慢性の経過をたどった咀嚼筋間隙膿瘍症例  [in Japanese] A Case of Chronic Masticator Space Abscess  [in Japanese]

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Author(s)

    • 平木 信明 HIRAKI Nobuaki
    • 産業医科大学医学部耳鼻咽喉科学教室 Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Fukuoka
    • 藤吉 達也 FUJIYOSHI Tatsuya
    • 産業医科大学医学部耳鼻咽喉科学教室 Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Fukuoka
    • 清水 隆 SHIMIZU Takashi
    • 産業医科大学医学部耳鼻咽喉科学教室 Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Fukuoka
    • 宇高 毅 UDAKA Tsuyoshi
    • 産業医科大学医学部耳鼻咽喉科学教室 Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Fukuoka
    • 吉田 雅文 YOSHIDA Masafumi
    • 産業医科大学医学部耳鼻咽喉科学教室 Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Fukuoka
    • 牧嶋 和見 MAKISHIMA Kazumi
    • 産業医科大学医学部耳鼻咽喉科学教室 Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Fukuoka

Abstract

咀嚼筋間隙膿瘍の文献的報告は少なく, 発症病態の詳細はあまり知られていない. 著明な炎症所見を欠き5年の経過をたどった咀嚼筋間隙膿瘍症例に対して経上顎洞的に膿瘍腔を開放した. 画像上は腫瘍性病変に類似していた. 下顎臼歯部歯周炎から下顎骨硬化性骨髄炎を生じ, 炎症がさらに咬筋, 内・外側翼突筋, 側頭筋に沿って波及したことによって, 咬筋上部と側頭筋下部レベルの咀嚼筋間隙で膿瘍形成した病態と推察される. 文献的には本症の臨床像は多彩である. 各咀嚼筋への炎症波及様式の相違や隣接する間隙への炎症波及の有無, 慢性に経過する下顎骨骨髄炎の存在等が反映されるためと考えられる. CT, MRIによる病巣の評価のみならず, 下顎歯病変, 各咀嚼筋の炎症性肥厚所見, 下顎骨骨髄腔の消失やテクネシウム集積で示される骨髄炎の存在に着目することが, 本症の病態把握に重要である.

Different neoplasms and infections are known to involve the masticator space, but pathological diagnosis and treatment of these lesions are not always simple due to anatomical complexity. We treated a 66-year-old man with an abscess in the nasopharyngeal masticator space. Physical and CT findings resembled those of a neoplastic lesion because the onset dated back 5 years and the patient was lacking in notable signs of infection. Surgery through the maxillary sinus to the lesion enabled us to confirm its pathology and drain pus, with subsequent cure. We noted periodontal infection of the mandibular molars accompanied with osteomyelitis as a cause of this abscess, so infected molars were extracted 13 days after surgery. The infection had spread upward along the mastication muscles, resulting in an abscess in both the upper masseter muscle and the lower temporalis muscle. Based on a review of the literature, most abscesses in the masticator space originate from the mandibular molar, while the most impressive physical finding varied between the submandibular region and temporal fossa, as did its acute or chronic clinical course. Such clinical manifestations appear to reflect the pattern of infection spread along the muscles of mastication and a pattern involving adjacent spaces. We emphasize diagnostic significance when assessing findings for each mastication muscle and mandibular bone depicted using computed tomography, magnetic resonance imaging, and bone-scan technetium.

Journal

  • Nippon Jibiinkoka Gakkai Kaiho

    Nippon Jibiinkoka Gakkai Kaiho 104(12), 1143-1146, 2001-12-20

    The Oto-Rhino-Laryngological Society of Japan, Inc.

References:  14

Cited by:  3

Codes

  • NII Article ID (NAID)
    10008095275
  • NII NACSIS-CAT ID (NCID)
    AN00191551
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    00306622
  • Data Source
    CJP  CJPref  J-STAGE 
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