Deep facial infection of odontogenic origin.

Odontogenic infections rarely extend beyond mandibular bone barriers into deep spaces of the face. When they do, they can be difficult to assess accurately by clinical and conventional radiographic techniques. These infections can have serious consequences if they are not detected and treated promptly. [1]

A 28-year-old woman complaining of facial triamus on the left was evaluated. Magnetic resonance imaging (MRI) revealed an inflammatory process in the deep facial and masticator areas on the left (figure). Because the patient's only symptom was trismus, the infection had not been suspected clinically. The inflammation responded satisfactorily to antibiotic therapy.

Patients with odontogenic infections typically report a recent onset of tenderness and swelling of the face and neck, which are usually accompanied by fever and leukocytosis. MRI is the most sensitive modality for identifying and evaluating facial-space inflammatory processes caused by odontogenic infections. These deep-space infections are difficult to assess clinically in their early stage. The masticator space is the primary site of spread of a mandibular infection. The parotid and parapharyngeal spaces are secondary sites of spread, and these infections can subsequently spread to the submandibular spaces.

From the Department of Radiology, Louisiana State University Health Science Center, New Orleans (Dr. Palacios), and the Department of Radiology and Otolaryngology, University of Illinois Medical Center, Chicago (Dr. Valvassori).

Reference

(1.) Yonetsu K, Izumi M, Nakamura T. Deep facial infections of odontogenic origin: CT assessment of pathways of space involvement. AJNR Am J Neuroradiol 1998;19:123-8.