How should lingual tonsillar abscess be treated?

Tonsils are very important lymphatic tissues. They are located in a very important part of the throat and can control our physical health. Problems with tonsils can cause a series of hazards and affect the human body. Therefore, tonsils will become inflamed when you have a cold, but sometimes tonsils will have abscesses. Such cases are relatively rare and are rarely seen in hospitals. Tonsillar abscesses can cause difficulty in swallowing and inability to eat normally, so surgical treatment should be chosen when necessary. Patients with lingual tonsil abscesses should pay attention to a light diet recently, eat more soups and water, and drink with a straw when necessary. Patients will have obstructions during the eating process, leading to oral infections and even a variety of complications.

Lingual tonsil abscess is a rare case. Recently, we encountered two patients in the outpatient clinic who underwent abscess incision and treatment due to sore throat and dysphagia.

The lingual tonsil is located between the lingual lambdoid groove and the epiglottis, and is divided into left and right tonsils by the median epiglottal wrinkle. Lingual tonsillar abscess refers to a superficial abscess formed by infection in the lingual tonsils; a deep abscess caused by lingual tonsil infection penetrating the capsule is also called lingual tonsillar abscess, that is, tongue root abscess.

Lingual tonsil abscesses are located deep and difficult to see directly. Using instruments to pull the tongue root is extremely painful and is often rejected by patients. The application of fiber endoscope has improved the diagnosis rate of lingual tonsillar abscess.

The lymphatic structures of the lingual tonsils are covered by mucosa and extend deep into the lenticular papillae to form fissures or blind tubes. There are a large number of mucous gland openings at its bottom, and the mucous glands penetrate deep into the lower 1/3 of the muscle layer. The amount of mucous glands is much richer than that of pharyngeal tonsils.

The main pathogenic bacteria of throat abscess are Staphylococcus aureus, while those of lingual tonsillar abscess are mainly Streptococcus.

Cause of disease: The cause of lingual tonsils and surrounding abscesses is mostly due to upper respiratory tract infection. ① Tonsillitis, caused by piercing the cyst, allowing pathogens to directly enter deep into the tonsils; ② The deep follicles of the tonsils can directly pierce the cyst and cause infection; ③ Abscesses can also occur by spreading along the tonsillar lymphatic vessels to the surrounding areas; ④ Feng Zhaoyuan proposed that closed abscesses in the tonsillar fossa can pierce the base and cause deep abscesses. Lingual tonsil infection can also spread deep into the loose tissue outside the mucous glands to form deep abscesses.

The infection of the lingual tonsil follicles directly forms an abscess, which is called lingual tonsil abscess. Because the lingual tonsil is divided into two parts by the median fold of the epiglottis, the lingual tonsil abscess should also be divided into the left and right sides. When the lingual tonsil infection spreads along the lymphatic vessels or mucous gland ducts or directly penetrates the basement membrane to form a deep abscess, it is called a lingual tonsillar abscess.

Clinical manifestations

Superficial lingual tonsil abscess usually presents suddenly, with symptoms such as sore throat, inability to swallow, drooling, slurred speech, and in severe cases, only difficulty breathing. During the examination, the tongue quality, color and mobility of the anterior part of the tongue limiter groove are not affected, but there are varying degrees of obstruction in protrusion. The tonsils at the root of the tongue on the affected side are red and swollen, and sometimes there are pus plugs or pus coating in the crypts. There is tenderness at the greater angle of the hyoid bone on the affected side of the abscess, but no swelling. There is no swelling, congestion or tenderness in the posterior part of the maxillo-lingual groove.

Lingual tonsillar abscess is located in the deep loose connective tissue of the tonsil. The infection is caused by the lingual tonsil along the lymphatic vessels or mucous gland ducts or directly infiltrating into the deep to form an abscess. The clinical manifestations are still pharyngalgia, dysphagia, drooling, speech disorders and forced posture. The tongue quality, color and movement are good. The lingual tonsils are red and swollen, but no nodules can be felt. Nodules and deep tenderness can be felt behind the maxillo-lingual groove and on the hyoid bone. The swelling in the submental area is centered on the hyoid bone or located on one side.