A 28-year-old man presents with severe sore throat, dysphagia, fever (38.5°C), and trismus for 3 days. Intraoral examination reveals unilateral tonsillar enlargement with deviation of the soft palate to the opposite side, and a bulge in the lateral pharyngeal wall. Which of the following is NOT a typical clinical feature of peritonsillar abscess?

Explanation

## Peritonsillar Abscess: Clinical Features **Key Point:** Peritonsillar abscess is a unilateral collection of pus between the tonsillar capsule and the superior pharyngeal constrictor muscle, presenting with characteristic intraoral and systemic findings. ### Typical Clinical Features of Peritonsillar Abscess | Feature | Characteristic | Notes | |---------|-----------------|-------| | **Tonsillar involvement** | Unilateral enlargement | Bilateral enlargement suggests acute tonsillitis, not abscess | | **Soft palate deviation** | Away from affected side | Due to mass effect and edema | | **Voice quality** | Muffled/hot potato voice | From restricted pharyngeal movement | | **Dysphagia** | Severe, often with drooling | May progress to airway compromise | | **Lymphadenopathy** | Ipsilateral cervical nodes | Reactive enlargement | | **Trismus** | Present | From involvement of pterygomandibular raphe | | **Fever** | High grade (>38°C) | Systemic toxicity | **High-Yield:** Bilateral tonsillar enlargement with exudate is the hallmark of acute bacterial tonsillitis (streptococcal pharyngitis), NOT peritonsillar abscess. Abscess is a complication that develops from inadequately treated or untreated unilateral tonsillitis. ### Why Bilateral Enlargement is Wrong Bilateral tonsillar enlargement with exudate indicates: - Acute infectious pharyngitis (likely Group A Streptococcus) - Symmetric inflammation of both palatine tonsils - Does NOT represent abscess formation (which is a localized, unilateral suppurative collection) **Clinical Pearl:** The classic triad of peritonsillar abscess is: (1) unilateral tonsillar enlargement, (2) soft palate deviation away from the affected side, and (3) severe dysphagia with trismus. Bilateral findings should prompt reconsideration of the diagnosis. **Warning:** Do not confuse acute tonsillitis with peritonsillar abscess. Abscess is a surgical emergency requiring drainage; tonsillitis is typically managed medically with antibiotics. [cite:Robbins 10e Ch 16]