngaphansi Kobudala obungu-6): Izingane ezincane zinamaketango amabili aqondile e-retropharyngeal lymph nodes (Nodes of Rouviere) akhipha izifo emakhaleni, esonweni, e-adenoids, nasezindlebeni ezimaphakathi. Lapho ukutheleleka kwendlebe noma i-sinus kubangela ukuthi enye yalawa ma-lymph nodes ikhuphuke futhi iqhume, ubomvu bugcwalisa isikhala se-retropharyngeal. (Ngeminyaka emi-5 kuya kweyesi-6, lawa ma-lymph nodes ngokwemvelo ayashwabana futhi anyamalale, yingakho ithumba le-retropharyngeal ngokuyinhloko liyisimo esiphuthumayo sezingane zasenkulisa ngaphandle uma umuntu omdala ebhoboza ngemuva komphimbo ngethambo lezinhlanzi, ithambo lenkukhu, noma induku ye-popsicle.) - Yehla i-Necrotizing Mediastinitis: Uma ithumba le-retropharyngeal liqhuma nge-alar fascia ezacile liye endaweni Yengozi, amandla adonsela phansi kanye nokucindezela kwesifuba okungekuhle ngesikhathi sokuhogela kuncela ubovu obuqhuma buqonde phansi emgodini wesifuba ozungeze inhliziyo kanye nemithambo emikhulu (acute ukwehla kwe-necrotizing mediastinitis), ethwele amaphesenti angu-40*25 wemoto ukuhlinzwa.

2. I-Lateral Parapharyngeal Space Rupture kanye ne-Lemierre's Syndrome¶

Uma ithumba le-peritonsillar liguguleka ngaseceleni ngokusebenzisa umsipha ophakeme we-pharyngeal constrictor ungene *esikhaleni se-parapharyngeal (carotid sheath), kungase kwenzeke izinhlekelele ezimbili zemithambo: - I-Lemierre's Syndrome (I-Internal Jugular Vein Septic Thrombophlebitis): Ishayelwa kakhulu yi-anaerobic bacterium Fusobacterium necrophorum, ukutheleleka kungene odongeni lwe-internal jugular vein, kwakheka ihlule legazi elinegciwane (septic thrombus) elibangela ukuvuvuka kwemithambo yangaphakathi imisipha ye-sternocleidomastoid entanyeni bese igeza i-septic emboli emaphashini (cavitary septic pulmonary emboli **, ubuhlungu besifa, kanye nokushaqeka kwe-septic). - I-Carotid Artery Mycotic Pseudoaneurysm a Blowout: Ukucekelwa phansi kwe-enzymatic udonga lomthambo wegazi wangaphakathi we-carotid kudala i-aneurysm yamanga entekenteke engaphumela emhlubulweni, okubangele ukopha kwekhala/umlomo okulandelwa ukopha kwemithambo ebulalayo.

Isithombe sokuxilonga esibhedlela kanye nokuphathwa kwezokwelapha¶

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

Cishe amaphesenti angu-20 kuya kwangu-30 eziguli ezethula ngokuvuvuka kolwanga oluthambile oluhlangene ndawonye empeleni ane-peritonsillar cellulitis (phlegmon), esakaza ukuvuvukala kwezicubu ngaphandle kwesikhala sobovu obuwuketshezi okwamanje, esixazululeka ngemithi elwa namagciwane efakwa emthanjeni kanye nama-steroid ngaphandle kokudinga induku yenaliti. - I-High-Frequency Intraoral noma i-Submandibular Ultrasound (Umugqa Wokuqala we-Quinsy): Odokotela bezimo eziphuthumayo nochwepheshe be-ENT babeka ngobumnene imvamisa ephezulu i-endocavitary ultrasound probe (embozwe emgodleni oyinyumba onesifutho sokubulala izinzwa) ngokumelene nolwanga oluvuvukile oluthambile, noma umhlathi ongaphandle* womlomo* i-trismus iqine kakhulu ukuthi ingalingana nophenyo ngaphakathi emlonyeni). I-Ultrasound ihlukanisa ngokushesha iphakethe elithi i-hypoechoic liquid pus (ithumba) ku-cellulitis eqinile futhi yenze imephu ukujula okuqondile ngamamilimitha kuya ku-pulsating umthambo we-carotid wangaphakathi usebenzisa i-Color Doppler ngaphambi kokuba inaliti ithinte ulwanga. - IV Contrast-Enhanced CT Scan of the Neck: Kuyisibopho noma nini kusolwa ithumba le-retropharyngeal, i-parapharyngeal extension, i-trismus enzima evimbela ukuhlolwa komlomo, noma i-Lemierre's syndrome kusolwa, kanye nasezinganeni ezincane. Ngokuphambene ne-CT, ithumba langempela livela njengeqoqo elichazwe kahle elibamba kancane elizungezwe umphetho ogqamile "othuthukisa indandatho", kanti i-thrombosis yangaphakathi ye-jugular vein ibonisa ukukhubazeka kokugcwalisa kulume lwe-jugular.

