A parapharyngeal abscess is a collection of infected, swollen, and inflamed tissue on the inside of the neck. Abscesses provide a space for bacteria to thrive and potentially spread to nearby blood vessels and lymph nodes. In most cases, parapharyngeal abscesses arise as a result of a severe infection of the tonsils, throat, or airways. Treatment in the form of oral antibiotics is usually enough to heal small abscesses before they cause complications. Large pus-filled cysts may need to be surgically drained to prevent airway obstruction and infection throughout the body.
The parapharyngeal space is an empty triangular space that lies between the pharynx, carotid artery, internal jugular vein, and several small neck muscles. Most abscesses in the parapharyngeal space are preceded by bacterial infections of the tonsils or pharynx. The pathogens spread through the broken and irritated tissue and form cysts in the area. Many different types of bacteria can cause abscesses to develop, including common strains of strep and staph.
A person of any age can develop a parapharyngeal abscess, although the problem is most commonly seen in children and adolescents. Adults who have weakened immune systems are also at higher risk. The first symptoms of a parapharyngeal abscess are similar to those of common throat infections, including sore throat, difficulty swallowing, low-grade fever, and fatigue. A growing abscess can cause noticeable neck swelling and significant airway obstruction. If the carotid artery or jugular vein is involved, a person can have a very high fever, mental confusion, and dangerous internal bleeding.
It is important for parents to contact a pediatrician when their child shows possible symptoms of a parapharyngeal abscess. A doctor may inspect the throat and tonsils for signs of infection. CT scans are helpful in visualizing the parapharyngeal space and looking for abnormal swelling. After the diagnosis is confirmed, blood and mucus samples may be collected to check for the specific bacteria involved.
When a parapharyngeal abscess is caught early, it can usually be treated with a four to six week course of oral antibiotics. A doctor may decide to drain a growing abscess using a needle inserted through the mouth or through a small cut made in the front of the neck. If there is constriction of the airways, a patient may need to be admitted to hospital so that specialists can supply oxygen and surgically open the pharynx. A cyst may need to be removed with a scalpel if it is likely to rupture and spread bacteria to blood vessels.