This document presents a case of a 45-year-old male with uncontrolled diabetes who presented with right facial swelling and discharge from his right ear and cheek. CT scan revealed multiple right facial space infections, including in the infratemporal space. The infratemporal space is a rare site for infection that can spread dangerously if not treated immediately. It is difficult to diagnose due to surrounding bones limiting visible symptoms. However, trismus may indicate infratemporal space infection when accompanied by swelling and pain. Aggressive treatment is needed for these serious odontogenic infections.

1. INFRATEMPORAL SPACE
INFECTION
CASE PRESENTATION
DR. MOHAMED EL SAYED
BDS, EBOMFS
OMF SURGERY CONSULTANT
KFMC, TAIF , KSA
2018

2. INTRODUCTION
• INFRATEMPORAL SPACE BOUNDARIES:
• SUPERIORILY ; INFRATEMPORAL SURFACE OF
• GREATER WING OF SPHENOID.
• INFERIORILY; LATERAL PTYRGOID MUSCLE
• LATERALLY; TEMPORALIS TENDON AND CORONOID PROCESS
• MEDIALLY; LATERAL PTYRGOID PLATE AND LATERAL PHARYNGEAL WALL
• POSTERIORLY; CONDYLE AND LATERAL PTYRGOID MUSCLE
• ANTERIORLY; INFRATEMPORAL SURFACE OF MAXILLA AND POSTERIOR SURFACE OF
ZYGOMATIC BONE

3. CONTENTS

4. CASE
• 45 YS OLD BANGLADESHI MALE PT. KNOWN CASE OF
UNCONTROLLED DM
• PRESENTED IN ED AT25/12/2017WITH RT FACIAL
SWELLING STARTED 22 DAYS BEFORE ADMISSION AND
ASSOCIATED WITH RT FACIAL PALSY DISCHARGING
PUS FROM RT EAR AND SKIN OF RT CHEEK TWO DAYS
BEFORE THE DAY OF ADMISSION RT.
• PT. WAS AFEBRILE , VITAL SIGNS WITHIN NORMAL
LIMITS, RBS WAS 334
• NO TRISMUS

5. CT WITH IV CONTRAST

6. IMPRESSION: RT SIDE MULTIPLE FACIAL SPACE
INFECTIONS;
INFRATEMPORAL,TEMPORAL,PAROTID,SUBMANDIBULAR

8. POST I&D CT

9. INFECTION OF INFRATEMPORAL SPACE
• INFRATEMPORAL SPACE INFECTION IS A RARE BUT SERIOUS SEQUEL OF ODONTOGENIC
INFECTION. THE DIAGNOSIS IS DIFFICULT DUE TO NON SPECIFIC SIGNS AND SYMPTOMS.
DIABETES MELLITUS AS A DEFINITIVE RISK FACTOR FOR ODONTOGENIC INFECTIONS NEEDS
MORE CONSIDERATION DURING CLINICAL PROCEDURES
• THE INFECTION MIGHT SPREAD THROUGH THE PTERYGOID PLEXUS TO THE CAVERNOUS SINUS
OR THROUGH THE VALVELESS OPHTHALMIC VEINS INTO THE ORBIT.
• OCCURS MOSTLY DUE TO DENTAL INFECTION, TOOTH EXTRACTION, FRACTURES AND/OR
INFECTIONS INVOLVING THE MAXILLARY SINUS. THIS CONDITION CAN BE LIFE THREATENING
IF NOT DEALT WITH IMMEDIATELY.
• IT IS USUALLY DIFFICULT TO DIAGNOSE BECAUSE THIS SPACE IS SURROUNDED WITH BONES
LIKE MANDIBULAR RAMUS, SPHENOID BONE AND LATERAL PTERYGOID PLATE WHICH
PREVENTS THE ABSCESS TO GIVE SYMPTOMS LIKE SWELLING AND/OR ERYTHEMA. THE MAIN
SYMPTOM THAT MAY PROVIDE SOME CLUE ABOUT INFRATEMPORAL SPACE INFECTION IS
TRISMUS. WHEN THE INFECTION AFFECTS THE PTERYGOID MUSCLES, TRISMUS TAKES
PLACE AND IF SWELLING AND PAIN ARE ALSO PRESENT, AN INFRATEMPORAL SPACE
INFECTION SHOULD BE CONSIDERED IN THE DIAGNOSTIC PROCESS.