A 35-year-old with odynophagia, trismus and muffled voice has a CT-confirmed parapharyngeal collection displacing the airway. They become more breathless when supine. What is the key initial management principle?
Deep-neck infection can distort anatomy and deteriorate rapidly. Airway planning precedes drainage because unplanned induction or repeated instrumentation can result in a cannot-intubate/cannot-oxygenate event.
A. Secure a controlled airway and involve an experienced surgical team before attempting drainage: Deep-neck infection can distort anatomy and deteriorate rapidly. Airway planning precedes drainage because unplanned induction or repeated instrumentation can result in a cannot-intubate/cannot-oxygenate event.
B. Perform a bedside aspiration without airway preparation: This risks aspiration, haemorrhage and loss of the airway.
C. Give oral antibiotics and review tomorrow: A collection with evolving airway symptoms needs urgent care.
D. Obtain a dental panoramic radiograph before escalation: It may be useful later but cannot delay airway management.
E. Give systemic steroids as sole therapy: They do not provide source control for an abscess.
If there were a small cellulitis without collection or airway compromise, intravenous antimicrobials and close review might be appropriate without immediate drainage.
Draft Clinora educational material only; not official JCIE content, an accredited programme, or a substitute for local policy and specialist judgement.
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