Skip to main content

Masticator space abscess derived from odontogenic infection: imaging manifestation and pathways of extension depicted by CT and MR in 30 patients

European Radiology volume 18, pages 1972–1979 (2008)Cite this article

Abstract

Propagation of odontogenic masticator space abscesses is insufficiently understood. The purpose was to analyse pathways of spread in 30 patients with odontogenic masticator space abscess. The imaging findings in 30 patients (CT in 30, MR in 16 patients) were retrospectively analysed. CT and MR imaging depicted a masticator space abscess within: medial pterygoid muscle in 13 patients (43.3%), lateral masseter and/or pterygoid muscle in 14 (46.7%) and superficial temporal muscle in 3 patients (10%). In the lateral masticator space intra-spatial abscess extension occurred in 7 of 14 patients (50%). The sub-masseteric space provided a pathway in seven (70%). Extra-spatial extension involved the submandibular space only in 3 of 14 patients (21.4%). Medial masticator space abscesses exhibited extra-spatial spread only. Extension affected the parapharyngeal space and/or soft palate in 7 of 13 lesions (53.8%). MR imaging in comparison to CT increased the number of abscess locations from 18 to 23 (27.8%) and regions affected by a cellular infiltrate from 12 to 16 (33.3%). The sub-masseteric space served as a previously underestimated pathway for intra-spatial propagation of lateral masticator abscesses. Medial masticator space abscesses tend to display early extra-spatial parapharyngeal space and/or soft palate extension.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Kim HJ, Park ED, Kim JH et al (1997) Odontogenic versus nonodontogenic deep neck space infections. J Comput Assist Tomogr 21:202–208

    PubMed  Article  CAS  Google Scholar 

  2. Flynn TR, Shanti RM, Levi MH et al (2006) Severe odontogenic infections, part 1: prospective report. J Oral Maxillofac Surg 64:1093–1103

    PubMed  Article  Google Scholar 

  3. Yonetsu K, Izumi M, Nakamura T (1998) Deep facial infections of odontogenic origin: CT assessment of pathways of space involvement. AJNR Am J Neuroradiol 107:807–809

    Google Scholar 

  4. Curtin HD (1987) Separation of the masticator space from the parapharyngeal space. Radiology 163:195–204

    PubMed  CAS  Google Scholar 

  5. Hardin CW, Harnsberger HR, Osborn AG et al (1985) Infection and tumor of the masticator space: CT evaluation. Radiology 157:413–417

    PubMed  CAS  Google Scholar 

  6. Tryhus MR, Smoker WR, Harnsberger HR (1990) The normal and diseased masticator space. Semin Ultrasound CT MR 11:476–485

    PubMed  CAS  Google Scholar 

  7. Som PM, Curtin HD, Silvers AR (1997) A re-evaluation of imaging criteria to assess aggressive masticator space tumors. Head Neck 19:335–341

    PubMed  Article  CAS  Google Scholar 

  8. Connor SEJ, Davitt SM (2004) Masticator space masses and pseudomasses. Clin Radiol 59:237–245

    PubMed  Article  CAS  Google Scholar 

  9. Chong VFH, Fan YF (1996) Pictorial Review: radiology of the masticator space. Clinical Radiology 51:457–465

    PubMed  Article  CAS  Google Scholar 

  10. Bransby-Zachary GM (1948) The sub-masseteric space. Br Dent J 84:10–13

    CAS  PubMed  Google Scholar 

  11. Jones KC, Silver J, Millar WS et al (2003) Chronic submasseteric abscess: anatomic, radiologic and pathologic features. AJNR Am J Neuroradiol 24:1119–1163

    Google Scholar 

  12. Ariji E, Moriguchi S, Kuroki T et al (1991) Computed tomography of maxillofacial infection. Dentomaxillofac radiol 20:147–151

    PubMed  CAS  Google Scholar 

  13. Oshima A, Ariji Y, Goto M et al (2004) Anatomical considerations for the spread of odontogenic infection originating from the pericoronitis of impacted mandibular third molar: Computed tomographic analyses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:589–597

