Zaglotochny abscess — a purulent inflammation of the cellulose located in zaglotochny space. Results from traumatizing a throat or distribution of gnoyerodny microorganisms from being in a nasopharynx or an ear of the infectious center. Zaglotochny abscess is shown by the intensive sore throat leading to violation of swallowing and refusal of food; twang or hoarseness of a voice, breath difficulty, temperature increase of a body, increase in cervical and occipital lymph nodes. Diagnosis of a disease is performed with application of a faringoskopiya, bakposev of dab from a pharynx, PTsR-diagnostics, the RPR test. Treatment of the majority of zaglotochny abscesses is a surgical opening and drainage. It is carried out against the background of system complex therapy by the antibacterial, anti-inflammatory and hyposensibilizing medicines.
Children under 4 years have the greatest tendency to formation of zaglotochny abscess. It is caused by the features of a structure of zaglotochny space which are available for them: big friability of cellulose and existence in it of lymph nodes which after 6 years completely atrophy. The highest incidence of zaglotochny abscess is noted among children from 2 months to 1 year. At adult age zaglotochny abscess meets rather seldom and usually is a consequence of traumatic injury of a throat. However the modern otolaryngology notes increase in number of cases of zaglotochny abscess at adult patients.
Causes of zaglotochny abscess
At children's age most often the infection is the cause of zaglotochny abscess. Purulent otitis can be primary center of an infection, mastoidit, the become complicated parotitis, pharyngitis, rhinitis, sinusitis, tonsillitis. Distribution of infectious process to zaglotochny space happens on lymphatic ways to damage of zaglotochny lymph nodes. The factor favoring to it is the weakened condition of an organism of the child, the reduced immunity, existence of diathesis or rickets. At children zaglotochny abscess can develop against the background of acute infectious diseases: SARS, measles, scarlet fever, diphtheria, flu. In rare instances it is a complication of an adenotomiya or a tonzillektomiya.
In adult age the traumatic factor comes out on top among the reasons of formation of zaglotochny abscess. Injury of a throat can happen a fish bone, rough food, an alien subject. Travmatization of a throat is possible during the carrying out gastroscopy, bronkhoskopiya, installation of a nazogastralny tube and an endotrakhealny anesthesia. Zaglotochny abscess at adults can arise as a complication of heavy quinsy. In certain cases it is caused by specific microflora and is a consequence of tuberculosis or syphilis, proceeding with defeat of cervical department of a backbone. In such cases speak about "cold" zaglotochny abscess. The risk of development of zaglotochny abscess is increased at patients with chronic diseases and the reduced immunity, at existence of diabetes, malignant tumor, HIV infection.
Classification of zaglotochny abscess
Zaglotochny abscess is classified depending on an arrangement. Allocate the following types of zaglotochny abscesses:
- epifaringealny — located above a palatal curtain;
- mezofaringealny — localized between a root of language and edge of a palatal curtain;
- gipofaringealny — being below a language root;
- mixed — occupying several anatomic zones.
Symptoms of zaglotochny abscess
Zaglotochny abscess is characterized by the sharp beginning with temperature increase of a body to 39-40 °C and violation of the general state. Development of zaglotochny abscess against the background of already available infectious disease is shown by sharp deterioration in a condition of the patient and emergence of new symptoms. Children become whining and uneasy, there is a sleep disorder, the refusal of food is characteristic, and children of chest age have a sucking violation.
One of the first signs of formation of zaglotochny abscess is the sore throat. Patients note strengthening of pain during swallowing, difficulty at a food proglatyvaniye. The sore throat is often so strongly expressed that patients refuse food. At an arrangement of zaglotochny abscess in the top department of a throat violation of nasal breath is observed, adults and children of advanced age have a twang of a voice. If zaglotochny abscess is localized on average or the lower department of a throat, then there is a hoarseness of a voice and the complicated breath, there can be suffocation attacks. Short wind with the complicated breath is observed (inspiratory). In vertical position of the patient aggravation of violations of breath because of pus running off down and overlappings of a trachea gleam by it is noted. There can be bubbling in a throat that most often occurs in the period of a dream.
Zaglotochny abscess is followed by lymphadenitis of regionarny lymph nodes. Side verkhnesheyny and occipital lymph nodes become swollen and painful. Typically compelled position of the patient: his head is thrown back back and turned in that party where zaglotochny abscess settles down. In many cases on the party of zaglotochny abscess hypostasis of the site of a neck located behind a corner of the lower jaw is noted.
Complications of zaglotochny abscess
Spread of an infection from zaglotochny abscess on the top airways can lead to emergence of bronchial pneumonia. Violation of respiratory function promotes development of stagnant pneumonia. Hematogenic spread of an infection to a skull cavity with developing of abscess of a brain or purulent meningitis is less often observed. In some cases at zaglotochny abscess reflex there can be a stop of warm activity.
