Cases reported "Peritonsillar Abscess"

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1/33. Case report: extranodal non-Hodgkin's lymphoma of the parapharyngeal space.

    We report an unusual case of primary extranodal non-Hodgkin's lymphoma of the parapharyngeal space. Clinical presentation looked like right peritonsillar abscess and hypoglossal palsy. After histologic study of his biopsy, this 19-year-old man was given a diagnosis of diffuse large-cell non-Hodgkin's lymphoma. Immunohistochemical study showed cell-type B and he was determined to have Stage IIE. Treatment combined chemotherapy and radiotherapy. Extranodal lymphoma of the head and neck presents a diagnostic problem. We review various approaches to extranodal non-Hodgkin's lymphomas of the head and neck. This condition especially requires communication between the surgeon and the pathologist, essential in preventing an incorrect or delayed diagnosis.
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2/33. Immediate tonsillectomy for peritonsillar abscess.

    OBJECTIVE: peritonsillar abscess (PTA) is one of the most common infectious diseases of the head and neck region requiring surgical intervention to relieve symptoms such as severe throat pain, fever, dysphagia, and trismus. However, the appropriate management of PTA is still controversial. In europe and the US, immediate tonsillectomy under general anesthesia has been accepted as the treatment for PTA. But in japan, immediate tonsillectomy has been regarded as contraindicated for PTA because of difficulties encountered in the operation during the acute stage, as well as possible postoperative complications. methods: A total of 103 cases of PTA treated at our clinic during the past 16 years were reviewed; immediate tonsillectomies had been performed in 99 of them. Surgical findings, postoperative course, and bacteriological examination were surveyed. RESULTS: The results showed that immediate tonsillectomy under general anesthesia was carried out safely without complications. Dramatic relief of the symptoms was obtained within a few days following each operation. A high incidence of anaerobes was observed by bacteriological examination, suggesting that sufficient drainage is required to treat this disease. CONCLUSION: We conclude that immediate tonsillectomy should be performed for peritonsillar abscess.
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3/33. Necrotizing fasciitis after peritonsillar abscess in an immunocompetent patient.

    Cervical necrotizing fasciitis (CNF) is a rapidly progressive, severe bacterial infection of the fascial planes of the head and neck. Group A beta haemolytic Streptococcus spp. (GABHS), staphylococcus spp., or obligatory anaerobic bacteria are the most common causative pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CNF. review of the literature reveals only seven such cases, with four successful outcomes. The authors present the case of a 50-year-old immunocompetent female with CNF arising from a peritonsillar abscess. Intravenous immunoglobulins in conjunction with surgery and antibiotics were used successfully. The authors also suggest the importance of the early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics, and possible usefulness of the intravenous immunoglobulins in the treatment of CNF, especially when the disease is associated with toxic shock syndrome.
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4/33. Synergistic necrotizing cellulitis as a complication of peritonsillar abscess.

    peritonsillar abscess, a complication of tonsillitis, is not uncommon. The usual treatment consists of needle aspiration or surgical drainage and antibiotic treatment. tonsillectomy may be used in the management of this condition, either at the time of diagnosis or after an interval period. Severe complications of peritonsillar abscess are rare. Synergistic necrotizing cellulitis is a fulminant infection associated with spread along fascial plains, necrosis of connective tissue and muscle, and high mortality. It is usually otondogenic in origin in the cervicofacial area and occurs in debilitated or immune compromised patients. We discuss cervicofacial-necrotizing soft tissue disease and report an unusual case of extensive synergistic necrotizing cellulitis of the neck, chest, and shoulder as a result of a peritonsillar abscess.
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5/33. Alveolar rhabdomyosarcoma presenting as a peritonsillar abscess.

    A rhabdomyosarcoma of the head and neck region is a rare childhood neoplasm often presenting with vague symptoms that can easily mimic other diseases. We present an unusual case of an alveolar rhabdomyosarcoma of the soft palate in a three-year-old child, that presented as a peritonsillar abscess.
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6/33. Necrotizing fasciitis secondary to peritonsillar abscess: a new case and review of eight earlier cases.

    Necrotizing fasciitis is a potentially fatal soft-tissue infection that occurs only rarely in the head and neck region. Broad-spectrum parenteral antibiotics and surgical debridement are the mainstays of treatment. Until now, only eight cases of necrotizing fasciitis secondary to peritonsillar abscess have been described in the English-language literature. In this article, we report a new case that occurred in an otherwise healthy 43-year-old woman. In addition to standard treatment, the patient underwent a hot tonsillectomy. After 23 months of follow-up, she is in good health.
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7/33. Internal carotid artery pseudoaneurysm masquerading as a peritonsillar abscess.