2. I-Intravenous Medical Therapy esheshayo (I-Fluids, ama-Steroids, nama-Broad-Spectrum Antibiotics)¶

Ngenxa yokuthi iziguli ezinethumba le-peritonsillar noma le-retropharyngeal azikwazanga ukugwinya uketshezi amahora angama-24 kuye kwangama-72 ngenxa ye-odynophagia ebuhlungu, sonke isiguli sidinga ukungenelela okuthathu ngokushesha ngemithambo lapho sifika:

1. I-Aggressive Intravenous Crystalloid Rehydration: A 1,000 mL bolus ka-0.9% we-saline evamile noma i-Ringer's lactated (noma 20 mL/kg ezinganeni) ibuyisela ivolumu emithanjeni futhi ilungise i-ketosis yokuphelelwa amanzi emzimbeni.
2. I-Corticosteroid Emithanjeni Yedosi Ephezulu Eyodwa (Dexamethasone): Ukuhlolwa kwemitholampilo okungahleliwe (okugunyazwe i-American Academy of Otolaryngology-Head and Neck Surgery) kufakazela ukuthi ukunikeza umthamo owodwa womthambo we-Dexamethasone 10 mg IV* kubantu abadala (noma mg6 kuya ku-0) kubantwana (noma mg 0.3 kuya ku-0 IV.) eceleni kwemithi elwa namagciwane ishwabana ngokushesha i-edema ye-pharyngeal, inciphisa amaphuzu ezinhlungu phakathi namahora angu-4, ikhulula i-medial pterygoid trismus ukuze isiguli sikwazi ukuvula umlomo waso, futhi ibuyisela ikhono lokugwinya uketshezi amahora angu-12 kuya kwangu-24 ngokushesha.
3. Ama-Empiric Polymicrobial Intravenous Antibiotics (Emboza i-GAS, Strep anginosus, kanye ne-Beta-Lactamase Anaerobes):
4. Indlela Yomugqa Wokuqala A: IV Ampicillin-Sulbactam (Unasyn) 3 amagremu IV njalo emahoreni angu-6 kubantu abadala (noma 50 mg/kg/umthamo wengxenye ye-ampicillin IV njalo ngemva kwamahora angu-6 ezinganeni), NOMA IV Amoxicillin-Clavulanate (e-Europe +IV/I-Benzy Metronidazole **).
5. I-First-Line Regimen B (i-Penicillin-Allergic noma i-MRSA Coverage): IV Clindamycin 600 kuya ku-900 mg IV njalo emahoreni angu-8 (noma 10 kuya ku-13 mg/kg/umthamo IV njalo emahoreni angu-8 ezinganeni), NOMA IV Ceftriaxone (nsuku zonkeI-Metronida IV 0 IV0 IV) IV IV njalo emahoreni angu-8), yengeza IV Vancomycin noma i-Linezolid uma kusolwa i-sepsis enzima noma i-MRSA.
6. Ukushintshela Ekwelapheni Ngomlomo Ngemva Kokuphuzwa: Uma ithumba selikhishiwe futhi isiguli sesiphelelwe amandla futhi sesikwazi ukugwinya uketshezi kahle ngaphandle kokuconsa, sishintshela enkambweni yomlomo engu-*10 kuya kweziyi-14 ye-Amoxicillin-Clavulanate (Augmentin, 875/125 mg oral 4 kuya ku-Clindamy ephindwe kabili ngosuku) izikhathi nsuku zonke)**.

