Cysticercosis Involving Muscle of Mastication: A Review and Report of Two Cases

Cysticercosis is a parasitic infection caused by the larval stages of the parasitic cestode, Taenia solium. It is a common disease in developing countries where it is also endemic. The central nervous system (CNS) is the most important primary site of infection and the disease can present with solitary or multiple space occupying lesions. Cases of cysticercosis presenting as isolated muscle mass (pseudotumours) without involvement of the CNS have also been recently described in the literature. We present two cases who presented to us with pain, swelling, and tenderness involving the temporalis muscle along with trismus. Ultrasonography and MRI findings were suggestive of cysticercosis involving the temporalis muscle which resolved after the albendazole therapy. 1. Introduction Cysticerci are spherical milky white cysts containing fluid and a single invaginated scolex with hooklets [1]. When humans ingest eggs or gravid proglottids from the parasite Taenia solium, the covering of the eggs is digested in the stomach and the larval form (cysticercus cellulosae) of the parasite is hatched [1]. The larvae penetrate the mucosa, enters the blood vessels and lymphatics, and are distributed in the tissues all over the body but preferentially locate in the brain, muscle, skin, liver, lungs, and heart [1]. They are also found in oral and perioral tissues, particularly in the muscles of mastication, facial expression, the suprahyoid muscles, and the postcervical musculature as well as in the tongue, buccal mucosa, and lip [2–4]. Here we report two cases of cysticercosis affecting the temporalis muscle. 1.1. Case Report 1 A 50-year-old female patient presented to our department with complaint of pain and mild swelling on the right side of the face since the last 2 months. She gave a history that pain is aggravated while opening the mouth, chewing and on application of pressure on that area and was not relieved by NSAIDs. Her past medical history revealed history of typhoid fever 3 months back for which she had taken complete course of treatment. On extraoral examination, maximal mouth opening was reduced to around 28？mm and a diffuse swelling around ？cms in diameter was also observed in the right temporalis muscle which was soft to firm in consistency and was tender on palpation (Figure 1). Examination of the TMJ and other muscles of mastication revealed normal findings. On intraoral examination edentulous spaces were present involving the right and left mandibular posterior teeth. Figure 1 On the basis of the history and examination findings, a clinical provisional