26. Phlegmon of the cheek. Topographic and surgical anatomy, etiology, clinical features, diagnosis, differential diagnosis

Question 1

Anatomical location and boundaries of the buccal space

Answer 1

• Between the buccinator and masseter muscles. The boundaries=>
• Anteromedially:Buccinator muscle
• Posteromedially: Masseter muscle=>
• Overlying the anterior border of the ramus of the mandible
• Laterally: Deep fascia from the capsule of the parotid gland and the platysma muscle
• Inferiorly: Attachment of the deep fascia to the mandible and the depressor anguli oris muscle
• Superiorly: Zygomatic process of the maxilla and the zygomaticus major and minor muscles

Question 2

Contents of the buccal space

Answer 2

• Buccal pad of fa
• Stenson’s (parotid) duct
• Facial artery

Question 3

Teeth commonly involved in infections of the buccal space, and how infections spread

Answer 3

• Maxillary and mandibular premolars and molars=>
• The spread determined by =>location of the root tip relative to the origin of buccinator
• If Infection from the lower third molar due to pericoronitis=>
• pus can travel forward along the muscle attached to the external oblique ridge and the body of the mandible=>
• pools intraorally opposite the first or second molars
• If pus penetrates the muscle in the retromolar area=> directed laterally into the buccal space

Question 4

Clinical features of a buccal space infection

Answer 4

• Intraoral Accumulation: swelling in the vestibule => pus accumulation on oral side of the muscle
• Extraoral Swelling:=> from the lower border of the mandible to the infraorbital margin and from the anterior margin of the masseter muscle to the corner of the mouth=>
• When pus accumulates lateral to the muscle
• Edema=> lower eyelid may be seen in some cases

Question 5

How buccal space infection spreads

Answer 5

• Can spread to=>
• Pterygomandibular space
• Infratemporal space=>
• Along the fascia accompanying Stenson’s duct
• Submasseteric space=>
• if tracks backward and penetrates the parotidomassetric fascia

Question 6

Procedure for incision and drainage of a buccal space infection

Answer 6

• Horizontal incision through oral mucosa of the cheek in the premolar and molar region
• If pus lateral to the muscle=> muscle is penetrated with curved mosquito forceps to enter the buccal space=>
• Drain placed and secured with a suture

Question 7

Differential diagnoses for a buccal space infection

Answer 7

• Cellulitis: Caused by Haemophilus influenzae
• Erysipelas
• Crohn’s Disease= recurrent buccal space abscesses