I-drainage yokuhlinzwa eqondile: I-Needle Aspiration vs. Ukusika kanye Nokukhipha Indle vs. I-Interval Tonsillectomy¶

1. Indlela Odokotela Abenza Ngayo Ukuphefumula Kwenaliti Ephephile (90% kuya ku-95% Isilinganiso Sokwelapha)¶

Kubantu abasha abasebenzisanayo kanye nabantu abadala abanethumba elingaxakile le-peritonsillar, umbhede noma i-ultrasound-guided needle aspiration ibuhlungu kakhulu, inqubo eshesha kakhulu futhi ixazulula amathumba angamaphesenti angama-90 kuye kwangama-95 ngaphandle kokusikwa kwegumbi lokuhlinzela:

1. I-Topical and Submucosal Anesthesia: Udokotela ufafaza ulwanga oluthambile** nge-topical benzocaine/lidocaine spray** (ukubukela umthamo ophelele ukuze agweme i-methemoglobinemia) futhi ajove u-1 kuya ku-2 mL we-1% noma u-2% we-lidocaine nge-epinephrine engu-1:100,000 ku-busulgesia engaphezulu* kwe-busulgesia engaphakathi* insika ye-tonsillar.
2. I-Mechanical Depth Guard (Ukuvikela I-Carotid Artery):Inaliti engu-18-gauge yomgogodla noma inaliti ende yokulangazelela ixhunywe kusirinji engu-10 mL. Ukuqinisekisa ukuthi inaliti ayisoze yangena ijule kunamamilimitha angu-10 kuya kwangu-15 (amayintshi angu-0.4 kuya kwangu-0.6) ibheke emthanjeni ongaphakathi we-carotid, udokotela usika ikepisi yenaliti yepulasitiki ukuze kuphela amasentimitha angu-1.0 kuya ku-1.5 wethiphu yenaliti yensimbi aphumele ngaphandle konogada bepulasitiki.
3. I-Strict Sagittal Trajectory Kwi-Superior Pole: Iqondise ngokuqinile ibheke emuva ngqo (indiza ye-sagittal, ehambisana naphansi yomlomo) empambanweni yomugqa ovundlile onqamule umsuka we-uvula kanye nomugqa oqondile ogudla insika yethoni yangaphambili (ungalokothi ulengise ubheke ngasendlebeni eyi-51) cm esigxotsheni esiphezulu ngenkathi uhlehla i-plunger, ngokuvamile efisa 2 kuya ku-10 mL yobomvu obubomvu obumhlophe obunuka kabi futhi inikeza ukukhululeka okusheshayo kwengcindezi nobuhlungu. (Uma isigxobo esiphezulu singakhiqizi ubovu kanye ne-ultrasound akusetshenziswanga, ukulangazelela kwesibili esigxotsheni esimaphakathi kungase kwenziwe, kodwa isigxobo esingaphansi siyagwenywa ngenxa yokuba seduze komthambo we-carotid.)

2. I-Intraoral Incision and Drainage (I&D) kanye Lapho I-Interval Tonsillectomy Kunconywa¶

• Ukusika nokukhipha amanzi (I-Quinsy Drainage): Uma ubomvu bukhulu kakhulu (butholakala) ukuthi bungakwazi ukudonsa inaliti engu-18-gauge noma bunqwabelana futhi ngemva kokufisa, uchwepheshe wenza okuncane 5 kuya ku-8 millimeter okusika okujula kwe-mucosal phezu kwesigxobo sesigxobo esiphezulu esine-tapel egadiwe engu-#11 kodwa indawo yonke ( i-blade), ifaka i-curved forceps Kelly hemostat forceps emgodini, ivule imihlathi ngobumnene ukuze kuhlukaniswe izindawo, idonsa ubomvu, futhi isiguli sigaye usawoti kanye ne-hydrogen peroxide.
• I-Tonsillectomy eshisayo ("Quinsy") vs. I-Interval Tonsillectomy: Izingane ezincane ezidinga i-anesthesia jikelele ukuze kukhishwe amanzi, noma iziguli ezinamathumba avela njalo (ngaphezu kweziqephu ezi-2) noma i-tonsillitis eqinile engapheli, zingase zikhishwe i-tonsillectomy ebuhlungu ngokushesha egunjini lokuhlinzela noma i-elective *isikhawu sokukhishwa kwe-tonsillside ngemva kwamaviki 4

