Risk of internal carotid injury during Peritonsillar abscess drainage in the emergency department

Abstract

Peritonsillar abscess (PTA) is a common neck infection that presents in the emergency department (ED). The treatment of PTA typically involves either incision and drainage or needle aspiration of the abscess, along with the administration of antibiotics. Patients with obvious PTA get needle aspiration in the ED. When the diagnosis is unclear, or there is a concern for a deeper extension of the abscess, accompanied by symptoms such as drooling and hoarseness, or to rule out other pathologies that mimic PTA, a Computed Tomography (CT) scan of the neck may be performed. Point-of-care ultrasound (POCUS) can also be used to diagnose PTA or facilitate abscess drainage. The method of choice for draining PTA in the ED is a needle aspiration. There is always a risk of bleeding and inadvertent injury of other structures during the procedure, but the most feared complication, even if theoretical, is the puncture of the internal carotid artery that lies behind the tonsil/abscess. Our Study suggests the risk of internal carotid injury is minimal.

Keywords: Emergency department; Needle aspiration; PTA.