Pterygomandibular Abscess,Anatomic Location,Etiology, Clinical presentation and Treatment


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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