Izinombolo zezimo eziphuthumayo zesifunda kanye nezinqubomgomo ze-ejensi¶

• I-United States ne-Canada: Dayela u-911* ngokushesha nganoma yimuphi umphimbo obuhlungu ohambisana nokuconsa, i-stridor, ukuma kwe-tripod, ubuhlungu bentamo, noma ukungakwazi ukugwinya amathe. Ukuze uthole ithumba elisolwayo le-peritonsillar (i-trismus, ukuchezuka kwe-uvula, izwi lezambane elishisayo), dlulela Umnyango Wezimo Eziphuthumayo Wesibhedlela onokukhava kwe-ENT (hhayi umtholampilo wokunakekelwa okuphuthumayo, ongakwazi ukukhipha amanzi aqondiswa nge-ultrasound noma i-CT imaging), ngokulandela **i-American Academy of Otolaryngology-Head and Neck Surgery)**Iziqondiso ze-AO-HNS.
• I-United Kingdom: Dayela u-999* ukuze uthole ukuyekethisa kwe-stridor noma emoyeni. Ngaphansi kwemihlahlandlela ethi ENT UK kanye ne-NICE, noma isiphi isiguli esisolwa ngokuba quinsy (ithumba le-peritonsillar), esikhonjwe ngokuvuvuka kwe-peritonsillar okuhlangene, ukuchezuka kwe-uvula, i-trismus, noma ukungakwazi ukugwinya uketshezi, kudinga ukudluliselwa esibhedlela esiphuthumayo ngosuku olufanayo eqenjini le-ENT le-IVxamenzsopennezolicillin, i-IVxamenzsopenicillin (noma i-co-amoxiclav), nokulangazelela inaliti.
• I-European Union: Dayela u-112* kuwo wonke amazwe angamalungu e-EU ngezimo eziphuthumayo zesikhala sentamo ejulile noma i-stridor. Iminyango yesibhedlela ye-ORL isebenzisa i-transoral ultrasound kanye ne-drainage yenaliti noma ukusika kanye nokukhipha amanzi ngokumbozwa ngokushesha kwama-antibiotic e-IV.
• I-Australia ne-New Zealand: Dayela u-000* e-Australia noma 111 eNew Zealand ngezimo eziphuthumayo zendiza. Landela Iziqondiso Zokwelapha (e-Australia) ngethumba le-peritonsillar: ukuhlolwa okuphuthumayo kwesibhedlela ukuze kukhishwe amanzi ngokuhlinzwa kanye IV benzylpenicillin + IV metronidazole (noma i-IV clindamycin ku-penicillin yokungezwani komzimba) kanye nomthamo owodwa we-IV dexamethasone.
• I-Asia-Pacific: Dayela u-119* e-Japan naseNingizimu Korea, 995 e-Singapore, 999 e-Malaysia nase-Hong Kong, noma 112 / 108 e-India ukuze uhanjiswe esibhedlela ngosizo lwamahora angu-24 we-ENT wokuhlinzwa nomgwaqo womoya.

Imibuzo evame ukubuzwa¶

Ngingawubona kanjani umehluko phakathi kwe-strep throat (i-tonsillitis) ne-peritonsillar abscess (quinsy)?¶

I-strep throat noma i-viral tonsillitis ibangela ubuhlungu nobubomvu nhlangothi zombili zomphimbo ngokulinganayo, i-uvula yakho (ithishu elincane lokubhoboza elilenga phakathi nomgogodla womphimbo wakho) lihlala limaphakathi nendawo, futhi usengavula umlomo wakho kakhulu futhi ugwinye amanzi. Ithumba le-peritonsillar (quinsy) lenzeka lapho ubomvu buqoqa ngemuva kwethoni eyodwa, okubangela izimpawu ezine ezihlukene: (1) Ubuhlungu obukhulu obugxile ohlangothini olulodwa obuphumela endlebeni kulolo hlangothi; (2) Iqhubu elivuvukele ophahleni lomlomo (ulwanga oluthambile) ngaphezu kwethonsi eyodwa ephusha i-uvula ngokucijile iye kolunye uhlangothi; (3) Isikhiya (i-trismus), lapho ukugogeka kwemisipha kukuvimbela ukuba uvule umlomo wakho ngaphezu kobubanzi bomunwe obu-1 kuya kwemibili; kanye (4) Nezwi elithi "hot-potato" elivalekile kanye nokuconsa.

