34. Abscess and phlegmon of pterygomandibular and parapharyngeal spaces. Topographic and surgical anatomy, etiology, clinical features,

Question 1

Boundaries of pterygomandibular space

Answer 1

• Superior=> Inferior part of the lateral pterygoid muscle
• Lateral=>Medial surface of the ramus of the mandible
• Medial=>Medial pterygoid muscle
• Posterior=>Deep part of the parotid gland
• Anterior=>Pterygomandibular raphe

Question 2

Contents of the pterygomandibular space

Answer 2

• Inferior alveolar artery, vein, and nerve.
• Lingual nerve
• Auriculotemporal nerve
• Mylohyoid nerve

Question 3

Common causes of infections in pterygomandibular space

Answer 3

• Odontogenic infections=> molar=>
• Pulpitis or pericoronitis
• Infection resulting from contaminated nerve infiltration

Question 4

Clinical features of a pterygomandibular space infection

Answer 4

• Severe trismus and difficulty swallowing
• Swelling of the soft palate and tonsils=>
• Uvula deviates to unaffected side
• Usually no extraoral swelling

Question 5

How infections in pterygomandibular space can spread to other areas

Answer 5

• Submandibular space
• Temporal space
• Lateral pharyngeal space

Question 6

Surgical approaches for draining pterygomandibular space abscess

Answer 6

• Intraoral incision
• Extraoral incision

Question 7

Boundaries of parapharyngeal (lateral pharyngeal) space

Answer 7

• Anterior=> Superior and middle constrictor of the pharynx and the pterygomandibular raphe
• Medial=> Superior constrictor of the pharynx
• Lateral=>Medial pterygoid muscle, pterygoid fascia, and parotid capsule
• Superior=> Base of the skull.
• Inferior=>Hyoid bone
• Posterior=> Carotid sheath and prevertebral fascia

Question 8

Contents of the parapharyngeal (lateral pharyngeal) space

Answer 8

• Carotid artery
• Internal jugular vein
• Vagus nerve
• Cervical sympathetic chain

Question 9

Etiologies of parapharyngeal space infections

Answer 9

• Mandibular third molar infections
• Tonsillar infections
• Pharyngitis
• Parotitis

Question 10

Clinical features of a parapharyngeal space infection

Answer 10

• Severe pain on the affected side of the throat
• Displacement of the tonsil, tonsillar pillars, and uvula => to medial side
• Dysphagia (difficulty swallowing).
• Inability to palpate the angle of the mandible
• Tension in the sternocleidomastoid muscle =>
• neck rotateS away from swelling

Question 11

Complications of untreated parapharyngeal space infections

Answer 11

• Septic jugular vein thrombophlebitis
• Cavernous sinus thrombosis
• Meningitis and brain abscess

Question 12

Surgical management approaches for parapharyngeal space infections

Answer 12

• Intra and extra oral incisions
• Combined approach