SUPRA-PHARYNGEAL (RETRO-PHARYNGEAIv) 

 ABSCESS. 



A sequel of phlegmonous pharyngitis. Symptoms ; masked by its depth - 

 pharyngeal wheezing or. roaring with little local swelling ; difficult swallow- 

 ing ; resisting tissues tend to chronicity. Results ; pharyngeal fistula, bur- 

 rowing along oesophagus, rupture into chest or bloodvessels, lymphade- 

 nitis, compression of vagus, or jugulars, permanent infected cavity with 

 small orifice. Diagnosis from pus in guttural pouches. Treatment ; exter- 

 nal opening ; antisepsis. 



This is a natural result of phleg-monous pharyngitis, but it is- 

 possessed of so great importance alike in its chronicity and its re- 

 sults that it seems to deserve a .special article. Ivike its initial 

 morbid condition it is especially common in the soliped, and like 

 that may be traceable to strangles, influenza, and local trauma- 

 tism. 



The symptoms are at first those of phlegmonous pharyngitis, 

 and, if the local swelling, induration and tenderne.ss are less- 

 marked than in other cases, it is due to the location of the in- 

 flammatory lesion deeply between the pharynx and the atlas and 

 occiput. Indeed the moderate a.spect of the external swelling,, 

 conjoined with the noisy wheezing or violent roaring, may be 

 taken as important diagnostic indications. The supra-pharyn- 

 geal region is so closely confined on its lateral aspects, by the 

 union of the fa.scia of the sternomaxillaris and mastoido-humeral 

 mu.scles, that the swelling is confined in the early .stages just as 

 the pus is later. As this resistant fascia prevents any relief by 

 lateral expansion, the engorged tissues press downward on 

 the .softer and less resistant upper wall of the pharynx and 

 seriously impair both respiration and deglutition. Similarly 

 when pus has formed, these lateral fibrous barriers, reenforced by 

 organized lymph, stand in the way of the advance of the pus 

 toward the .skin, and lead it to dissect its way downward toward 

 the pharynx. Even here the thickening of the ti.ssues by the or- 

 ganized products of the lymph will often interpose a serious bar,, 

 and the pus remains pent up indefinitely, a .source of wheezing, 

 roaring and impaired deglutition, and a constant threat of 

 secondary absce.ss or septic infection. Even the dense fibroid 

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