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[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
- 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
- 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