MASTICATORY SPACE INFECTION

1. Masticatory Space
Infection
DR. SWATI SAHU
MDS FELLOW
ORAL & MAXILLOFACIAL SURGERY

2. Masticatory space
There are 5 masticatory spaces.
1. Pterygomandibular space
2. Submassetric space
3. Superficial temporal space
4. Infratemporal space
5. Deep temporal space

4. PTERYGOMANDIBULAR
SPACE INFECTION
Boundries:
 Anterior-Buccal Space
 Posterior-Parotid gland with lateral pharyngeal
space
 Superior- Lateral pterygoid muscle
 Inferior-Inferior border of mandible
 Deep or Lateral- Medial surface of ascending
ramus of mandible

5. Contents -
 Inferior Alveolar neurovascular bundle.
 Lingual & auriculotemporal nerves.
 Mylohyoid nerve & vessels
Etiology -
 Infected mandibular 3rd molars
 Pericoronitis
 Infected needles or contaminated LA solutions.

6. Spread of infection
 Superiorly to the infratemporal space.
 Medially to lateral pharyngeal space.
 To submandibular space.

7. Clinical features
 Absence of extra-oral swelling
 Severe trismus.
 Difficulty in swallowing.
 Anterior bulging of half of soft
palate & tonsillar pillars with
deviation of uvula to unaffected
side.

8. Treatment
 Intraoral-vertical incision(1.5cm) made on
anterior & medial aspect of→ ramus of
mandible→sinus forceps→opened and closed
and withdrawn→pus drained and sutured.
 Extraoral- incision made at an angle of
mandible→sinus forceps→pus drained
&sutured.

9. SUBMASSETERIC SPACE INFECTION
Boundaries-
 Superiorly-zygomatic arch
 Inferiorly- inferior border of mandible
 Laterally- medial surface of masseter muscle.
 Medially- lateral surface of ramus of mandible.
 Posteriorly- parotid gland and its facia.
 Anteriorly- buccal space &buccopharyngeal fascia.

10. Contents -
 Masseteric artery and vein
Etiology
 Pericoronitis related to vertical or distoangular impaction of
third molar.
 Fracture of angle of mandible

11. Clinical features
 External facial swelling is moderate.
 Tenderness over angle of mandible.
 Limited mouth opening.
 Pyrexia &malaise.
 Necrosis of muscle.

12. Treatment
Incision &drainage
 Intraoral approach-done on the lower part of
ramus→sinus forceps →downward and
backward→drain inserted and secured
 Extraoral approach-incision is placed behind the angle
of mandible→Hilton’s method→rubber drain inserted
and secured.

13. TEMPORAL SPACES
Superficial temporal-
 Laterally- temporalis fascia.
 Medially-temporalis muscle.
Deep temporal-
 Laterally- temporalis muscle.
 Medially-temporal bone & greater wing of sphenoid

14. SUPERFICIAL TEMPORAL SPACE
INFECTION
LIKELY CAUSES –
 Upper Molars
 Lower Molars
CONTENTS –
 Temporal fat pad
 Temporal branch of facial n.

15. NEIGHBOURING SPACES –
Buccal
Deep temporal
CLINICAL FEATURES -
Pain ,trismus, swelling may or may not be present.
APPROACH FOR INCISION & DRAINAGE –
 Intraoral
 Extraoral
 Intraoral-extraoral

16. INFRATEMPORAL & DEEP
TEMPORAL SPACE INFECTION
LIKELY CAUSES –
 Upper Molars
CONTENTS –
 Pterygoid plexus
 Internal maxillary a. and v.
 Mandibular div. of trigeminal n.
 Skull base foramina

17. NEIGHBOURING SPACES –
 Buccal
 Superficial temporal
 Inf. petrosal sinus
CLINICAL FEATURES -
 Marked trismus
 Swelling of face in front of ear, over TMJ , behind zygomatic process
 Eyes is closed & proptosed
APPROACH FOR INCISION & DRAINAGE –
 Intraoral
 Extraoral
 Intraoral-extraoral

18. Thank you