Masticator space infections

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Background

  • Consists of 4 contiguous potential spaces bounded by the muscles of mastication:
    • Masseteric, superficial temporal, deep temporal, pterygomandibular
  • Bacteria gain entry to the space from[1]:
    • Odontogenic (tooth extractions, periodontitis, pericoronitis, dental caries, pulpitis, etc) - most common source
    • Trauma (e.g. to the TMJ)
    • Surgery
    • Injections (e.g. inferior alveolar block)
  • Spaces communicate with the tissue planes that extend down the neck to the mediastinum

Clinical Features

  • Initial symptoms are similar to TMJ disease
  • Trismus
  • Tenderness to muscles of mastication
  • Facial swelling and erythema
  • Fever, malaise, dysphagia

Differential Diagnosis

Facial Swelling

Evaluation

  • CT of facial bones with IV contrast

Management

  • Clindamycin IV
  • Consult ENT for surgical drainage of abscess

Disposition

  • Admit

References

  1. Ko I-C, Yoon K-H, Park K-S, et al. An unusual abscess formation in the masticator space after acupressure massage: a case report. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2015;41(1):52-56. doi:10.5125/jkaoms.2015.41.1.52.