Submasseteric abscess: A rare head and neck abscess.

The objective of the article is to highlight and make people aware of a rare abscess which is often missed or misdiagnosed. As only a few cases have been reported, the authors feel that reporting such a case would help in proper management of the disease. We are presenting a 6.5-year-old male child with 3 weeks history of right facial swelling in the parotid region, with low-grade fever and trismus. Submasseteric abscess is a rare abscess which is often misdiagnosed as a parotid abscess or parotitis. Only a few cases have been reported. The cause is mostly dental in origin. Intravenous antibiotics often fail to alleviate the symptoms as this is a closed space and needs prompt drainage. Therefore, awareness of this complication of dental infections is vital for proper diagnosis and timely management.

Submasseteric Abscess

PURPOSE: The masserteric space is an important tissue compartment of the face, but a disease in it is difficult to diagnose and treat. The submasseteric abscess is located between the masseter muscle and mandibular ramus with different appearances such as sepsis, infection, or tumor. Especially the common misdiagnosis of submasseteric abscess is acute or chronic parotitis. The purpose of this report is to pay special attention to the possible diagnosis of submasseteric abscess for the symptoms of unilateral cheek swelling and tenderness that accompany marked trismus. METHODS: A 11-year-old boy came to our hospital because of facial swelling, tenderness, and trismus in a history of left cheek swelling and toothache. We diagnosed his case as submasseteric abscess by CT scan and surgical intervention was performed. Under general anesthesia, the abscess was opened by the intraoral incision and considerably massive pus was drained. RESULTS: Swelling, tenderness, and trismus became to subside during postoperative 10 days and general condition and vital signs became stable. After 6 months, CT scan showed that both masseteric muscles were symmetric and there was no periosteal reaction of the mandible. CONCLUSION: In conclusion, submasseteric abscess is a rare infection with the symptoms of cheek tenderness and marked trismus. A detailed medical history and clinical examination of a patient as well as computed tomography(CT) are important tools in the accurate diagnosis and efficient treatment of the submasseteric abscess. Adequate drainage, removal of cause, and antibiotic infusion are the management of choice.

Surgical correction of maxillofacial deformity with fibrous-osseous lesion of mandible using the intraoral vertical ramus osteotomy

A 22-year-old male patient had developed a submasseteric abscess secondary to a mandibular osteomyelitis at the age of 7 years old. The initial presentation at that time seems to be acute suppurative parotitis. The computed tomographic scans taken before surgery demonstrated diffuse deformity, sclerotic change and osteolytic lesion in the mandible. There was no marrow space on both sides of mandibular ramus and thin-walled cortical bone was seen. So, from the results of the computed tomography, the surgery was performed intraoral vertical ramus osteotomy (IVRO) instead of performing the more commonly used bilateral sagittal split ramus osteotomy (BSSRO). In this report, we present a case of surgical correction of mandibular prognathism with fibrous-osseous lesion of mandible with using IVRO.