Endoscopic Drainage of an Odontogenic Pterygoid Muscle Abscess

The infratemporal fossa (ITF) is a potential space bounded by bony structures that can be occupied by both benign and malignant tumors. It is also a potential area of abscess development, most commonly of dental origin. As with any abscess, the treatment of an ITF abscess is surgical drainage. We present a case of an ITF abscess involving the pterygoid muscles following dental extraction in a poorly controlled diabetic patient. The ITF was accessed with an endoscopic transseptal approach through the maxillary sinus to drain the abscess. This case of successful management supports the feasibility of the endoscopic approach in dealing with abscesses of the ITF. 1. Introduction The infratemporal fossa (ITF) is a potential space bounded by bony structures, namely, the temporal and the sphenoid bones superiorly, the mandible laterally, the pterygoid plates medially, the articular tubercle of the temporal bone and the styloid process posteriorly, and the maxillary sinus anteriorly. The masticator space is one of the deep compartments of the head and neck that contains the muscles of mastication. The medial and lateral pterygoid muscles are shared by both the ITF and the masticator space. The ITF can be occupied by both benign and malignant tumors, which represent less than 1% of head and neck tumors [1]. It is also a potential area for abscess development, most commonly of dental origin [2, 3]. Communications between the ITF, the pterygopalatine fossa (PPF), the parapharyngeal space, the orbit, and the cranial cavity allow contiguous spread of infection between all of these areas. As with any abscess, the treatment of an ITF abscess is surgical drainage. However, this deep space is not easily accessible, and no consensus exists on the best surgical approach to this region. In fact, surgical access options to the ITF have evolved over time with reports of periauricular, transtemporal, and transmaxillary approaches described by various surgeons [4, 5]. However, morbidities such as facial nerve dysfunction, facial deformities, conductive hearing loss, and dental malocclusion have been reported with these methods [1, 6, 7]. The use of the endoscope to access the ITF via the paranasal sinuses may prevent these morbidities [8]. We present a case of ITF abscess involving the pterygoid muscles following dental extraction in a poorly controlled diabetic patient. The ITF was accessed with an endoscopic transseptal approach through the maxillary sinus to drain the abscess. To our knowledge, this is the first report of such an approach for an infectious complication in