Chapter 031. Pharyngitis, Sinusitis, Otitis, and Other Upper Respiratory Tract Infections (Part 14)

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Infection of the submandibular and/or sublingual space typically originates from an infected or recently extracted lower tooth. The result is the severe, lifethreatening infection referred to as Ludwig's angina (see "Oral Infections," above). Infection of the lateral pharyngeal (or parapharyngeal) space is most often a complication of common infections of the oral cavity and upper respiratory tract, including tonsillitis, peritonsillar abscess, pharyngitis, mastoiditis, or periodontal infection. This space, located deep to the lateral wall of the pharynx, contains a number of sensitive structures, including the carotid artery, internal jugular vein, cervical sympathetic chain, and portions of cranial nerves IX...

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Nội dung Text: Chapter 031. Pharyngitis, Sinusitis, Otitis, and Other Upper Respiratory Tract Infections (Part 14)

Chapter 031. Pharyngitis, Sinusitis, Otitis, and Other Upper Respiratory Tract Infections (Part 14) Infection of the submandibular and/or sublingual space typically originates from an infected or recently extracted lower tooth. The result is the severe, life- threatening infection referred to as Ludwig's angina (see "Oral Infections," above). Infection of the lateral pharyngeal (or parapharyngeal) space is most often a complication of common infections of the oral cavity and upper respiratory tract, including tonsillitis, peritonsillar abscess, pharyngitis, mastoiditis, or periodontal infection. This space, located deep to the lateral wall of the pharynx, contains a number of sensitive structures, including the carotid artery, internal jugular vein, cervical sympathetic chain, and portions of cranial nerves IX through XII; at its distal end, it opens into the posterior mediastinum. Involvement of this space with infection can therefore be rapidly fatal. Examination may reveal some tonsillar displacement, trismus, and neck rigidity, but swelling of the lateral pharyngeal wall can easily be missed. The diagnosis can be confirmed by CT. Treatment consists of airway management, operative drainage of fluid collections, and at least 10 days of IV therapy with an antibiotic active against streptococci and oral
anaerobes (e.g., ampicillin/sulbactam). A particularly severe form of this infection involving the components of the carotid sheath (postanginal septicemia, Lemierre's disease) is described above (see "Oral Infections,"). Infection of the retropharyngeal space can also be extremely dangerous, as this space runs posterior to the pharynx from the skull base to the superior mediastinum. Infections in this space are more common among children
inspection. A soft tissue mass is usually demonstrable by lateral neck radiography or CT. Because of the risk of airway obstruction, treatment begins with securing of the airway, which is followed by a combination of surgical drainage and IV antibiotic administration. Initial empirical therapy should cover streptococci, oral anaerobes, and S. aureus; ampicillin/sulbactam, clindamycin alone, or clindamycin plus ceftriaxone is usually effective. Complications result primarily from extension to other areas; for example, rupture into the posterior pharynx may lead to aspiration pneumonia and empyema. Extension may also occur to the lateral pharyngeal space and mediastinum, resulting in mediastinitis and pericarditis, or into nearby major blood vessels. All these events are associated with a high mortality rate. Further Readings American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media: Diagnosis and management of acute otitis media. Pediatrics 113:1451, 2004 American Academy of Pediatrics Subcommittee on Management of Sinusitis and Committee on Quality Improvement: Clinical practice guideline: Management of sinusitis. Pediatrics 108:798, 2001
Cooper RJ et al: Principles of appropriate antibiotic use for acute pharyngitis in adults: Background. Ann Intern Med 134:509, 2001 [PMID: 11255530] Dowell SF et al: Otitis media—principles of judicious use of antimicrobial agents. Pediatrics 101:165, 1998 Gonzales R et al: Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults: Background. Ann Intern Med 134:490, 2001 [PMID: 11255526] Hickner JM et al: Principles of appropriate antibiotic use for acute rhinosinusitis in adults: Background. Ann Intern Med 134:498, 2001 [PMID: 11255528] Piccirillo JF: Acute bacterial sinusitis. N Engl J Med 351:902, 2004 [PMID: 15329428] Rafei K et al: Airway infectious disease emergencies. Pediatr Clin North Am 53:215, 2006 [PMID: 16574523]
Schwartz B et al: Pharyngitis—principles of judicious use of antimicrobial agents. Pediatrics 101:171, 1998 Sinus and Allergy Health Partnership: Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Otolaryngol Head Neck Surg 130:1, 2004 Van Zuijlen DA et al: National differences in incidence of acute mastoiditis: Relationship to prescribing patterns of antibiotics for acute otitis media? Pediatr Infect Dis J 20:140, 2001 Wenzel RP et al: Acute bronchitis. N Engl J Med 355:2125, 2006 [PMID: 17108344]