27. Phlegmon of infratemporal and temporal areas. Topographic and surgical anatomy, etiology, clinical features, diagnosis, differential diagnosis

Question 1

Anatomical location and boundaries of the infratemporal space

Answer 1

• The superior extension of the pterygomandibular space
• boundaries are=>
• Laterally=>Ramus of the mandible and the temporalis muscle
• Medially=>Medial and lateral pterygoid muscles
• Continuous w/ the temporal fossa

Important anatomical structures within this space include => mandibular nerve, mylohyoid nerve, lingual nerve, buccal nerve, chorda tympani nerve, maxillary artery, and part of the pterygoid venous plexus

Question 2

Etiological factors leading to an infratemporal abscess

Answer 2

• Infected root canals of posterior teeth of the maxilla and mandible
• Complications from a posterior superior alveolar or an inferior alveolar nerve block

Question 3

Clinical features of an infratemporal abscess

Answer 3

• Trismus and pain during mouth opening w/ lateral deviation towards the affected side
• Edema in the region anterior to the ear=>
• Extending above the zygomatic arch
• Edema of the eyelids

Question 4

How infratemporal abscess treated

Answer 4

• Intraoral Drainage=> Incision made at the depth of the mucobuccal fold=>
• Laterally to the maxillary third molar and medially to the coronoid process=>
• => in a superoposterior direction
• Hemostat inserted into the suppurated space for drainage
• Extraoral Drainage

Question 5

Anatomical location and boundaries of the temporal space

Answer 5

• Superior continuation of the infratemporal space and divided into=>
• Superficial Temporal Space=>
• Bounded laterally by the temporal fascia and medially by the temporalis muscle.
• Deep Temporal Space=>
• Between the medial surface of the temporalis muscle and the temporal bone

Question 6

Etiological factors leading to a temporal abscess

Answer 6

• Spread of infection from the infratemporal space

Question 7

Clinical features of a temporal abscess

Answer 7

• Painful edema of the temporal fascia
• Trismus=> temporalis and medial pterygoid muscles
• Pain on palpation of the edema

Question 8

How temporal abscess treated

Answer 8

• Drainage=> incision horizontally at margin of the scalp hair=>
• 3 cm above the zygomatic arch=>
• It continues between the two layers of the temporal fascia to the temporalis muscle
• A curved hemostat used for drainage

Question 9

Potential complications of infratemporal and temporal abscesses

Answer 9

• Spread of infection to adjacent fascial spaces
• Systemic complications=> sepsis
• Spread to cranial cavity