A Pharyngeal Abscess Presenting Airway Stenosis in Elderly Patient

Abstract

A 73-year-old woman complained of sore throat and consulted a general physician. A diagnosis of tonsillitis was made and she received oral then intravenous antibiotics. Once her symptoms improved, however, muffled voice and trismus developed. Peritonsillar abscess was suspected and she was referred to our department. No peritonsillar abscess was found but there was swelling of the left lateral band. Transnasal endoscopy showed prominent swelling of the lateral to posterior pharyngeal wall and also revealed pharyngeal stenosis. Enhanced computed tomography revealed a large abscess with ring-enhancement situated on the lateral pharyngeal wall to retropharyngeal space. Abscess opening under general anesthesia was planned. Trans oral intubation under video laryngoscope was first attempted, but failed due to trismus and airway stenosis. So, an awake intubation was finally performed under observation of bronchoscopy. After the mouth gag was set, left pharyngeal wall was swollen medially. The abscess was opened revealing yellowish pus. The cavity of the abscess was carefully explored and irrigated with saline. Finally, the nasal airway was settled for airway control. After the surgery, patient dramatically improved and oral intake was started the next day. She was uneventfully discharged hospital 8 days after surgery.

Tonsillitis and peri-tonsillar abscess are easily diagnosed by oral examination. On the other hand, swelling of lower part of lateral band is difficult by oral observation alone, but may cause lethal airway stenosis. Transnasal observation using an endoscope is useful for airway assessment caused by swelling of lateral band inflammation.