Kungani ithumba le-peritonsillar lenza kube nzima ukuvula umlomo wakho ube banzi (trismus)?¶

I-Trismus (i-lockjaw) yenzeka ngenxa yokuthi isikhala se-peritonsillar ohlangothini lomphimbo wakho sihlala eduze komsipha ophakathi we-pterygoid, omunye wemisipha enamandla yokuhlafuna ebhekene nokuvala umhlathi ongezansi. Lapho ubomvu bebhaktheriya buphuma ku-capsule ye-tonsil futhi bucasula i-fascia ethinta umsipha we-pterygoid ophakathi, imisipha ingena ku-spasm ebuhlungu, evikelayo. Noma nini lapho isiguli esinomphimbo obuhlungu asikwazi ukuhlanganisa iminwe emithathu enqwabelene iqonde phakathi kwamazinyo aso angaphambili (noma ivuleke ibe banzi kunamasentimitha angu-2 / 0.8 amayintshi), kuwuphawu lomtholampilo ukuthi ukutheleleka kusabalele ngaphandle kwethoni kuya ezicutshini ezijulile.

Liyini “izwi lezambane elishisayo,” futhi kungani lenzeka?¶

"Izwi lezambane elishisayo" (ngokomtholampilo elibizwa ngokuthi i-muffled dysphonia noma i-rhinolalia clausa) lizwakala sengathi umuntu uzama ukukhuluma ngenkathi ebambe isiqephu esishisayo sezambane elibhakiwe ngemuva komlomo ngaphandle kokunyakazisa ulimi lwakhe noma ulwanga oluthambile. Kwenzeka ngenxa yokuthi iqoqo elishubile lobovu kulwanga oluthambile likhubaza imisipha yomlomo futhi livimbe i-resonance chamber yomphimbo ongaphezulu, kuyilapho ukunyakaza okuphansi kolimi noma ulwanga kubangela ubuhlungu obubukhali. Izwi lezambane elishisayo lingenzeka ku-peritonsillar ithumba, i-retropharyngeal abscess, noma i-acute epiglottitis, futhi njalo idinga ukuhlolwa komnyango wezimo eziphuthumayo wosuku olufanayo.

Odokotela balitshela kanjani ithumba le-peritonsillar ngaphandle kwethumba le-retropharyngeal?¶

Ithumba le-peritonsillar lihlala eceleni kwethoni eyodwa kwabancane nabadala, okubangela ukukhiya kwemihlathi (trismus) nokuphushela i-uvula ngakolunye uhlangothi uma ubheka emlonyeni. Ithumba le-retropharyngeal lakheka ngemuva kodonga lwangemuva lomphimbo (imvamisa ezinganeni ezingaphansi kweminyaka engu-6 ubudala zazo ama-lymph nodes ajulile e-retropharyngeal angenwa igciwane ngemva kokutheleleka kwekhala noma indlebe, noma kubantu abadala abagwinya ithambo lezinhlanzi elibukhali). Esikhundleni se-lockjaw kanye ne-uvula esemaceleni, isiguli esinethumba le-retropharyngeal sibamba intamo yaso iqine ngokuphelele futhi sizwa ubuhlungu obukhulu lapho sizama ukutshekisa ikhanda laso emuva ukuze sibheke ophahleni (ukunwetshwa kwentamo), ngoba ukwelula intamo kwelula umgogodla ngokumelene nephakethe lobovu.

