A peritonsillar abscess is the most common complication of tonsilitis. As discussed in our sore throat section, the condition occurs due to a collection of pus developing deep to the tonsil. This pus requires drainage; "Ubi pus, ibi evacua".
The collection can be drained either by making a small incision into the overlying soft tissue or, more commonly, via a needle aspiration. The later is discussed here.
A good headlight
Lack's "metal" tongue depressor
Large bore cannula (grey 16G)
Mouthwash or gargle
A well informed, comfortable patient and a good light source are key for success.
The patient's oropharynx is anaesthetised using xylocaine spray. Whilst this is working, the cannula is processed to allow 'safe' drainage (image opposite);
The cannula is deconstructed to its individual parts.
The protective sheath is then cut and repositioned on the needle leaving around 1.5 - 2cm of the needle exposed and taped into position. (This prevents the needle from passing too deep.)
A 10ml syringe is then attached to the needle.
The cannula and syringe are then used to aspirate the abscess.
The classic aspiration point is described by tracing a line superiorly from the medial surface of the last standing mandibular molar until it meets with a line traced horizontally from the base of the uvula. However, each quinsy is different and aspiration points should follow the area of greatest swelling.
If successful, patients often describe feeling instant relief.
As with all procedures, quinsy drainage should only be attempted by those qualified to do so.