A patient presents with a peritonsillar abscess (Quinsy). On examination, there is uvular deviation to the right (away from the affected side). Which is the preferred drainage technique in an adult, and what is the anatomical danger during incision?

• A Needle aspiration is contraindicated; mandatory intraoral drainage under general anaesthesia only
• B I&D at the inferior pole of the tonsil; risk of damaging the hypoglossal nerve
• C Needle aspiration or incision and drainage (I&D) under local anaesthesia in the superior pole of the tonsil at the point of maximum fluctuation; danger — internal carotid artery (lateral to the tonsillar fossa) ✓
• D Hot abscess tonsillectomy is the first-line procedure in all adults with peritonsillar abscess

Explanation

Peritonsillar abscess typically forms in the superior peritonsillar space between the tonsillar capsule and the superior pharyngeal constrictor. Drainage is achieved by needle aspiration (diagnostic and therapeutic) or I&D at the point of maximum fluctuation — typically at the superior pole where pus accumulates, just lateral to the uvula in the soft palate. The critical anatomical danger is the internal carotid artery, which runs postero-laterally to the tonsillar fossa; the carotid bulb may be in an anomalous medial position in some patients, making incision beyond 5 mm deep hazardous. Quinsy tonsillectomy (hot tonsillectomy) is reserved for recurrent abscess or failed drainage.

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

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Written and medically reviewed by the StethoPrep medical team.