An unusual abscess formation in the masticator space after acupressure massage: a case report

Abstract

Clinical features of masticator-space abscess (MSA) are very similar to those of parotitis or temporomandibular disorder (TMD), making early differential diagnosis difficult. Local causes of MSA include nerve block anesthesia, infection after tooth extraction, and trauma to the temporomandibular joint (TMJ); the systemic cause is immunodeficiency. Odontogenic causes account for most etiologies, but there are also unusual causes of MSA. A 66-year-old male patient visited the emergency room (ER) presenting with left-side TMJ pain three days after receiving an acupressure massage. He was tentatively diagnosed with conventional post-trauma TMD and discharged with medication. However, the patient returned to the ER with increased pain. At this time, his TMD diagnosis was confirmed. He made a third visit to the ER during which facial computed tomographic (CT) images were taken. CT readings identified an abscess or hematoma in the left masticator space. After hospitalizing the patient, needle aspiration confirmed pus in the infratemporal and temporal fossa. Antibiotics were administered, and the abscess was drained through an incision made by the attending physician. The patient's symptoms decreased, and he was discharged.

Keywords: Abscess; Acupressure; Masticatory; Temporomandibular joint disorders.

Fig. 1. Panoramic view shows chronic periodontitis and right lower first molar root fracture.

Fig. 2. Temporomandibular joint tomography view shows limited mouth opening. A, D. Temporomandibular joint tomography when the mouth is closed. B, C. Temporomandibular joint tomography when the mouth is opened.

Fig. 3. Contrast-enhanced facial computed tomography shows 4.2×1.9×2.3 cm fluid collection. A. Preoperative image of computed tomography axial view. Lobulated fluid collection with thin enhancing rim is seen in left masticator space. B. Preoperative image of computed tomography coronal view with fluid collection in left masticator space.

Fig. 4. Pus from masticator space.

Fig. 5. Contrast-enhanced facial computed tomography shows 3.2×2.1×3.8 cm fluid collection. A. Follow-up image of computed tomography axial view. Decreased size of peripheral enhancing fluid collection is seen in left masticator space. B. Follow-up image of computed tomography coronal view with decreased fluid collection in left masticator space.