Figure shows an infected grade 4+ or kissing tonsillitis affecting a 3 year old child. Confluent fibrin covers its surface bilaterally. Patient has poor appetite, painful swallow, stertor, and "hot potato" voice. (T - tonsil, SP - soft palate)
Grade 4+ tonsil hypertrophy (>75% of space between pillars.
T - tonsil, (+) - uvula, SP - soft palate.
The typical site of an infected pre-auricular sinus is shown. Incision and drainage of the formed abscess and antibiotic therapy are indicated. Excision of the sinus tract will be performed at a later date, once the infection with its accompanying inflammation has settled completely.
An indurated, fluctuant and tender lesion due to underlying formed abscess (red arrow) complicating sinus tract infection. (white arrow - sinus opening)
Facial abscess (ellipse) complicating pre-auricular sinus tract infection which eventually had burst spontaneously (top left). Formal incision and drainage was performed along the puncture site. Wick dressing was inserted; this will allow healing from inside-out until the infection and inflammatory changes settled. An antibiotic course and pain relief are given. the pre-auricular sinus and its tract will be removed at a later date. (Arrow - preauricular sinus pit).
Erythematous and swollen postauricular sulcus & mastoid area
Temporal bone CT-scan: Mucosal thickening of mastoid air cells
Swollen, red,and oedematous skin overlying left mastoid area
with blunting of postauricular sulcus.
Bulging right lateral pharyngeal wall due to formed abscess (A). T - tonsil, U - uvula. R - right, L - left.
Swollen right side of neck (X).
Pus drained with swab for culture and sensitivity being taken. R - right.
Inflamed and oedematous arytenoid and inter-arytenoid mucosa (+) in significant laryngopharyngeal reflux disease. (A - anterior)
Granulations can occur on the luminal side of trachea after tracheostomy. This may cause blood-stained tracheal secretions, poor voice projections (lesser leak of air upwards around the tube), and failure of decannulation (breathless with stridor). Excision of granulation and treating local aggravating factors
need to be done.