下顎歯周囲感染症から波及した咀嚼筋隙膿瘍の2症例

Abstract

The masticator space is located between the masseteric fascia and the pterygoid muscle fascia. Here we report two cases of masticator space abscesses spreading from infections of mandibular teeth. Case 1 is an 85-year-old lady who were referred to Yokohama City University Hospital with a left-cheek swelling and trismus. An enhanced CT scan revealed an abscess extending from the left infratemporal fossa to the temporal fossa. A purulent discharge was observed from her left lower gingiva. We performed surgical drainage under general anesthesia. After infection control, the affected teeth were extracted. Case 2 is an 82-year-old lady who was administered oral bisphosphonate for osteoporosis. She presented to another hospital with fever, trismus and swelling anterior to the right ear after right lower tooth extraction. Because MRI revealed persistent osteomyelitis of her mandible even after antibiotic treatment, she was referred to us. Enhanced CT showed an abscess in the right infratemporal fossa. After surgical drainage similar to Case 1, antibiotics were administered for approximately 4 months to control the osteomyelitis. It is important to recognize that infections of the mandibular teeth can cause an abscess in the masticator space through the pterygomandibular and infratemporal spaces.