Masticator space

The masticator space is one of the deep compartments of the head and neck.

Gross anatomy 

The masticator space are paired suprahyoid cervical spaces on each side of the face. Each space is enveloped by the superficial (investing) layer of the deep cervical fascia.

The superficial layer of deep cervical fascia splits into two at the lower border of the mandible, the inner layer running deep to the medial pterygoid muscle and attaches to the skull base medial to foramen ovale and the outer layer covering masseter and temporalis muscles and attaches to the parietal calvaria superiorly.

Contents

• muscles of mastication
• ramus and body of mandible
• mandibular division of the trigeminal nerve (Vc)
  • enters the masticator space via the foramen ovale ¹
• ^​inferior alveolar nerve
• inferior alveolar artery and vein

Boundaries and relations

• anteriorly: buccal space
• posterolaterally: parotid space
• medially: parapharyngeal space

Communications

Masticator space malignancy can spread perineurally via the mandibular division of the trigeminal nerve into the middle cranial fossa. 

Radiographic appearance

Ultrasound

• limited use when imaging the masticator space
• masseter muscles, zygomatic arch, outer cortex of the ramus of mandible and suprazygomatic segment of temporal muscle can all be visualized
• limited visualisation of a number of important structures ³:
  • pterygoid muscles
  • pterygoid venous plexus
  • mandibular branch of the trigeminal nerve

CT

• best modality for detecting bony erosion in the cortex of the mandible and is excellent for characterizing tumour matrix mineralization
• abscess in the masticator space shows up as a fluid collection with peripheral rim enhancement whereas a phlegmon shows low density oedematous tissue without peripheral enhancement ²
• schwannoma appears as a well-circumscribed fusiform mass with extension through the foramen ovale and is higher in attenuation that adjacent muscle and shows contrast enhancement ⁵

MRI

MRI better characterises soft tissue invasion by tumours and perineural tumour spread ²:

• schwannoma demonstrates intermediate signal on T1-WI and hyperintensity on T2-WI with contrast enhancement
• neurofibroma generally show heterogeneity on T2-WI and heterogeneous contrast enhancement ⁵
• locally invasive carcinoma from the nasopharynx or oral cavity demonstrate intermediate-to-high signal on T2-WI and low signal on T1-WI, with or without bone destruction and perineural spread; lymphadenopathy is common ⁸    

Nuclear medicine

• PET/CT with FDG tracer can be used to detect metastatic disease and to differentiate recurrent tumours from post-radiation change ²

Related pathology

• odontogenic abscess
• osteomyelitis
• direct spread of squamous cell carcinoma
• lymphoma
• minor salivary gland tumours
• muscle sarcoma
• bone sarcoma
• osteoradionecrosis
• schwannoma
• neurofibroma
• benign masseteric hypertrophy
• accessory parotid tissue