• Prerequisites and learning objectives
• Lesson
  • Content
    • 1 - Pathophysiology - General information
    • 2 - Rhinopharyngitis
      • 2.1 - Etiologies
      • 2.2 - Diagnosis
      • 2.3 - Treatment
      • 2.4 - Complications associated with rhinopharyngitis
      • 2.5 - Differential diagnosis
      • 2.6 - Hypertrophy of adenoid vegetations causing recurrent rhinopharyngitis
      • 2.7 - Other factors favoring nasopharyngeal infections
    • 3 - Angina
      • 3.1 - Etiology
      • 3.2 - Clinical diagnosis
      • 3.3 - Bacteriological diagnosis
      • 3.4 - Clinical forms
        • 3 . 4 . 1 - Acute catarrhal angina (or erythematous angina)
        • 3 . 4 . 2 - Angina with purulent exudate (or erythemato-pultaceous angina)
        • 3 . 4 . 3 - Pseudomembranous angina (or false-membrane angina)
        • 3 . 4 . 4 - Ulcerative and necrotic angina
        • 3 . 4 . 5 - Vesicular angina
        • 3 . 4 . 6 - Gangrenous, necrotizing angina
      • 3.5 - Treatment
      • 3.6 - Differential diagnosis of angina
    • 4 - Chronic tonsillitis
      • 4.1 - Chronic tonsillitis in children
      • 4.2 - Chronic tonsillitis in adults
    • 5 - Complications of tonsillar infection
      • 5.1 - Local complications
      • 5.2 - General complications
    • 6 - Tonsillectomy indications
      • 6.1 - Indications
      • 6.2 - Contraindications
  • Key points
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5  -  Complications of tonsillar infection

Complications are due to GAS infection and seen during acute angina or during reactivation of chronic angina. GAS-induced angina often evolves favorably in 3 to 4 days, even in the absence of treatment, but infection may give rise to septic, local, or general complications, as well as post-streptococcal syndromes (including AAR and acute glomerulonephritis).

5 . 1  -  Local complications

Local and regional suppurative complications in relation with GAS infection are mainly represented by peritonsillar phlegmon, but may include suppurative cervical adenitis laterocervical abscess), retropharyngeal abscess, acute otitis media, sinusitis, mastoiditis, and cervical cellulitis.

→ Peritonsillar phlegmon

A peritonsillar phlegmon is a suppurative cellulitis occurring between the tonsil capsule and pharyngeal wall.

The clinical picture is characterized by acute angina or reactivation of chronic tonsillitis, with unusual disease progression :

• temperature remaining in the vicinity of 38°C, and then further rising;
• painful dysphagia, increasing in severity, being unilateral, with painful earache.
• The appearance of the patient is evocative, at the full stage of the disease:
• pale and motionless, head tilted to the affected side of the body, allowing saliva that cannot be swallowed to flow from the mouth;
• bad breath as well as nasal and deaf-like voice.

• at the presuppurative stage of phlegmonous angina, antibiotic treatment may induce healing;
• at the phlegmon stage, reflected by insomnia, trismus, edema of the cion (uvula palatinae), and possibly confirmed by exploratory fine-needle aspiration puncture (revealing the presence of pus), surgical evacuation of the suppurative collection is indispensable: vertical incision of the anterior arcus palatini, followed by a clamp debridement (Figure 4.1). At times, a simple aspiration the collected liquid on a daily basis may prove sufficient. Antibiotic treatment is systematically associated.

Fig 10.

Fig 11 : Surgical treatment of right peritonsillar phlegmon

A: Right peritonsillar phlegmon punctured through the anterior arcus palatini, enabling a bacteriological pus sample to be collected (A).

B. The phegmon is incised through the anterior arcus palatini; the opening is enlarged using a clamp in order to facilitate the evacuation of the purulent liquid (with bacteriological sampling).

Recovery is obtained within a few days.

In order to avoid new episodes, cold tonsillectomy is proposed and should be conducted within a minimum period of 5 to 6 weeks after the phlegmon, but this intervention is no longer performed systematically.

→ Suppurative cervical adenitis (or laterocervical abscess)

This is a suppuration of a lymph node within the jugular-carotid chain. This complication is more rare.

Following an angina phase, a painful torticollis and deep cervical thickening with febrile syndrome occur. Imaging (scanner) facilitates topographic diagnosis.

The treatment is based on antibiotic therapy at the pre-suppurative stage. During the swelling phase, the collection is evacuated via cervical incision and drainage.

Fig 12.