Unlikely Case of Submasseteric Abscess Originating from a Maxillary the Patient Made a Full Recovery,Result with Scarring on the Ruptured Region
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Submasseteric abscess Submasseteric abscess Unlikely case of submasseteric abscessUnlikely originating case of submasseteric from a maxillary molar:abscess The originating skipping from lesion a maxillary molar: The skipping lesion Abstract ObjectiveAbstract Min Jim Lima & Alauddin Muhamad Husinb We report a case of submassetericObjective abscess originating from a maxillary tooth, complicated by underlying diabetes mellitus and a multidrug- a OralKementerian Maxillofaciala Kesihatan Surgery Malaysia, Department, Oral Maxillofacial Hospitalb Tanah Surgery Min Jim Lim & Alauddin Muhamad Husin resistantWe report organism. a case of submasseteric abscess originating from a maxillary Merah,Department, Tanah Hospital Merah, Kelantan, Tanah Merah, Malaysia Tanah Merah, Kelantan, b a Oral Maxillofacial Surgery Department, Hospital Sultanah tooth, complicated by underlying diabetes mellitus and a multidrug- OralMalaysia Maxillofacial Surgery Department, Hospital Tanah b Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia Merah,Kementerian Tanah KesihatanMerah, Kelantan, Malaysia, Malaysia Oral Maxillofacial Surgery resistant organism. Materials and methods b OralDepartment, Maxillofacial Hospital Surgery Sultanah Department, Nur Zahirah, Hospital Kuala Sultanah Terengganu, NurTerengganu, Zahirah, KualaMalaysia Terengganu, Terengganu, Malaysia Corresponding author: A 61-year-old male patientMaterials with uncontrolled and methods diabetes mellitus presented with swelling on the left cheek of 2 weeks in duration with rapid CorrespondingDr. Min Jim Lim author: A 61-year-old male patient with uncontrolled diabetes mellitus presented Oral Maxillofacial Surgery Department progression to trismus, dysphagia and rupture of swelling with pus Hospital Tanah Merah discharge.with swelling Culture on the and left sensitivity cheek of testing 2 weeks revealed in duration the presence with rapid of 17500Dr. Min Tanah Jim LimMerah Oral Maxillofacial Surgery Department progression to trismus, dysphagia and rupture of swelling with pus Kelantan multidrug- resistant Klebsiella pneumoniae. Based on the patient’s history Hospital Tanah Merah Malaysia discharge. Culture and sensitivity testing revealed the presence of 17500 Tanah Merah and clinical presentation, a diagnosis of submasseteric abscess originat- Kelantan multidrug- resistant Klebsiella pneumoniae. Based on the patient’s history [email protected] ing from the maxillary molar was made. Antibiotic administration, con- Malaysia andtrol clinicalof systemic presentation, disease and a diagnosis wound dressing of submasseteric were done abscess as treatment. originat- [email protected] ing from the maxillary molar was made. Antibiotic administration, con- How to cite this article: trol of systemic disease and woundResult dressing were done as treatment. HowLim MJ, to Muhamad cite this Husin article:A. Unlikely case of submasseteric abscess originating from a maxillary The patient made a full recovery,Result with scarring on the ruptured region. Limmolar: MJ, The Muhamad skipping Husin lesion. A. Unlikely case of J Oral Science Rehabilitation. 2018 Dec;4(4):52–55. submasseteric abscess originating from a maxillary The patient made a full recovery, with scarring on the ruptured region. molar: The skipping lesion. Conclusion J Oral Science Rehabilitation. 2018 Dec;4(4):52–55. Submasseteric abscess is a rareConclusion case of infection that can occur in the submasseteric space. As is commonly known, infection of the submas- setericSubmasseteric space originates abscess fromis a rare mandibular case of infection third molars; that hence,can occur maxillary in the molarssubmasseteric seem to space. be an unlikely As is commonly source of known, infection. infection Diagnosis of the of submas- seteric spaceabscess originates that originates from mandibular from maxillary third molars; molars hence, can be maxillary difficult owingmolars to seem its rarity to be anand unlikely thus the source unlikeliness of infection. of being Diagnosis the first of submasdiagnosis- thatseteric comes abscess to mind. that originates from maxillary molars can be difficult owing to its rarity and thus the unlikeliness of being the first diagnosis that comes to mind. Keywords Submasseteric abscess; maxillaryKeywords molar; skipping lesion. Submasseteric abscess; maxillary molar; skipping lesion. 