Presentation
Right facial swelling for a week, now presenting with trismus. Not particularly tender. Imaging to determine source and spread.
Patient Data
Right sided masticator space abscess, with a collection deep to the masseter overlying the buccal surface of the mandible. Air in the soft tissues towards the mental process. The masticator muslces are swollen, but there is no spread of the collection superior to the zygoma. A few reactive lymph nodes are seen. Carious teeth, but no cortical erosion. Subluxed right TMJ, with a flattened mandibular condyle.
Carious teeth, with some lucency around LL7 but no frank dental abscess.
The patient underwent dental extraction and a course of antibiotics.
They returned 8 months later with recurrent symptoms.
Interval right mandibular dental extraction.
New extensive lucency throughout the right mandible.
Multiloculated collection surrounding the right mandibular ramus, extending to the condyle/TMJ space. Erosion and fragmentation of the right mandible compatible with osteomyelitis.
Case Discussion
This case illustrates the effects deep dental infections can have, especially when spread to the soft tissues has occurred. Between the masseter and mandible is an important region to examine as collections here can sometimes be clinically silent.