The diagnosis of masticator space infection is clinical. Radiographs occasionally demonstrate osteomyelitis of the mandible. CT may define the extent of an abscess but is not required in the management of those well enough to be treated as outpatients. CT may be needed in more ill-appearing patients. Abscess culture usually yields Streptococcus and oral anaerobes but is unnecessary in uncomplicated immunocompetent patients.
Because the parotid gland overlies the masseter, diagnostic confusion with parotitis can result when there is swelling over these structures. Useful distinctions are that the symptoms of parotitis are cyclically related to eating, whereas the pain of an abscess is constant, 14 and parotitis is not associated with the significant trismus that accompanies infection of the masticator space.15 Other diagnoses to consider with lateral jaw pain include jaw discomfort of angina, masticator space neoplasm, TMJ dysfunction, referred dental pain, pharyngeal infection, tonsillitis or peritonsillar abscess, and otitis media or externa. History and physical exam are usually sufficient to exclude these other considerations.
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