Quinsy drainage

Definition:

Quinsy otherwise also known as peritonsillar abscess is a collection of pus in the peritonsillar space between the superior constrictor and capsule of the tonsil.  It is usually unilateral, and commonly affects adolescent males.
Pathophysiology:
     Infection usually starts in the crypta magna from where it spreads beyond the confines of the capsule causing peritonsillitis initially, and peritonsillar abscess later.
Aetiology:
     Recurrent attacks of tonsillitis cause obstruction and obliteration of intra tonsillar clefts and the infection spreads to peritonsillar area causing suppuration.
Clinical features:
1. Patient looks very ill and febrile
2. Odynophagia (painful swallowing)
3. Dribbling of saliva
4. Inability to open mouth
5. Muffled / Hot potato voice other wise known as rhinolalia clausa
On examination:
     The tonsil is found pushed downwards and medially, it blanches on slight pressure.  The uvula is edematous and is pushed to the opposite side.  Tonsillar pillars are congested.  Patient also has halitosis (bad breath), trismus and tender enlarged jugulodigastric nodes.

Surgical management:
Incision and drainage:  This is perrformed with patient in sitting position to prevent aspiration of pus into the larynx.  First the oral cavity and throat of the patient is sprayed with 4 % topical xylocaine spray to anaesthetise the mucosa.
A Saint claire Thompson qunisy forceps, or a gaurded 11 blade can be used.  The 11 blade is gaurded to prevent the blade from penetrating the tonsillar substance deeply and damaging underlying vital structures like internal carotid artery.
Site of incision:
Is commonly over the point of maximum bulge.  It can also be made at the junction between a horizontal imaginary line drawn from the base of the uvula to the anterior pillar and a vertical imaginary line drawn along the anterior pillar.  After incison is made a sinus forceps is introduced to complete the drainage procedure.

This video clipping shows quinsy being drained under local anesthesia.