A Case of Infratemporal Fossa Abscess with Signs of Chronic Maxillary Osteomyelitis

Abstract

The infratemporal fossa is bordered superiorly by the infratemporal surface of the greater wing of the sphenoid bone and part of the temporal bone; medially by the lateral plate of the pterygoid process of the sphenoid bone; and anteriorly by the posterior surface of the maxilla. As it is completely surrounded by bone, it is frequently difficult to determine whether an abscess is present by direct visual observation or palpation alone. We report an extremely rare case of an infratemporal fossa abscess arising from chronic maxillary osteomyelitis developing after extraction of a maxillary molar. Despite drainage during initial oral anti-inflammatory treatment, pus continued to drain from the wound over a long period of time. This drainage ended when the eroded bone of the maxillary tuberosity on the affected side was curetted in a secondary procedure. The harvested bone tissue exhibited histological findings of chronic osteomyelitis. This suggests that the route of infection involved acute transformation of maxillary osteomyelitis by odontogenic infection advancing posteriorly and superiorly.

Temporoparietal and Infratemporal fossa abscess as a complication of dental extraction – a rare and potentially lethal condition

“…3 Even though both the jaws have been implicated, in most cases the tooth responsible was a mandibular molar. 6 However, combined abscess of the temporoparietal and infratemporal fossa complicating dental extraction are rarer still with even fewer references. 1,4 Since the infratemporal space is a relatively closed space, an abscess of this region rarely causes a visible swelling.…”

“…Hence an isolated infection of the infratemporal space is a difficult condition to diagnose. 5,6 The abscess can be appreciated visually and palpated clinically only when it extends upwards to involve the temporoparietal region. Early cases may thus be missed easily or misdiagnosed leading to potentially lethal complications due to spread of infection along different routes.…”

“…The clinician should not wait for signs like swelling of the temporal region to develop due to the risk of complications as discussed above. 6 Once the condition is diagnosed, treatment must be instituted at the earliest in order to prevent the progress to the above named complications. 7 Treatment includes the administration of appropriate intravenous antibiotics and drainage of the abscess.…”

“…The disadvantage with all these approaches lies in the fact that a clear field of view is all but impossible during incision and drainage. 6 Among all these approaches, the intraoral approach has been used widely over the years for access when the abscess is restricted to the infratemporal fossa alone. 9 But recently in 2014, endoscopic drainage of the infratemporal fossa abscess via the trans-maxillary approach has been reported for the first time in the literature.…”

Temporal Fossa Abscess Caused by Apical Periodontitis: A Case Report

“…The inflammation that occurred in apical area of the maxillary molar was extended through buccinator muscle, pterygomandibular space, temporal space, pterygopalatine fossa, masticatory muscles space, and . As the case of infratemporal fossa abscess, Kasahara et al [4] reported developing after extraction of a maxillary molar, and D Leventhal et al [5] reported complication of dental injection.…”