Ingabe ukukhipha ithumba le-peritonsillar egumbini lezimo eziphuthumayo kubuhlungu, futhi kwenziwa kanjani?¶

Ngaphambi kokuthinta ithumba, udokotela ophuthumayo noma uchwepheshe we-ENT unikeza umuthi wezinhlungu emithanjeni kanye ne-dexamethasone efakwa emthanjeni (i-steroid enamandla eqeda ukuvuvukala edambisa ngokushesha ukuqaqamba komhlathi nokuvuvukala), bese evala umlomo ngesifutho esibangela ukuba ndikindiki kanye nomjovo omncane wendawo wokubulala izinzwa. Esebenzisa i-ultrasound probe eseceleni kombhede ukuze abone iphakethe lobovu futhi agweme imithambo yegazi eseduze, udokotela ufaka inaliti egadiwe eyisentimitha nje elingu-1 engxenyeni engenhla yolwanga oluthambile abese ekhipha ubomvu obuwuketshezi obuvaleleke kusisirinji. Iziguli eziningi zizwa ukukhululeka ngokushesha, ukukhululeka okumangalisayo kokucindezela okushaywayo kanye nobuhlungu bendlebe lapho ubomvu bufisa, futhi amaphesenti angu-90 angabuyela ekhaya emitholampilo yomlomo emahoreni ambalwa.

Kungani ngiba nobuhlungu obukhulu ezindlebeni ngasohlangothini olulodwa nethonsi yami evuvukele uma indlebe yami ingenalo igciwane?¶

Ithoni, ulwanga oluthambile, kanye nendlebe ephakathi konke kuhlanganyela ncamashi negatsha lemizwa yezinzwa, elibizwa nge-glossopharyngeal nerve (Cranial Nerve IX, ikakhulukazi igatsha le-Jacobson's tympanic). Uma ithumba le-peritonsillar lelula i-capsule nolwanga oluthambile ohlangothini lwesobunxele lomphimbo wakho, inzwa ye-glossopharyngeal ishisa izimpawu zobuhlungu obukhulu esiqwini sakho sobuchopho, esingakwazi ukuhlukanisa ukuthi isignali ivela emphinjeni noma endlebeni. Lesi simo sibizwa ngokuthi i-reference otalgia; ngokushesha nje lapho ithumba lomphimbo likhishwa, ubuhlungu bendlebe buphela.

Imithombo neziqondiso ezisemthethweni¶

• I-American Academy of Otolaryngology-Ukuhlinzwa Kwekhanda Nentamo (AAO-HNS, United States): Iziqondiso Zokusebenza Komtholampilo Nezitatimende Zokuvumelana Nge-Peritonsillar Abscess (Quinsy), I-Intraoral Ultrasound Triage, I-Corticosteroid Adjunct Therapy, ne-Needle Aspiration vs. Ukusika nokukhipha amanzi.
• I-ENT UK kanye ne-National Institute for Health and Care Excellence (NICE, United Kingdom): I-Acute Sore Throat kanye ne-Peritonsillar Abscess (Quinsy) Ukudluliselwa Kwezimo Eziphuthumayo, I-Intravenous Antibiotic, kanye Nemihlahlandlela Yokukhipha Indle.
• I-Infectious Diseases Society of America (IDSA) kanye ne-American Academy of Pediatrics (AAP): Ukuphathwa Kwezifo Ezingena Ezintanjeni Ezijulile Ezinganeni Nabantu Abadala: I-Retropharyngeal, Parapharyngeal, ne-Peritonsillar Abscesses.
• I-American College of Emergency Physicians (ACEP): Inqubomgomo Yomtholampilo Yephuzu Lokunakekela I-Intraoral kanye ne-Submandibular Ultrasound yokuhlukanisa i-Peritonsillar Abscess vs. I-Peritonsillar Cellulitis.
• Imihlahlandlela Yokwelapha (Australia): Imihlahlandlela Yemithi Elwa Namagciwane Yethumba Elibukhali Le-Peritonsillar (Quinsy) kanye Nezifo Zesikhala Esijulile Sentamo.

Iziqondiso ezihlobene¶

• I-Epiglottitis, i-croup, i-stridor, nokuvinjelwa komzila womoya ophezulu
• I-angina ka-Ludwig, ithumba lezinyo lamazinyo, nokuvuvukala komzila womoya ongaphansi kwe-submandibular
• I-post-tonsillectomy yesibili yokopha: Usuku 5 kuya ku-10 eschar sloughing kanye nokuhlolwa kwendlela yomoya
• Itshe lendlala yamathe elivinjiwe (sialolithiasis) vs i-suppurative parotitis
• Izinombolo zesimo esiphuthumayo ngezwe