52 Volume 4 | Issue 4/2018 Journal of Oral Science & Rehabilitation 52 Volume 4 | Issue 4/2018 Journal of Oral Science & Rehabilitation Submasseteric abscess Introduction statim, followed by 2 mega units every 6 h. The patient was also referred to the medical depart- Submasseteric abscess is a rare complication ment for management of underlying diabetes that commonly has dental origins, particularly mellitus. The patient was prescribed a 500 mg the mandibular third molars.1 However, the metformin oral tablet once daily. Aspiration was development of a submasseteric abscess from done with a size 16 syringe needle, but yielded maxillary molars is scarcer. We could find only no product. It was regrettable that a CT scan 1 case report in our literature search.2 Owing to was not available at that time. the rarity and late symptomatic manifestation On day 5 after admission, there was a break- of such cases, diagnosis may not be easy for the down of the overlying skin with pus discharge general practitioner. Management of submas- at the left posterior submandibular region, seteric abscess can be further complicated in extending to the submasseteric region. The patients with impaired immune systems or margin of the wound was friable and necrotic. infected with multidrug-resistant organisms. In However, the patient claimed that the pain had this article, we would like to highlight the case subsided with the absence of dysphagia. Wound of a patient who presented with a rare submas- debridement was done, and it was irrigated with seteric abscess from an unlikely origin, compli- chlorhexidine and normal saline. A rubber tube cated by uncontrolled diabetes and a multi- was placed to allow further drainage (Fig. 2). drug-resistant organism. Topical metronidazole was placed on the wound and covered with gauze. A swab was taken and sent for culture and sensitivity testing. The result Case report was penicillin-resistant Klebsiella pneumoniae with sensitivity to cefuroxime. Hence, cefuroxime A 61-year-old male patient with underlying was chosen as a replacement for penicillin. Daily diabe tes mellitus presented to the Dental wound dressing was done, together with the Department with the chief complaint of swell- placement of topical metronidazole. ing on the left cheek with a duration of 2 weeks. On day 13, the swelling over the left subman- The patient claimed that the swelling had begun dibular and submasseteric region had subsided. at the left angle of the jaw and had been increas- The patient did not have any dysphagia or tris- ing in size. The swelling was accompanied by mus. There was no more pus discharge from the severe throbbing pain and difficulty in swallow- wound or from the rubber drain, and only a raw ing. Upon further probing, the patient said that wound was exposed (Fig. 3). After the rubber he had undergone a difficult and unsuccessful drain had been removed, a wound dressing was extraction of the maxillary left second molar done and the wound was left to heal by second- 2 weeks prior. ary intention. A full-mouth scaling and removal Upon physical examination, there was a of the retained root of the maxillary left second large, diffuse swelling on the left face involving molar were done. The patient was then dis- the left masseter region and extending to the charged with a weekly appointment for review left submandibular region with the loss of pal- and wound dressing. pable mandibular angle (Fig. 1). The swelling The patient was followed over a 2-month was firm, tender, warm and erythematous. The period. At the last follow-up, the patient patient was also experiencing trismus, with presented with scarring of the area posterior to mouth opening of 20 mm interincisally. Intraoral the left angle of the mandible that was slightly examination revealed poor oral hygiene and a darker than the surrounding skin, but with retained root of the maxillary left second molar, minimal contracture (Fig. 4). which was tender to percussion. The gingiva surrounding the retained root of the maxillary left second molar was assessed to be suffi- Discussion ciently healed, without any signs of infection. The teeth and the gingiva on the opposing arch In 1948, Bransby-Zachary described a potential were healthy. An immediate diagnosis of sub- space that constitutes a masticator space known masseteric cellulitis with possible involvement as the submasseteric space.3 He mentioned that of the lateral pharyngeal space was made. The the common cause of submasseteric space patient was immediately warded and given infection was pericoronitis of the third molar.3 intravenous crystalline penicillin 4 mega units The submasseteric space is a potential space Journal of Volume 4 | Issue 4/2018 53 Oral Science & Rehabilitation Submasseteric abscess Fig. 1 Fig. 2 Fig. 1 formed between the lateral wall of the mandible hematoma was presumed to have extended into Swelling of the left of the and the medial aspect of the masseter muscle the submasseteric space, without having face involving the and its investing fascia. Submasseteric abscess infected the buccal space or the infratemporal left masseter region. is often not the foremost diagnosis when a space tissue.