Lancing an abscess: indications, technique, description
The main method of treating a paratonsillar or pharyngeal abscess that occurs in the pharynx is surgical opening of a purulent formation. It is indicated for patients of any age, taking into account contraindications. The technology of the surgical intervention recommends to carry out the operation 4-5 days after the onset of abscess formation. Failure to comply with this recommendation may lead to the fact that the operation is performed too early, when the abscess cavity has not yet formed. In this case, pathogenic microorganisms have already concentrated around the amygdala, but the stage of melting of the adenoid tissue has not yet begun. To clarify the stage of purulent inflammation, a diagnostic puncture is performed.
The technique for diagnosing the readiness of an abscess for opening is to pierce the upper point of the swollen tissues near the affected tonsil. It is advisable to perform a puncture under the control of a fluoroscope or ultrasound. Puncture the area of the abscess, the doctor draws its contents into a sterile syringe.
Possible options:
- The presence of pus in the syringe barrel is a symptom of a formed abscess, a signal for an operation.
- The presence of a mixture of lymph and blood with pus in a syringe is a symptom of an unformed abscess, when adequate antibiotic therapy can prevent surgery.
Content:
- Indications for opening an abscess
- Stages of opening an abscess
- Rules of conduct after surgery to open abscesses:
Indications for opening an abscess
Indications for diagnosing an abscess using a puncture:
- Severe pain symptom, aggravated by turning the head, swallowing, trying to talk;
- Hyperthermia over 39 ° c;
- Angina, lasting more than 5 days;
- Hypertrophy of one tonsil (less often two);
- Enlargement of one or more lymph nodes;
- Intoxication symptoms - muscle aches, fatigue, weakness, headache;
- Tachycardia, heart palpitations.
If diagnostic puncture is performed under ultrasound or X-ray guidance, most of the pus can be removed during the procedure. However, this does not completely solve the problem; you will still have to remove the abscess.
Grounds for surgical intervention:
- After cleaning the abscess cavity, the conditions for the spread of pus disappear;
- During surgery, the cavity is treated with antiseptics, which cannot be done during a puncture;
- If the abscess is small, it is removed together with the capsule without opening it;
- After removing the pus, the general condition improves, pain disappears, symptoms of intoxication, the temperature decreases;
- Since the microorganisms that cause purulent inflammation have been removed almost completely, the risk of relapse is minimal;
- In some cases, simultaneously with the opening of the abscess cavity, the glands are removed, which helps to eliminate the focus of inflammation, and reduces the risk of re-disease.
Surgery to remove an abscess in the throat is performed on an outpatient basis. This is a well-established procedure that does not cause complications. After surgical opening of the abscess, the patient is sent for follow-up treatment at home, comes for a control examination after 4-5 days.
Indications for inpatient treatment of paratonsillar abscess:
- Children's age (preschoolers are hospitalized with their parents);
- Pregnant women;
- Patients with somatic diseases or reduced immunity;
- Patients at high risk of postoperative complications (sepsis, phlegmon);
- Patients with an unformed abscess to control its formation.
Before the planned operation, the patient is prescribed antibiotics to weaken the pathogenic microorganisms and prevent their spread. Surgical intervention is performed under local anesthesia. If the case is urgent, it is allowed to open the abscess without anesthesia.
Stages of opening an abscess
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An incision is made with a depth of no more than 1-1.5 cm in the place of the highest point of a purulent formation, since it is there that the thinnest layer of tissue is, and the abscess is closest to the surface. The depth of the incision is due to the risk of damage to nearby nerves and blood vessels.
- Pus is released from the cavity.
- The surgeon uses a blunt instrument to destroy possible partitions inside the cavity to improve the outflow of pus and prevent its stagnation.
- Treatment of the abscess cavity with an antiseptic solution for disinfection.
- Suturing the wound.
To prevent relapse, a course of antibiotic therapy is prescribed. When an abscess is opened, it may be found that the pus is not in the capsule, it has spread between the tissues of the neck. If this complication is caused by anaerobic microbes that develop without access to oxygen, drainage is performed through additional incisions in the neck to allow air to flow in and remove pus. If the risk of recurrence is eliminated, drainage incisions are sutured.
Rules of conduct after surgery to open abscesses:
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In order to avoid swelling and slow down the regeneration, it is forbidden to warm up the neck;
- To minimize the risk of vasoconstriction or dilation, only drinks at room temperature are allowed;
- The use of liquid food is recommended;
- A ban on alcohol and smoking is mandatory;
- To prevent relapse, it is imperative to undergo a course of treatment with antibacterial and anti-inflammatory drugs, use vitamin-mineral complexes;
- 4-5 days after the operation, the doctor examines the patient, assessing the risk of possible complications, the regeneration process.
In most cases, postoperative relapses are extremely rare. After a week allotted for the rehabilitation period, the patient can be recommended the usual regimen.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
