Objective: The purpose of this study was to investigate odontogenic infection pathways into the maxillofacial fascial spaces, especially into the parapharyngeal space, in relation to causal tooth and clinical symptoms.
Study Design: CT and MR images were retrospectively investigated in 47 patients with spread of odontogenic infection into the maxillofacial spaces. The involvement of spaces was evaluated based on lateral asymmetry of their shapes and density on CT images or intensity on MR images.
Results: Involvement on images was observed in 70%, 49%, and 30% of the submandibular, the masticator, and the parapharyngeal spaces, respectively. Patients with submandibular space involvement often had spontaneous pain. Of 14 patients with parapharyngeal space involvement, 8 patients showed dysphagia and/or fever, and 13 patients showed involvement of the mandibular molar as a cause of infection. All of these 14 patients also had submandibular space involvement, while only 7 patients (50%) showed changes in the medial pterygoid muscle. The fat layer between the medial pterygoid muscle and parapharyngeal space was maintained in 11 of 14 (79%) patients with parapharyngeal involvement.
Conclusion: CT and MR images clearly demonstrated the spread of odontogenic infection into the maxillofacial spaces. Involvement of the parapharyngeal space was mostly caused by infection originating in the mandibular molar, and was considered to be secondary spread from the submandibular space and/or medial pterygoid muscle.
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