Oro-Maxillofacial Surgery MCQ Answer 23

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The correct Answer is C

Secondary fascial spaces

The group of spaces when taken as a group, the masseteric, pterygomandibular, and temporal spaces are known as the masticator space, because they are bounded by the muscles and fascia of mastication. These spaces communicate freely with one another, so when one becomes involved the others may also. The term masticator space does have some general clinical usefulness, but it lacks specificity and is therefore less useful than specific space designations.

The primary spaces are immediately adjacent to the tooth-bearing portions of the maxilla and mandible. If proper treatment is not received for infections of the primary spaces, the infections may extend posteriorly to involve the secondary fascial spaces. When this occurs, the infections frequently become more severe, causing greater complications and greater morbidity, and more difficult to treat. Because these spaces are surrounded by connective tissue fascia, which has a poor blood supply, infections involving these spaces are difficult to treat without surgical intervention to drain the purulent exudate.

The masseteric space exists between the lateral aspect of the mandible and the medial boundary of the masseter muscle . It is involved by infection most commonly as the result of spread from the buccal space or from soft tissue infection around the mandibular third molar. When the masseteric space is involved, the area overlying the angle of the jaw and ramus becomes swollen. Because of the involvement of the masseter muscle, the patient will also have moderate to severe trismus caused by inflammation of the masseter muscle.

The pterygomandibular space lies medial to the mandible and lateral to the roedial pterygoid muscle. This is the space into which local anesthetic solution is injected when an inferior alveolar nerve block is performed. Infections of this space spread primarily from the sublingual and submandibular spaces. When the pterygomandibular space alone is involved, there is little or no facial swelling, but the patient almost always has significant trismus. Therefore trismus without swelling is a valuable diagnostic clue for pterygomandibular space infection. The most common occurrence of this clinical picture is caused by needle tract infection from a manbidular block.

The temporal space is posterior and superior to the masseteric and pterygomandibular spaces . It is divided into two portions by the temporalis muscle--a superficial portion that extends to the temporal fascia and a deep portion that is continuous with the infratemporal space. The superficial and deep temporal spaces are secondarily involved rarely and usually only in severe infections. When these spaces are involved, the swelling that occurs is evident in the temporal area, superior to the zygomatic arch and posterior to the lateral orbital rim.

Contemporary Oral and Maxillofacial Surgery Petersen et. al. 1988 p. 415