Parapharyngeal Abscess
A deep pus collection beside the throat
Quick Facts
- Type: Deep neck space infection
- Cause: Spread of throat or dental infection
- Risk: Airway and blood vessel involvement
- Seek urgent care: Always — this is an emergency
Overview
A parapharyngeal abscess is a collection of pus that forms in the parapharyngeal space, a deep area on the side of the neck next to the throat. It is one of several deep neck space infections and is considered a medical emergency because of where it sits, close to the airway and to major blood vessels and nerves.
It usually develops when an infection of the throat, tonsils, teeth, or nearby structures spreads into this deep space, where bacteria multiply and pus collects. As the abscess grows it can push on the airway, cause significant swelling, and spread to other neck spaces. Prompt diagnosis and treatment, often including hospital care, antibiotics, and drainage, are essential to prevent serious complications.
Symptoms
Symptoms often build over a few days following a throat or dental infection and may include:
- Severe sore throat and pain on swallowing
- Fever and feeling very unwell
- Painful, stiff neck or swelling on one side of the neck
- Difficulty or pain opening the mouth (trismus)
- A muffled or "hot potato" voice
- Swollen, tender neck glands
Warning signs that need emergency care include difficulty breathing, noisy breathing, drooling, inability to swallow saliva, and rapidly worsening neck swelling. These suggest the airway may be threatened.
Causes
A parapharyngeal abscess is caused by bacterial infection that spreads into the deep neck space.
- Throat and tonsil infections: Severe tonsillitis or a peritonsillar abscess can extend into the parapharyngeal space.
- Dental infections: Infected teeth or gums, particularly in the back of the mouth, can spread to the deep neck.
- Other sources: Infections of the salivary glands, ears, or sinuses, or injury to the throat, can also be responsible.
The infection is usually caused by a mix of bacteria normally found in the mouth and throat. Once pus forms in the deep space, it can spread further if not treated.
Risk Factors
- Recent or severe throat or tonsil infection
- Untreated dental infections or poor oral hygiene
- A weakened immune system, such as from diabetes
- Recent throat injury or procedures
- Delayed treatment of an infection in the mouth or throat
Diagnosis
Because this is a serious infection, diagnosis is made quickly using examination and imaging:
- Examination: A doctor assesses the throat, neck, breathing, and mouth opening, and checks for signs of airway compromise.
- CT scan with contrast: The main imaging test to confirm an abscess, show its size and location, and check whether it has spread.
- Blood tests and cultures: To assess the infection and help guide antibiotic choice.
Rapid assessment is important so that treatment, including protecting the airway, can begin without delay.
Treatment
Treatment is urgent and usually takes place in hospital.
- Airway protection: The first priority is making sure the airway is safe, since deep neck swelling can obstruct breathing.
- Intravenous antibiotics: Broad antibiotics given through a vein to treat the infection.
- Drainage: The pus is usually drained, either through a needle or through surgery, depending on the size and location.
- Treating the source: Managing the underlying tonsil, dental, or other infection.
- Supportive care: Fluids, pain relief, and close monitoring.
With prompt treatment most people recover, but delay can lead to serious, life-threatening complications.
Prevention
- Seek treatment early for severe sore throats and tonsil infections
- Maintain good oral hygiene and have dental infections treated promptly
- Complete any prescribed course of antibiotics
- Manage conditions such as diabetes that affect the immune system
- Do not ignore worsening throat pain, neck swelling, or trouble swallowing
When to See a Doctor
A parapharyngeal abscess is a medical emergency. Call emergency services or go to an emergency department immediately if you have:
- Difficulty breathing or noisy, labored breathing
- Drooling or being unable to swallow your own saliva
- Severe neck swelling, stiffness, or pain that is rapidly worsening
- A muffled voice, high fever, and severe sore throat
- Difficulty opening your mouth
Do not wait, as deep neck infections can quickly threaten the airway and spread to vital structures.
Frequently Asked Questions
What is a parapharyngeal abscess?
It is a collection of pus in a deep space on the side of the neck, next to the throat. It usually develops when a throat, tonsil, or dental infection spreads into this space, and it is a medical emergency.
Why is a parapharyngeal abscess dangerous?
The deep neck space lies close to the airway and to major blood vessels and nerves. A growing abscess can press on the airway, spread to other neck spaces, and cause life-threatening complications, so it needs urgent treatment.
How is a parapharyngeal abscess treated?
Treatment is usually in hospital and includes protecting the airway, intravenous antibiotics, and draining the pus with a needle or surgery. The underlying tonsil, dental, or other infection is also treated.
What are the emergency warning signs?
Difficulty or noisy breathing, drooling, being unable to swallow saliva, rapidly worsening neck swelling, a muffled voice, and trouble opening the mouth are emergencies. Seek immediate medical care if these occur.
How can deep neck infections be prevented?
Treating severe sore throats and tonsil infections early, maintaining good oral hygiene, promptly treating dental infections, and completing prescribed antibiotics all help reduce the risk of an infection spreading into the deep neck.
References
- MedlinePlus, U.S. National Library of Medicine. Throat disorders.
- Mayo Clinic. Peritonsillar abscess and deep neck infections.
- American Academy of Otolaryngology–Head and Neck Surgery. Deep Neck Infections.
- MedlinePlus, U.S. National Library of Medicine. Abscess.