Parapharyngeal abscess can be differentiated from peritonsillar abscess (PTA) on clinical examination by the direction of tonsillar displacement:

• A PTA displaces the tonsil downward and laterally; parapharyngeal abscess displaces it anteriorly and medially
• B PTA shows no tonsillar displacement; parapharyngeal abscess displaces anteroinferiorly
• C PTA displaces tonsil medially and downward with uvula deviation; parapharyngeal abscess displaces tonsil medially with fullness of lateral pharyngeal wall ✓
• D Both produce identical displacement patterns, requiring CT for differentiation

Explanation

Peritonsillar abscess (quinsy) forms in the peritonsillar space (between tonsillar capsule and pharyngeal constrictor), pushing the tonsil medially and downward with contralateral uvular deviation, causing hot-potato voice and trismus. Parapharyngeal abscess forms in the lateral pharyngeal (parapharyngeal) space, producing medial bulging of the lateral pharyngeal wall and tonsil without the same degree of uvular deviation, and is associated with neck stiffness and torticollis. CT is definitive for deeper space abscesses but clinical distinction is important.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.