Masticator space infections

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:
  • 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

• Buccal space infections
• Dental problems
• Canine space infection
• Facial cellulitis
• Herpes zoster
• Masticator space infections
• Maxillofacial trauma
• Neoplasm
• Parapharyngeal space infection
• Salivary gland diagnoses
  • Parotitis
    • Bilateral parotitis
    • Suppurative parotitis
    • Viral parotitis (Mumps)
  • Ranula
  • Sialoadenitis
  • Sialolithiasis
• Superior vena cava syndrome

Evaluation

• CT of facial bones with IV contrast

Management

• Clindamycin IV
• Consult ENT for surgical drainage of abscess

Disposition

• Admit