Dentistry Infectious Diseases

Infratemporal Abscess

Anatomic Location. The space in which this abscess
develops is the superior extension of the pterygomandibularspace. Laterally, this space is bounded by theramus of the mandible and the temporalis muscle,while medially, it is bounded by themedial and lateralpterygoid muscles, and is continuous with the temporalfossa (Fig. 9.45 a). Important anatomic structures,such as the mandibular nerve, mylohyoid nerve, lingualnerve, buccal nerve, chorda tympani nerve, andthe maxillary artery, are found in this space. Part ofthe pterygoid venous plexus is also found inside thisspace.

Etiology. Infections of the infratemporal space may
be caused by infected root canals of posterior teeth ofthe maxilla and mandible, by way of the pterygomandibularspace, andmay also be the result of a posteriorsuperior alveolar nerve block and an inferior alveolarnerve block.

Clinical Presentation. Trismus and pain during
opening of the mouth with lateral deviation towardsthe affected side, edema at the region anterior to theear which extends above the zygomatic arch, as well asedema of the eyelids are observed (Fig. 9.45 b).

Infratemporal AbscessInfratemporal Abscess
Treatment. The incision for drainage of the abscess is
made intraorally, at the depth of the mucobuccal fold,and, more specifically, laterally (buccally) to the maxillarythird molar and medially to the coronoid process,in a superoposterior direction (Fig. 9.45 c). A hemostatis inserted into the suppurated space, in asuperior direction. Drainage of the abscess may beperformed extraorally in certain cases. The incision isperformed on the skin in a superior direction, and extendsapproximately 3 cm. The starting point of theincision is the angle created by the junction of thefrontal and temporal processes of the zygomatic bone.Drainage of the abscess is achieved with a curved hemostat,which is inserted through the skin into thepurulent accumulation.

Infratemporal Abscess
Fig. 9.45 a–c. Infratemporal abscess. aDiagrammatic illustration
showing the spread of the abscess into the infratemporal
space. b Clinical photograph of an infratemporal abscess.
Swelling of the region of the right zygomatic arch and
edema of eyelids. c Incision at the depth of the vestibular
fold for incision and drainage of an infratemporal abscess