Anatomic Location.
This space is bounded
laterally by the medial surface of the ramus of the mandible, medially by the
medial pterygoid muscle, superiorly by the lateral pterygoid muscle, anteriorly
by the pterygomandibular raphe, and posteriorly by the parotid gland. The
pterygomandibular space contains the mandibular neurovascular bundle, lingual nerve,
and part of the buccal fat pad. It communicates with the pterygopalatal,
infratemporal, submandibular, and lateral pharyngeal spaces.
Etiology
An abscess of this
space is causedmainly by infection of mandibular third molars or the result of an
inferior alveolar nerve block, if the penetration site of the needle is
infected (pericoronitis).
Clinical
Presentation
Severe trismus and
slight extraoral edema beneath the angle of the mandible are observed.
Intraorally, edema of the soft palate of the affected side is present, as is
displacement of the uvula and lateral pharyngeal wall, while there is
difficulty in swallowing.
Treatment
The incision for
drainage is performed on themucosa of the oral cavity and, more specifically, along
the mesial temporal crest. The incision must be 1.5 cm long and 3–4 mm deep. A
curved hemostat is then inserted, which proceeds posteriorly and laterally
until it comes into contact with the medial surface of the ramus. The abscess
is drained, permitting the evacuation of pus along the shaft of the instrument.
Diagrammatic
illustration showing the spread of a dentoalveolar abscess into contiguous
fascial spaces. (1 Submandibular abscess, 2 pterygomandibular abscess, 3 parapharyngeal
abscess, 4 retropharyngeal abscess)
Incision for drainage
of a pterygomandibular abscess
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