Retrograde Spread of Buccal Space Infection into Temporal Space with Temporal Muscle Necrosis in a Medically Compromised Patient - A Case Report

Superficial temporal space lies between the temporal fasciae. Abscess in the temporal and infratemporal space is very rare. They develop as a result of the extraction of infected maxillary molars. Temporal space infections or abscesses can be seen in the superficial or deep temporal regions. A 65 - year - old male patient reported with a complaint of painful swelling over the right cheek and restricted mouth opening with a history of extraction of second mandibular molar before four weeks. On examination, an ill-defined diffuse swelling was seen. Treatment was started with IV empirical antibiotics and planned for surgical drainage. Surgical drainage of the abscess in the temporal space was done along with debridement of the necrosed temporalis muscle. Infections of the maxillofacial region are of great significance to general dentists and maxillofacial surgeons. They are of clinical importance as they are commonly encountered, and are also challenging as timely intervention is needed to prevent fatal complications. The infections arising from the tooth are initially confined to the alveolar bone and surrounding periosteum. They spread along the path of the least resistance to the cortical plates. Once the infection penetrates the cortical plates, they reach the muscle plane.1 If the infection perforated is above the muscle attachments, it’s confined to an intraoral abscess. If the cortical plates are perforated below the muscular attachments, extraoral swelling develops. The next barrier is the periosteum which is strong and elastic in nature. Once the periosteum is breached, infections reach the soft tissue planes, the fascia. Most of the infections are confined to a particular space and the surrounding fascia. Based on the toxins produced by the microorganisms, the infection can spread to adjacent spaces and even retrograde. Common deep space infections are Ludwig's angina followed by peritonsillar, submandibular, and parotid abscesses. 2 Infratemporal and temporal space infections are rarely compared to other deep space infections. Many etiological factors form the base for the infections of deep spaces, dental caries, extraction of infected, non-infected tooth maxillary sinusitis, tonsillitis, maxillary sinus fracture, temporomandibular arthroscopy, drug-induced infections. Infections of odontogenic origin, spreading along infratemporal and temporal space are most common with maxillary molars followed by mandibular molars. We report a case of retrograde spread of buccal space infection into temporal space secondary to mandibular tooth extraction.

Retrograde Spread of Buccal Space Infection into Temporal Space with Temporal Muscle Necrosis in a Medically Compromised Patient - A Case Report

Superficial temporal space lies between the temporal fasciae. Abscess in the temporal and infratemporal space is very rare. They develop as a result of the extraction of infected maxillary molars. Temporal space infections or abscesses can be seen in the superficial or deep temporal regions. A 65 - year - old male patient reported with a complaint of painful swelling over the right cheek and restricted mouth opening with a history of extraction of second mandibular molar before four weeks. On examination, an ill-defined diffuse swelling was seen. Treatment was started with IV empirical antibiotics and planned for surgical drainage. Surgical drainage of the abscess in the temporal space was done along with debridement of the necrosed temporalis muscle. Infections of the maxillofacial region are of great significance to general dentists and maxillofacial surgeons. They are of clinical importance as they are commonly encountered, and are also challenging as timely intervention is needed to prevent fatal complications. The infections arising from the tooth are initially confined to the alveolar bone and surrounding periosteum. They spread along the path of the least resistance to the cortical plates. Once the infection penetrates the cortical plates, they reach the muscle plane.1 If the infection perforated is above the muscle attachments, it’s confined to an intraoral abscess. If the cortical plates are perforated below the muscular attachments, extraoral swelling develops. The next barrier is the periosteum which is strong and elastic in nature. Once the periosteum is breached, infections reach the soft tissue planes, the fascia. Most of the infections are confined to a particular space and the surrounding fascia. Based on the toxins produced by the microorganisms, the infection can spread to adjacent spaces and even retrograde. Common deep space infections are Ludwig's angina followed by peritonsillar, submandibular, and parotid abscesses. 2 Infratemporal and temporal space infections are rarely compared to other deep space infections. Many etiological factors form the base for the infections of deep spaces, dental caries, extraction of infected, non-infected tooth maxillary sinusitis, tonsillitis, maxillary sinus fracture, temporomandibular arthroscopy, drug-induced infections. Infections of odontogenic origin, spreading along infratemporal and temporal space are most common with maxillary molars followed by mandibular molars. We report a case of retrograde spread of buccal space infection into temporal space secondary to mandibular tooth extraction.