    Google Scholar 

  14. Megran DW, Scheifele DW, Chow AW (1984) Odontogenic infections. Pediatr Infect Dis 3:258–265

    Google Scholar 

  15. Storoe W, Haugg RH, Lillich TT (2001) The changing face of odontogenic infections. J Oral Maxillofac Surg 59:739–748

    PubMed  Article  CAS  Google Scholar 

  16. Schwimmer AM, Roth SE, Morrison Sl (1986) The use of computerized tomography in the diagnosis and management of temporal and infratemporal space abscess. Oral Surg Oral Med Oral Pathol 160:207–212

    Google Scholar 

  17. Akst LM, Albani BJ, Strome M (2005) Subacute infratemporal fossa cellulitis with subsequent abscess formation in an immunocompromised patient. Am J Otolaryngol 26:35–38

    PubMed  Article  Google Scholar 

  18. Braun IF, Hoffman JC, Reede D et al (1984) Computed tomography of the buccomasseteric region. II Pathology. AJNR Am J Neuroradiol 5:611–616

    PubMed  CAS  Google Scholar 

  19. Doxey GP, Harnsberger HR, Hardin DW et al (1985) The masticator space: the influence of CT scanning on therapy. Laryngoscope 95:1444–1447

    PubMed  Article  CAS  Google Scholar 

  20. Wolfram-Gabel R, Kahn JL, Bourjat P (1997) The parapharyngeal adipose corpus: morphologic study. Surg Radiol Anat 19:249–255

    PubMed  CAS  Google Scholar 

  21. Leu YS, Lee JC, Cahn KC (2000) Submasseteric abscess: report of two cases. Am J Otolaryngol 21:281–283

    PubMed  Article  CAS  Google Scholar 

  22. Mandel L, Barmash H (1958) Submasseteric abscess. Oral Surg Oral Med Oral Pathol 11:1210–1219

    PubMed  Article  CAS  Google Scholar 

  23. Balatsouras DG, Kloutsos GM, Protopapas D et al (2001) Submasseteric abscess. J Laryngol Otol 115:68–70

    PubMed  Article  CAS  Google Scholar 

  24. Geers C, Nyssen-Behets C, Cosnard G et al (2005) The deep belly of the temporalis muscle: an anatomical, histological and MRI study. Surg Radiol Anat 27:184–191

    PubMed  Article  CAS  Google Scholar 

  25. Fielding AF, Reck SF, Barker JW (1987) Use of magnetic resonance imaging for localization of a maxillofacial infection: report of a case. J Oral Maxillofac Surg 45:548–50

    PubMed  CAS  Article  Google Scholar 

  26. Newman MH Jr, Emley WE (1974) Chronic masticator space infection. Arch Otolaryngol 99:128–131

    PubMed  Google Scholar 

  27. Schuknecht B, Valavanis A (2003) Osteomyelitis of the mandible. Neuroimaging Clin N Am 13:605–618

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section Neuroradiology, MRI Medizinisch Radiologisches Institut, Bahnhofplatz 3, CH 8001, Zurich, Switzerland

    B. Schuknecht

  2. Department of Cranio-Maxillofacial Surgery, University Hospital of Zurich Switzerland, Frauenklinikstr 24, CH 8091, Zurich, Switzerland

    G. Stergiou & K. Graetz

  3. MRI, Bahnhofplatz 3, CH 8001, Zurich, Switzerland

    B. Schuknecht

Authors
  1. B. Schuknecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Stergiou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Graetz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Schuknecht.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Schuknecht, B., Stergiou, G. & Graetz, K. Masticator space abscess derived from odontogenic infection: imaging manifestation and pathways of extension depicted by CT and MR in 30 patients. Eur Radiol 18, 1972–1979 (2008). https://doi.org/10.1007/s00330-008-0946-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-008-0946-5

Keywords

  • Masticator space abscess
  • Odontogenic infection
  • Submasseteric space
  • MR imaging
  • CT