Skill Checkup: Peritonsillar Abscess Drainage

Arlen D. Meyers, MD, MBA

Disclosures

November 06, 2018

The peritonsillar abscess (PTA) remains a common clinical entity in the emergency department and in an otolaryngology practice. The exact incidence has been estimated at 37 cases per 100,000 people per year.

The most common treatments for PTAs include:

  • Needle aspiration

  • Incision and drainage

  • Quinsy tonsillectomy

Incision and Drainage Technique

With a guarded scalpel (only part of the blade is exposed to prevent a deep incision from being made), make a small incision above the tonsil, in the soft palate. Medial and superior incisions are safer from the standpoint of potential injury to the carotid artery. See the video below:


Using a curved Kelly clamp, enter the incision and perform gentle blunt dissection inferiorly, posteriorly, and slightly laterally. Gentle dissection in the area of fluctuance is usually sufficient to enter the abscess cavity. Once the abscess cavity is found, continue gentle dissection with the curved Kelly clamp to break up any loculations. See the video below:

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