J Korean Assoc Oral Maxillofac Surg.  2017 Jun;43(3):197-203. 10.5125/jkaoms.2017.43.3.197.

Modified drainage of submasseteric space abscess

• Choi MG

• KMID: 2386367
• DOI: http://doi.org/10.5125/jkaoms.2017.43.3.197

Abstract

Once a submasseteric space infection is diagnosed, the key to resolving the infection is via surgical intervention to evacuate the pus. Although it is possible and occasionally practical to drain the submasseteric space via an intraoral approach, an extraoral approach may sometimes be required. Surgeons have encountered complications such as facial nerve damage during extraoral incision and drainage procedures, and they have felt that extraoral dissection was very difficult. As such, an easier and simpler technique is needed. Our department recently modified various drainage techniques for submasseteric space abscesses. Damage to the marginal branch of the facial nerve did not occur, and this technique was very simple and rapid, such that a novice physician could perform this procedure. This modified technique was possible with trismus and under local anesthesia. After intraorally checking the position of the drain, the intraoral wound is closed with an absorbable suture and the drain is fixed to the extraoral skin. When a masseteric space infection is diagnosed, multiple space involvement is ruled out, and dependent drainage is required, this modified drainage technique can be useful.

Keyword

Submasseteric space abscess; Modified drainage

MeSH Terms

Abscess*
Anesthesia, Local
Drainage*
Facial Nerve
Skin
Suppuration
Surgeons
Sutures
Trismus
Wounds and Injuries

Figure

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  Fig. 1 The patient exhibited swelling of the mandibular angle area.

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  Fig. 2 The impacted third left, mandibular molar was thought to be the cause of infection.

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  Fig. 3 On computed tomography scan, a pus collection was found between the ramus and master muscles.

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  Fig. 4 After incising the vestibular mucosa along the anterior border of the master muscle, a hemostat was introduced through the intraoral wound and directed backwards. While the instrument was in contact with the lateral surface of the ramus, the masseter muscle was detached from the ramus as much as possible.

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  Fig. 5 After detachment of the masseter muscle from the ramus, a 1.0 cm horizontal incision was marked 2.0 cm below the lower border of the mandibular angle. The tip of the hemostat was pushed toward the incision, lifting up on the incision marking. After incising only the elevated skin, the tip of the hemostat was pushed through the incised skin.

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  Fig. 6 The drain was attached to the hemostat, and the hemostat was withdrawn. After checking the position of the drain intraorally, the intraoral incised wound was closed with an absorbable suture.

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  Fig. 7 Cellulitis with abscess formation within the masseter muscle was seen on computed tomography scan.

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  Fig. 8 A hypodense area with an enhanced peripheral rim was seen between the ramus and the overlying master muscle. The hypodense area indicates a pus collection.

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  Fig. 9 Abscess cavity between the ramus and masseter muscles and an extracted socket on the first right mandibular molar.

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