Terrible complication of zaglotochny abscess is asphyxia — suffocation as a result of overlapping of a gleam of airways. Asphyxia can arise because of the expressed hypostasis of a throat or at spontaneous opening of zaglotochny abscess with izlitiy in a gleam of a throat of a large number of purulent masses. When opening abscess in zaglotochny space pus on friable cellulose spreads to large vessels of a neck or filters into a sredosteniye. Defeat of vessels can become the reason of arrozivny bleeding, thrombosis of a jugular vein or phlebitis. Penetration of an infection into a sredosteniye causes development of a purulent mediastinit who quickly leads to developing of sepsis.
Diagnosis of zaglotochny abscess
Zaglotochny abscess is diagnosed by the otolaryngologist on the basis of the data obtained during survey of the patient and carrying out a faringoskopiya. At survey the compelled position of the head of the patient, local hypostasis of a neck, increase in lymph nodes and their morbidity attracts attention at a palpation. Faringoskopiya reveals local infiltration on a back wall of a throat and an opukholevidny swelling of spherical shape. The manual research of a throat defines morbidity in the place of a swelling and existence of the symptom of fluctuation demonstrating that education represents a congestion of liquid pus.
Clinical blood test speaks about existence of inflammatory process: also increase in SOE to 40 mm/h is noted . The microscopy and a bacteriological research of dab from a pharynx allow to define a type of the activator which became the reason of zaglotochny abscess. Most often it is hemolytic streptococci, golden staphylococcus, klebsiyet, anaerobic and epidermalny staphylococcus, colibacillus. The tubercular or syphilitic etiology of abscess is possible. In this regard carry out PTsR-diagnosis of syphilis and tuberculosis, the RPR test, the analysis of a phlegm on a tuberculosis mikobakteriya.
For detection of associated diseases of an ear and a nasopharynx which perhaps became the reason of formation of zaglotochny abscess the otoskopiya, a rinoskopiya, ultrasonography and a X-ray analysis of okolonosovy bosoms, a backbone X-ray analysis in cervical department can be required.
Treatment of zaglotochny abscess
The revealed zaglotochny abscess is subject to surgical opening and drainage. In the place of the greatest vybukhaniye do an abscess section by a scalpel or peaked scissors. Enter a tip of an electric suction into a section and suck away pus. Important at once after opening of zaglotochny abscess quickly to make pus suction to avoid its hit in airways. In airways at the time of opening of abscess some authors recommend to make for the prevention of flowing of pus previously its puncture and to suck away pus. In certain cases after opening of zaglotochny abscess of edge of the made section stick together, then resort to their repeated drawing apart with use of the zhelobovaty probe or Gartman's nippers.
Suppurating low located abscesses which are followed zateky to the area of a neck, open through external surgical access. The section is made on the front and side surface of a neck parallel to edge - a clavicular and mastoidal muscle.
At existence of symptoms of a sdavleniye of airways with breath violation introduction of a respiratory tube (intubation) contraindicated. In such cases emergency aid for the purpose of restoration of respiratory function consists in carrying out a krikotomiya — a section on the forward surface of a neck with formation of an opening in a guttural cartilage through which breath is carried out. For elimination of the hypoxia which arose because of breath violations oxygenotherapy is in addition shown.
Opening of zaglotochny abscesses of the syphilitic or tubercular nature is not carried out because of danger of secondary infection. Treatment of such abscesses consists in their repeated punctures with introduction of antitubercular and antisyphilitic medicines directly in abscess. Along with it the general antitubercular and antisyphilitic therapy is appointed.
Surgical treatment of zaglotochny abscess is performed in combination with system antibacterial therapy and sanitation all available in a nasopharynx or an ear of the infectious centers. Also resolvents (paracetamol, an ibuprofen, ) and the hyposensibilizing medicines (, , ), polyvitamins are appointed also febrifugal. Before opening of abscess the patient needs to rinse carefully a throat solutions of anti-septic tanks.
Forecast and prevention of zaglotochny abscess
Timely detection and opening of zaglotochny abscess in most cases is the key to a favorable outcome of a disease. At development of complications the forecast of a disease serious. The patient can die from asphyxia, cardiac arrest, sepsis, arrozivny bleeding. However in the modern developed medicine such cases meet extremely seldom.
The best prevention of development of zaglotochny abscess is early diagnostics and correct treatment the ENT specialist diseases, timely carrying out surgical sanitation of the purulent centers. In prevention of zaglotochny abscess of traumatic genesis the correct holding the diagnostic and medical procedures connected with introduction to a throat of the endoscope or a respiratory tube is important; accurate removal of foreign matters of a throat; careful observance of the technology of surgeries on structures of a nasopharynx (removal of tumors of a throat and adenoides, a tonzillektomiya).