A 25-year-old presents with right-sided peritonsillar abscess (quinsy): uvular deviation to the LEFT, trismus, 'hot potato' voice, and fluctuant bulging of the right anterior pillar. The most appropriate first-line drainage procedure in a cooperative adult under local anaesthesia is:
- A Emergency tonsillectomy under general anaesthesia
- B Needle aspiration at the point of maximal bulge on the anterior pillar ✓
- C Incision and drainage at the point of maximal fluctuation, just lateral to the base of the uvula in the soft palate
- D CT-guided drainage under sedation
Explanation
Peritonsillar abscess first-line management is needle aspiration at the point of maximal fluctuation (typically superior pole of the anterior tonsillar pillar, medial to the upper pole of the tonsil, lateral to the uvula base). This has 85-95% success rate, can be performed under local anaesthesia in adults, and avoids the need for general anaesthesia. Note: in quinsy the uvula deviates AWAY from the affected side (pushed by the oedema). Incision and drainage (I&D) is used if aspiration fails or in children/uncooperative patients. Immediate tonsillectomy is reserved for recurrent quinsy, failed drainage, or where airway compromise requires GA.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.