Submasseteric Abscess: Consideration in Diagnosis and Intervention

Abstract

Submasseteric space infection is a rare infection which is frequently misdiagnosed. The symptoms can vary and mimic other infections such as parotitis or parotid abscess due to its close proximity to the parotid gland. A common causative factor is a preceding dental infection but it may be idiopathic. We report an atypical case of a 76-year-old Malay lady with multiple comorbid, who presented with left sided facial swelling for two weeks associated with poor oral intake. She had no fever neither was there preceding history of dental infection nor any facial trauma. Clinical examination showed a non-tender fluctuating left facial swelling involving the preauricular area and angle of mandible extending to the level of cricoid cartilage. Although the initial working diagnosis was parotid abscess, the CECT neck revealed a large left submasseteric abscess. Patient underwent incision and drainage under general anaesthesia whereby 40ml of pus was drained. However, patient succumbed due to sepsis. Submasseteric abscess at times can be diagnostically perplexing due to its close relationship to other head and neck spaces. Furthermore, underlying comorbid may mask the symptoms eventually leading to delay in diagnosis and management. Radiological investigations can serve as a significant diagnostic modality and aid in substantiating provisional diagnosis as in this patient. Intravenous antibiotics often fail to alleviate the symptoms and this condition needs prompt drainage.