Summary about Disease
A masticator space abscess is a collection of pus within the masticator space, a potential space in the face that contains muscles of mastication (chewing), blood vessels, and nerves. It's typically a serious infection that requires prompt diagnosis and treatment to prevent complications. If left untreated, it can spread to other spaces in the head and neck, leading to life-threatening conditions.
Symptoms
Facial swelling, often around the jawline and cheek
Pain, especially when chewing or opening the mouth (trismus)
Difficulty opening the mouth (lockjaw)
Redness and warmth of the overlying skin
Tenderness to palpation in the affected area
Fever
Malaise (general feeling of discomfort)
Difficulty swallowing (dysphagia)
Toothache (if the infection originated from a tooth)
Causes
Odontogenic infections: The most common cause, arising from infected teeth (dental abscesses) that spread into the masticator space.
Trauma: Facial injuries can introduce bacteria into the space.
Surgery: Infections can occur after dental or facial surgery.
Salivary gland infections: Although less common, infections of the parotid or submandibular glands can spread.
Foreign bodies: Rarely, foreign objects penetrating the area can cause infection.
Medicine Used
Antibiotics: Broad-spectrum intravenous antibiotics are typically administered initially. Once culture results are available, the antibiotic may be tailored to target the specific bacteria identified. Common antibiotics used include:
Penicillin-based antibiotics (e.g., ampicillin-sulbactam)
Clindamycin
Metronidazole (often used in combination with other antibiotics for anaerobic coverage)
Cephalosporins
Pain relievers: Analgesics (e.g., acetaminophen, ibuprofen, or opioids) are used to manage pain.
Is Communicable
No. A masticator space abscess is not communicable. It is an infection arising from internal sources or introduction of bacteria through trauma or surgery, not a contagious disease spread from person to person.
Precautions
The following precautions can reduce the risk of developing a masticator space abscess, but focus primarily on preventing the underlying causes:
Good oral hygiene: Regular brushing, flossing, and dental check-ups can prevent dental infections.
Prompt dental care: Seek immediate treatment for toothaches, dental abscesses, or other oral infections.
Careful wound care: Clean and disinfect any facial wounds to prevent infection.
Post-operative care: Follow all post-operative instructions carefully after dental or facial surgery.
How long does an outbreak last?
The duration of a masticator space abscess depends on the severity of the infection, the promptness of treatment, and the individual's overall health. With appropriate treatment (antibiotics and drainage), improvement is usually seen within a few days. Complete resolution can take 1-2 weeks or longer. Untreated abscesses can persist and worsen indefinitely, leading to serious complications.
How is it diagnosed?
Clinical Examination: Physical examination revealing facial swelling, trismus, and tenderness.
Imaging Studies:
CT scan: The most common and definitive imaging modality, providing detailed visualization of the masticator space, abscess location, and surrounding structures.
MRI: May be used in specific cases, especially to evaluate soft tissue involvement.
Ultrasound: Can be used to identify fluid collections, but less detailed than CT or MRI.
Aspiration/Culture: A sample of pus is aspirated from the abscess and sent for culture and sensitivity testing to identify the causative bacteria and guide antibiotic selection.
Dental Examination: Essential to evaluate for odontogenic sources of infection.
Timeline of Symptoms
The timeline can vary, but a typical progression might look like this:
Initial Stage (1-3 days): Toothache (if odontogenic), mild facial pain, slight swelling.
Progression (2-5 days): Increasing facial swelling, worsening pain, developing trismus (difficulty opening the mouth), redness and warmth of the skin.
Advanced Stage (days-weeks if untreated): Severe swelling, significant trismus, fever, difficulty swallowing, potential spread of infection to other spaces.
Important Considerations
Airway compromise: Large abscesses can compress the airway, leading to breathing difficulties. This requires immediate medical attention.
Spread of infection: Untreated abscesses can spread to other spaces in the head and neck (e.g., parapharyngeal space, retropharyngeal space), potentially leading to mediastinitis, sepsis, or cavernous sinus thrombosis, all life-threatening conditions.
Necrotizing fasciitis: Rare but serious complication involving rapid tissue destruction.
Prompt treatment is crucial: Early diagnosis and treatment with antibiotics and drainage are essential to prevent complications and ensure a favorable outcome. Consultation with an oral and maxillofacial surgeon or ENT specialist is often necessary.