Computed tomographic assessment in deep space infections of odontogenic origin

Abstract

Background/Aim: The objective of the article is to investigate the pathways of spread of odontogenic infection in the facial and neck spaces and to determine the accuracy of contrast enhanced computed tomography (CT) in diagnosing deep neck space infections. Study Design/Materials and Methods: Contrast enhanced CT scans of 27 patients with extensive spread of odontogenic infection into the facial and neck spaces were analyzed to document the pathways of spread. Results: The results of the study indicated that the masseter space was the most commonly involved space followed by the pterygoids (both lateral and medial) and a different spread (other than medial pterygoids) to the parapharyngeal space has been proposed. Odontogenic infections from the mandible spread in two different ways. It first spreads upward, into the masseter and/or medial pterygoid muscles in the masticator space, and downward, into the sublingual and/or submandibular spaces, and then spreads into the spaces or muscles adjacent to one or more of these locations. Infections from the masseter muscle spreads into the parotid space to involve the temporalis and lateral pterygoid muscles. Infections from the medial pterygoid muscle spread into the parapharyngeal space to involve the lateral pterygoid muscle. Infections in the maxilla do not spread downward; instead, they tend to spread upward and superficially into the buccal space. Conclusion: CT is useful in depicting the exact site and extent of infection and in planning the treatment of extensive odontogenic infection, which can be life threatening when therapy is ineffective.