Back to all available

How safe are the blood vessels when draining a peritonsillar abscess?

otorhinolaryngology
surgery-and-surgical-specialties

Abstract

Background: Peritonsillar abscess (PTA) is a common deep neck infection that is an emergency in otolaryngology. The goal of this study is to find out how far apart a PTA is from major blood vessels like the internal carotid artery (ICA), external carotid artery (ECA), and internal jugular vein (IJV). It will also look at how the ICA's path changes and how that affects the risk of vascular injury during PTA drainage.

Methods: We looked back at 94 adults who had unilateral PTA. We used contrast-enhanced neck CT scans to find the distance between the ICA, ECA, and IJV and the front and back abscess capsule. We compared measurements on the side that was affected to those on the side that was healthy. The ICA's path was checked for any irregularities, such as twisting or coiling. We wrote down the patient's age, the size of the abscess, how long the symptoms lasted, and the size of the tonsils. Pfeiffer's criteria were used to figure out the risk level for ICA injury.

Results: The distances from the PTA to the ICA, ECA, and IJV were much longer than the distances on the healthy side (p < 0.05 for all). The average distance from the back of the PTA to the ICA was 14.1 ± 3.5 mm, while it was 9.1 ± 1.7 mm on the healthy side. This means that the abscess moved the carotid artery further away from the tonsillar area. Nine patients (9.6%) had an abnormal ICA course. Six of them (6.3%) had tortuosity, and three of them (3.1%) had coiling. According to risk classification, 14 patients (14.9%) had a "moderate" risk of ICA injury while draining. There were no big differences in the distances between blood vessels in male and female patients.

Conclusion: In this group, 14.9% of PTA patients had a moderate theoretical risk of vascular injury because their carotid distance was shorter or their carotid anatomy was not normal. PTA usually moves the carotid artery farther away, but differences in the way blood vessels are shaped can make injuries more likely. Being aware of these anatomical factors and using imaging guidance can help doctors lower the risk of serious vascular problems during PTA drainage procedures.

Ask to review this manuscript

Notes for potential reviewers

  • Volunteering is not a guarantee that you will be asked to review. There are many reasons: reviewers must be qualified, there should be no conflicts of interest, a minimum of two reviewers have already accepted an invitation, etc.
  • This is NOT OPEN peer review. The review is single-blind, and all recommendations are sent privately to the Academic Editor handling the manuscript. All reviews are published and reviewers can choose to sign their reviews.
  • What happens after volunteering? It may be a few days before you receive an invitation to review with further instructions. You will need to accept the invitation to then become an official referee for the manuscript. If you do not receive an invitation it is for one of many possible reasons as noted above.
  • PeerJ does not judge submissions based on subjective measures such as novelty, impact or degree of advance. Effectively, reviewers are asked to comment on whether or not the submission is scientifically and technically sound and therefore deserves to join the scientific literature. Our Peer Review criteria can be found on the "Editorial Criteria" page - reviewers are specifically asked to comment on 3 broad areas: "Basic Reporting", "Experimental Design" and "Validity of the Findings".
  • Reviewers are expected to comment in a timely, professional, and constructive manner.
  • Until the article is published, reviewers must regard all information relating to the submission as strictly confidential.
  • When submitting a review, reviewers are given the option to "sign" their review (i.e. to associate their name with their comments). Otherwise, all review comments remain anonymous.
  • All reviews of published articles are published. This includes manuscript files, peer review comments, author rebuttals and revised materials.
  • Each time a decision is made by the Academic Editor, each reviewer will receive a copy of the Decision Letter (which will include the comments of all reviewers).

If you have any questions about submitting your review, please email us at [email protected].