Pathophysiology

The masticator space consists of four potential spaces bounded by the muscles of mastication. (See Fig 2.3.2-3) These spaces include the masseteric, superficial temporal, deep temporal, and pterygomandibular spaces.13 Since they are contiguous, it is rare for a single one to be infected. Secondary infection usually occurs by extension from one of the anterior spaces (buccal, sublingual, or submandibular).

FIG. 232-3. Masticator space.

Infection of the masseteric space most frequently arises via extension from soft tissue infection around the third molar. Rarely, it may follow as a complication to an inferior alveolar nerve block, an open fracture at the angle of the mandible, or as an extension from osteomyelitis of the zygoma or temporal bones. 14

The temporal spaces are rarely involved. If this occurs, it is usually the result of a serious, overwhelming infection. The pterygomandibular space is usually infected secondarily by extension from the sublingual or submandibular spaces or from infection from around the third molar. Untreated, infection can spread to the adjacent spaces of the head and neck that are contiguous with the mediastinum, resulting in mediastinitis, pericarditis, and death. 15

Soft tissue infections of the spaces in the perimandibular and parapharyngeal region are frequently caused by oral anaerobes. These include Peptostreptococcus, Fusobacterium sp., Bacteroides sp. (oralis and melaninogenicus), Propionibacterium, and Clostridium sp.2 Masticator space infections are frequently mixed, with at least two organisms present.15

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