Dilute initial dentofacial abscess of buccal space: a technical note

The treatment of the dentofacial abscess was always surgical because the evacuation of the purulent collection and removal of the cause are mandatory. Large abscesses, especially those that reach the submandibular space, require laboratory and imaging exams, but small abscesses restricted to the buccal space can be successfully treated by diluting the purulent collection with saline solution using needle and syringe.

Microbiological Approach in Management of Recurrent Dento - Buccal Space Infection - Report of Three Uncommon Cases

The route of facial infection usually depends on the jaw-tooth relationship factors followed by virulence and type of microorganisms. Staphylococci are frequently associated with abscess formation. However, at times head and neck infection with an odontogenic origin are caused by gram-negative species like Klebsiella pneumonia without any predisposing opportunistic infectious etiology. In this report, we presented 3 rare cases of buccal space infection associated with Klebsiella pneumonia without any predisposing systemic disease. Appropriate diagnosis followed by antibiotics oral cephazolin (500mg BID) and intra-muscular gentamicin (150mg BID) at adequate strength and duration has brought a significant decrease in the progression of the disease that yielded complete recovery after 10days. Thus with odontogenic infections it is appropriate to always begin with the empiric antibiotic regimen with correlation to clinical presentation thinking of the most likely suspected microorganisms, which are usually the normal flora of the region, without forgetting the importance of early surgical intervention to reduce morbidity and complications.

Temporalis space infection secondary to an undiagnosed intra-oral foreign object – a case report

The penetration of foreign objects is one of the leading causes of maxillofacial infection following trauma. Failure to detect such objects at initial stages can lead to complications like abscess formation, cellulitis, or space infections. Detection is even more complicated if the patient presents to the maxillofacial center after a delay of days or weeks following trauma. Sole reliance on radiographs or CT can be inconclusive as most of these objects are radiolucent and can be difficult to detect even by the experienced radiologists. We report the case of a patient who had an unwitnessed trauma and presented to our center 7 days after the incident, with signs of buccal space infection. Failure to detect the embedded intra-oral wooden object at an earlier stage led to the propagation of infection to superficial temporal space. The management strategy and pitfalls associated with conventional imaging in detecting wooden object are discussed.

Classification of postoperative edema based on the anatomic division with mandibular third molar extraction

Purpose Several investigations have been performed for a postoperative edema after extraction, but the results have been controversial due to low objectivity or poorly reproducible assessments of the edema. The aim of this study was to suggest a classification and patterns of postoperative edema according to the anatomical division associated with extraction of mandibular third molar as a qualitative evaluation method. Methods This study was conducted forty-four mandibular third molars extracted and MRI was taken within 48 h after extraction. The postoperative edema space was classified by MRI (one anatomic component—buccinator muscle—and four fascial spaces—supra-periosteum space, buccal space, parapharyngeal space, and lingual space), and evaluated independently by two examiners. The inter-examiner reliability was calculated using Kappa statistics. Results The evaluation of buccinator muscle edema showed good agreement and the fascial spaces showed constant high agreement. The incidence of postoperative edema was high in the following order: supra-periosteum space (75.00%), buccinator muscle (68.18%), parapharyngeal space (54.55%), buccal space (40.91%), and lingual space (25.00%). Conclusion Postoperative edema could be assessed clearly by each space, which showed a different tendency between the anatomic and fascial spaces.