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.

抄録全体を表示

Odontogenic infections occasionally lead to suppuration in spaces that are not adjacent to the mandible. Some of these infections become in difficulty to control and develope into deep neck infections by gravitating in the neck, which can possibly lead to life threatening situations such as mediastinitis. The carotid sheath (carotid space) is thought to be one of the important routes for suppuration in the parapharyngeal space and spreading down to the mediastinum. In this article, we report two patients with a dental abscess that was complicated with carotid sheath infections, and the pathways for the spread of these infections from the mandible to the carotid space were analyzed retrospectively on CT images. In one case, it was a common route via the parapharyngeal space involving the carotid sheath. However, in the other, it was an unusual route, from the submandibular space to the carotid sheath along a branch of the jugular vein. In conclusion, the parapharyngeal space is the common anatomic pathway to the carotid sheath, but the submandibular space in which the branch of the jugular vein that runs into the carotid sheath is not common and should be recognized.

抄録全体を表示

In this study, we investigated the clinical and imaging findings of 14 patients with subcutaneous emphysema, who were examined at our department between 2012 and 2017. 　Patients with subcutaneous redness, swelling, and crepitation that were suspected to be associated with subcutaneous emphysema were examined using computed tomography （CT）. The age, sex, affected region, administered treatment, time to the examination after onset, and whether the emphysema had spread into various tissue spaces were analyzed in these patients. The tissue spaces that were examined for subcutaneous emphysema were chosen based on the anatomical tissue space definitions produced by H. Ric Harnsberger16, and included the temporal, buccal, masticatory muscle, submandibular, parapharyngeal, posterior pharyngeal, parotid gland, submental, anterior and posterior cervical, and mediastinal spaces. These tissue spaces were examined for foamy structures and honeycomb or irregularly shaped regions of aeration, exhibiting homogeneously low signal intensity, which were considered to be indicative of the spread of subcutaneous emphysema. 　Clinical images are presented. Case 1 involved a patient with a maxillary alveolar fracture. Subcutaneous emphysema caused by a CO2 dental laser was noted in case 2. 　Regarding sex and age, the incidence of subcutaneous emphysema was significantly higher among females and patients in their 20s, and the most common site of occurrence was the lower jaw, especially the molar region. The most frequent cause was an air turbine used for tooth extraction. Regarding spread to tissue spaces, foamy structures and irregular regions of aeration with low signal intensity were noted in the masticatory muscle, submandibular, and parapharyngeal tissue spaces in 12 of the 14 patients. 　When a lower impacted wisdom tooth is extracted using an air turbine, compressed air-based dental treatment devices should be used very carefully, and when subcutaneous emphysema is suspected based on clinical findings it is necessary to immediately examine it using CT and determine its extent. It was suggested that CT is useful for diagnosing subcutaneous emphysema.

抄録全体を表示