EETEO-PHAEYNGEAL ABSCESS. 9 



posterior wall of the pharynx can be readily seen on oral inspec- 

 tion. The pus here will have a tendency to induce dyspnoea, 

 from its close proximity to the upper opening of the larynx, and 

 also dysphagia, from its obstructing the passage into the lower 

 part of the pharynx. (See Fig. 2.) 



The symptoms in these cases are often so urgent as to 

 require prompt surgical intervention in the way of evacuation 

 of the pus, or the performance of tracheotomy, to relieve the 

 dyspnoea. 



There is not time for the pus to track any distance before 

 serious symptoms arise ; hence its release by an incision made 

 through the mouth is the most speedy and satisfactory. If the 

 incision is made in or near the middle line of the posterior wall 

 of the pharynx, there are no structures of importance that can be 

 exposed to injury. As soon as the pus is liberated the patient 

 should be turned over on to the face, so that the fluid may be less 

 likely to enter the larynx by easily running out of the mouth. 



In chronic retro-pharyngeal abscess the collection is usually 

 dependent upon tuberculous disease of the cervical vertebrae, or 

 a tuberculous deposit in the retro-pharyngeal lymphatic gland. 

 In these cases the symptoms are, as a rule, much less urgent, and 

 consequently time is given for the tuberculous material to track 

 somewhat extensively. It will thus tend to spread laterally, and 

 may then present in the neck behind or even in front of the 

 sterno-mastoid, or it may pass downwards into the posterior 

 mediastinum. The anterior common ligament of the spine lies 

 in front of the bone abscess, and the latter may bulge on each 

 side of the ligament. 



The evacuation of the material may be carried out through the 

 tissues of the neck by an incision made along the posterior 

 border of the sterno-mastoid. The deeper part of the dissection 

 will lie behind the carotid sheath, and must be carried out with 

 the utmost care. By this method of opening these tuberculous 

 collections no chance of contamination through the mouth will 

 occur, and the actual site of disease in the bodies of the cervical 

 vertebras may even be explored. 