    Blunt carotid arterial injuries are uncommon. Motor vehicle crashes are the most frequent cause, but this type of vascular injury can be secondary to any direct blow to the neck, intraoral trauma, or strangulation. Types of vascular injuries include dissection, pseudoaneurysm, thrombosis, rupture, and arteriovenous fistula formation. patients with pseudoaneurysm of the internal carotid artery will usually present with neurologic complaints, ranging from the minor to complete stroke. On physical examination, neck hematoma, bruits, pulsatile neck mass, or a palpable thrill may be found. However, in 50% of cases, no external signs of neck trauma are observed. Onset of symptoms may occur within a few hours to several months after the initial injury. angiography is considered the gold standard for diagnosis, but carotid Doppler ultrasound recently has been shown to be very sensitive in detecting these types of injuries. Treatment of pseudoaneurysm is often surgical, with endovascular stenting.
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8/33. Cervical necrotizing fasciitis: sources and outcomes.

    BACKGROUND: Abscesses of the peritonsillar region are among the most common deep abscesses of the head and neck. However, cervical necrotizing fasciitis (CNF) associated with a peritonsillar abscess is an extremely rare condition, with only 12 well-documented cases described. patients: We reviewed and compared all 12 cases of CNF arising from peritonsillar abscesses, including our own case. CNF that developed after peritonsillar abscesses was also compared with that developing predominantly after odontogenic infection. RESULTS: The overall mortality was higher in the group with peritonsillar abscesses (33% vs 25%). CONCLUSION: It is probable that of all cases of CNF, that arising from peritonsillar abscess has the worst prognosis.
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9/33. Solitary fibrous tumor of the parapharyngeal space.

    solitary fibrous tumors are rare tumors originating from the mesenchymal tissue. In most cases they arise from the subpleural tissue but have also been described in other locations in the body. Most such tumors in the head and neck region occur in the orbit. Although malignant tumors can occur, benign tumors are far more common. The therapy is surgical excision. For a conclusive diagnosis, a typical morphology and immunohistochemistry are required. The tumor is strongly positive for CD34 and vimentin. This report describes the clinical appearance and treatment of a solitary fibrous tumor of the parapharyngeal space in a female patient. The symptoms were similar to those in a peritonsillar abscess, one of the more common ear-nose-throat dysfunctions. Fewer than 10 cases of a solitary fibrous tumor of the parapharyngeal space have been described in the literature.
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10/33. head and neck infections caused by streptococcus milleri group: an analysis of 17 cases.

    BACKGROUNDS: streptococcus milleri group (SMG) is a common inhabitant of the mouth and gastrointestinal tract, and can be an aggressive pathogen causing abscess formation at various sites in the body. However, it has rarely been listed as a cause of head and neck infections. OBJECTIVES: The present study was performed to evaluate the clinical significance of SMG by reviewing the microbiology and clinical records of patients with SMG in head and neck infections retrospectively. STUDY DESIGN: A retrospective review of all patients diagnosed as having SMG bacterial infections at Onomichi General Hospital, Hiroshima, between the years 2001 and 2002 was performed; 17 patients developed head and neck infections with SMG. Here, we describe the clinical features and management of SMG in head and neck infection. RESULTS: The patient population consisted of 12 males and 5 females with a median age of 62 years (age range, 8-78 years). The sites of infection were as follows: maxillary sinus (n=6), peritonsillar region (n=4), subcutaneous (n=3), submandibular space-retropharyngeal space (n=1), deep neck-mediastinum (n=1), parapharyngeal space (n=1), submandibular space (n=1), tonsil (n=1), parotid gland (n=1), and masseter muscle (n=1). Ten cases (59%) were of suppurative diseases. Six cases (35%) had mixed SMG with anaerobe infection. Three cases showed deteriorating clinical courses, and all three of these cases were culture-positive for SMG with anaerobes. In addition, one deteriorating case showed gas gangrene regardless of repeated surgical debridement and intravenous antibiotic therapy; hyperbaric oxygen therapy improved this patient's condition. CONCLUSION: It is important to recognize SMG as a pathogen in head and neck infection. In addition, the care should be taken with infectious diseases caused by SMG with anaerobes as the patient's clinical course can deteriorate rapidly.
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