WIDI - CA0130-Odontogenic Abscess

CA0130-Odontogenic Abscess

History

30-year old male with left facial swelling and tenderness mainly in the submandibular space. Primary clinical suspicion was an odontogenic infection. CT

Exam

Contrast-enhanced CT of the maxillofacial region and neck and related anatomy with images obtained in the balanced or venous vascular phase to ensure optimal visualization of both arterial and venous structures as well as possible reactive changes around infected collections. 0.5-3.0 mm thick sections were obtained in the axial plane and reformatted 3D and/or in the coronal and sagittal planes and viewed inter actively in 3 dimensions at the computer work station.

Findings

Oral Cavity, Floor of the Mouth, Maxilla and Mandible

There is extensive generalized endodontic and periodontal disease. Specifically, there is bone erosion of the lingual cortical plate of the left mandible at the level of the second and third molar tooth roots and periapical region.

There is adjacent cellulitis and an abscess associated with this bony defect. The abscess crosses the midline below the mylohyoid muscle in the submental space. It also crosses the midline, as it penetrates the mylohyoid muscle to enter the floor of the mouth. Posteriorly the abscess abuts the submandibular gland overall measuring about 58 mm x 53 mm x 4 cm.

There is cellulitis of the adjacent superficial fascia, the subcutaneous fat and skin and edema within the fat of the adjacent parapharyngeal space on the left.

Oropharynx and Nasopharynx

There is no involvement of the oropharynx or nasopharynx. There is no reactive or suppurative retropharyngeal lymphadenopathy.

Major Salivary Glands

There is an 11mm stone in the proximal duct of the left submandibular gland. There is dilatation of the intraglandular ducts without evidence of acute sialoadenitis.

There is no significant abnormality of the parotid, right submandibular or sublingual glands that would be an alternative explanation for the patient’s symptoms.

The remainder of the neck is normal for the patient’s age.

Vascular Findings

There is no evidence of thrombus, thrombophlebitis or other occlusive or inflammatory process of the jugular vein or smaller venous tributaries.

Upper Lung Zones and Mediastinum

The upper lung zones and mediastinum visualized are normal.

Other Findings

There are no other significant findings.

Impression

Findings are consistent with a periapical tooth infection with bone erosion of the lingual cortical plate of the left mandible on the with the infection likely originating from the roots of the 2^nd and 3^rd molars. There is a secondary abscess in the left submandibular space spreading into the floor of the mouth across the midline as well as across the midline in the submental space.

As an incidental finding, there is an 11mm, obstructing stone in the proximal duct of the left submandibular gland without evidence of acute sialoadenitis on this exam.

Recommendations

The emergency medical service was notified about the origin of the patient’s infection and the maxillofacial surgeons were alerted that the abscess involved both the floor of the mouth and submandibular space.