Ohori Junichiro, Umakoshi Mizuo, Miyashita Keiichi, Hayamizu Yoshiko, Harada Mizue, Kurono Yuichi
Department of Otolaryngology, Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima.
Nihon Jibiinkoka Gakkai Kaiho. 2013 Aug;116(8):947-52. doi: 10.3950/jibiinkoka.116.947.
The peritonsillar abscess (PTA) is one of the most common infectious diseases in the head and neck area and is treated with puncture, incision, or abscess tonsillectomy. In the present study, we performed a retrospective study for the patients who were diagnosed as having PTA on the basis of CT findings at the Kagoshima University Hospital between January 2007 and April 2012. The clinical characteristics were compared with the CT images and the indication of abscess tonsillectomy was discussed. In total, 145 patients (152 sides), mean age of 41 years (range: 5-80 years) were enrolled in the study. Patients having any surgical treatment such as puncture and incision before visiting our hospital were excluded. The CT findings revealed that PTA could be classified into two categories by the shapes of the abscess: the Oval type and Cap type. Further, the location of the abscess was differentiated superior and inferior, and classified into 4 categories: superior Oval type, superior Cap type, inferior Oval type, and inferior Cap type. The results showed that the number of the superior Oval type PTA was largest and followed by superior Cap type, inferior Cap type, and inferior Oval type in this order. When the CT classifications were compared with clinical findings, patients with the inferior Cap type abscess had laryngeal edema and airway obstruction more frequently than the other categories of PTA. Histological examination of the specimens obtained during surgery showed that the Cap type abscess tended to include more muscular tissue compared to the Oval type, indicating that inflammation might be more severe and wider in the Cap type than the Oval type. Those findings suggest that the inferior Cap type of PTAs need more intensive and reliable treatments such as abscess tonsillectomy.
扁桃体周脓肿（PTA）是头颈部最常见的传染病之一，治疗方法包括穿刺、切开或脓肿扁桃体切除术。在本研究中，我们对2007年1月至2012年4月在鹿儿岛大学医院根据CT检查结果被诊断为患有PTA的患者进行了回顾性研究。将临床特征与CT图像进行比较，并讨论脓肿扁桃体切除术的适应症。本研究共纳入145例患者（152侧），平均年龄41岁（范围：5 - 80岁）。排除在来我院就诊前接受过穿刺和切开等任何手术治疗的患者。CT检查结果显示，根据脓肿形态，PTA可分为两类：椭圆形型和帽型。此外，脓肿位置分为上下两部分，共分为4类：上椭圆形型、上帽型、下椭圆形型和下帽型。结果显示，上椭圆形型PTA数量最多，其次依次为上帽型、下帽型和下椭圆形型。当将CT分类与临床结果进行比较时，下帽型脓肿患者比其他类型的PTA更频繁地出现喉水肿和气道阻塞。手术中获取标本的组织学检查表明，与椭圆形型相比，帽型脓肿往往包含更多肌肉组织，这表明帽型脓肿的炎症可能比椭圆形型更严重、范围更广。这些发现表明，下帽型PTA需要更积极可靠的治疗，如脓肿扁桃体切除术。
