=====Oro-pharyngeal infections=====
====Peritonsillar Abscess (Quinsy)====
  *the most common deep head and neck infection that affects patients of all ages
  *favoured treatment is antibiotic therapy combined with abscess drainage.
  *Abscess drainage takes the form of needle aspiration, intra-oral incision and drainage, or quinsy tonsillectomy.
  *indications for abscess tonsillectomy became controversial over the past years due to increased risk of spread of infection and postoperative tonsillar bed bleeding
[{{ :wiki:head_and_neck:tonsillitis.png?300|**//Tonsillitis//** }}]
[{{ :wiki:head_and_neck:peritonsillar_cellulitis.jpg?300|**//Peritonsillar cellulitis//**}}]
[{{ :wiki:head_and_neck:peritonsillar_abscess.jpeg?300|**//Peritonsillar abscess//**}}]

**Typical presentation:**
  *Sore throat -worse on 1 side
  *Fever
  *'Thick' or 'hot potato' voice (not hoarse, croaky voice)
  *Stertor
  *Trismus
  *Inability to swallow more than saliva or a sip or water

**Diagnosed as Triad:**
  -Trismus
  -Uvula deviation
  -dysphonia - 'hot potato voice'

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  *Peritonsillar cellulitis is a variation on the theme of a true abscess, but the cellulitic phase is easy to confuse with a true abscess
  *true adult peritonsillar abscess usually will not resolve without some type of surgical drainage procedure, peritonsillar cellulitis is much more likely to respond to antibiotics alone
  *dysphagia and drooling tend to be discriminators for an abscess, and trismus is more common in cellulitis but patients presenting with either process have quite similar clinical scenarios.

===Management===
  *Bacteria involved include Strep Grp A, Viridans Strep, Fusobacterium necrophorum (anaerobe) amongst **many** others, therefore antibiotic choice varies
  *antibiotic Rx - usually Penicillin based but beware Amoxycillin as illness may be EBV. Choices include:
    *Amoxicillin/clavulanic acid 875mg BID x 10 days
    *Penicillin VK 500mg QID + Metronidazole 500mg QID x 10 days
    *PCN Allergy: Clindamycin 150mg QID x 10 days
  *dexamethasone 6mg recommended by some
  *analgesia - paracetamol, NSAIDs
  *surgical Rx - needle drainage, formal incision & drainage

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**Several scoring systems have been proposed to aid Mx:**

^<WRAP notice round>Novel PTA score</WRAP> ^Points |
^Halitosis ^1 |
^Uvula oedema ^1 |
^Unilat swelling of arched palate ^1 |
^Trismus ^1 |
^S100A8/A9 serum >2550ng/ml ^1 |
^S100A8/A9 saliva >8180ng/ml ^1 |
|//Score ≤2: Primary medical Rx\\ Score >2: surgical Rx//\\ S100A8/A9 are myeloid related proteins | |


^<WRAP notice round>Liverpool Peritonsillar Abscess Score (LPS)</WRAP> ^Points |
^Unilateral sore throat ^3 |
^Trismus ^2 |
^Male gender ^1	|
^Pharyngeal voice change ^1 |
^Uvular	deviation ^1 |
|//Score <4: unlikely to have PTA// ^ |

====Ludwig's Angina====
  *Ludwig's angina usually originates as a dental infection of the second or third mandibular molars, including partially erupted third molars. 
  *infection initially spreads to the sublingual space and progresses to the submandibular space.
  *usually polymicrobial involving oral flora, both aerobes and anaerobes.
  *most commonly:
    *neck swelling, neck pain - "bull neck," with increased fullness of the submental area and loss of mandibular angle definition
    *trismus
    *odynophagia, dysarthria, dysphagia - increased tongue prominence indicates sublingual space involvement.
    *Fever and chills are common.
  *Stridor indicates impending airway obstruction
  *typically NO lymphadenopathy. The presence of crepitus should raise suspicion for other pathologies, such as necrotizing fasciitis.

==Differential==
  *peritonsillar abscess, retropharyngeal abscess, submandibular abscess, epiglottitis, oral carcinoma, angioedema, submandibular hematoma, and diphtheria.

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**References include:**\\ 
[[https://www.hindawi.com/journals/dm/2018/2040746/|Novel PTA score 2018]]\\ 
[[https://www.morressier.com/article/liverpool-peritonsillar-abscess-score-lps-development-predictive-score-prospective-observational-study/5adde3c2d462b80290b59370|Liverpool PTA score dev]]\\ 
[[https://q-pem.com/wp-content/uploads/2018/05/Differentiating-Tonsillar-abscess-and-cellulitis.pdf|Differentiating Peritonsillar abscess and cellulitis 2018]]\\ 
[[https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-020-00375-x|Complications of PTA - Annals of Micro 2020]]\\ 
https://journals.lww.com/em-news/fulltext/2001/02000/emergency_department_approach_to_peritonsillar.15.aspx\\ 
https://coreem.net/core/peritonsillar-abscess/\\ 
[[https://www.statpearls.com/kb/viewarticle/24447/?utm_source=TrendMD&utm_campaign=StatPearls_TrendMD_0&utm_medium=cpc|]]Stat Pearls - Ludwig's angina\\