Wk 8, Case 5 - Review

Patient History
Right jaw and dental pain for five days.

Findings
Contrast-enhanced CT was performed of the maxillofacial region and neck. Study is abnormal. There is an abnormality involving the right masticator space. There is asymmetric enlargement of the right masticator space with the suggestion of some fluid adjacent to the medial aspect of the right ramus of the mandible with obliteration of the adjacent fat which could represent early abscess. In addition, there is asymmetric enlargement of the right masseter muscle and medial displacement and enlargement of the right pterygoid muscle. No obvious evidence of bone erosion is identified. There is reticulation of the adjacent subcutaneous fat and ipsilateral platysma muscle superficial to the right masticator space extending inferiorly. In addition, there is subtle increased attenuation involving the right parotid gland which could be due to parotid inflammation from the ipsilateral inflammatory masticator space process. There is also subtle enlargement of right Stensen's duct which could also be due to infectious process.

These abnormalities are typically infectious processes due to posterior spread of an odontogenic infection involving the ipsilateral molar teeth and should be correlated with any relevant findings.

No evidence of infections are identified involving the floor of mouth. There is prominence of the adenoidal tissue involving the soft palate and tonsils. There does appear to be asymmetrically enlarged level 1B and level 2 lymph nodes which may be reactive.

The visualized portion of the brain is within normal limits.

Conclusions
1. Diffuse abnormality involving the right masticator space with likely fluid adjacent to the medial cortex of the ramus of the right mandible and probable myositis involving the medial pterygoid and masseter muscles as described above consistent with myositis, possible subtle abscess. These abnormalities are typically infectious processes due to posterior spread of an odontogenic infection involving the ipsilateral molar teeth and should be correlated with any relevant findings. MR with contrast would further evaluate the extent of abnormality and confirm the presence of possible abscess.
2. Prominence of the lymphoid tissue involving the region of Waldeyer's ring.