This is a case of a 46-year-old male having a 2-year recurrent non
resolving left ear pain, treated as otitis media, with trismus upon
consult at the ED. Head and neck CT scan revealed a fairly demarcated
heterogenous mass, 2.9x3.4x2.7 cm, effacing temporalis and deep
masseteric muscles superiorly and lateral pterygoid muscle inferiorly,
suspicious for malignancy. Incision biopsy via intraoral approach,
revealed benign fibromuscular and adipose tissue with mild chronic
inflammation, negative for tuberculosis, Gram stain positive, and
culture growth of K. Pneumoniae sensitive to Co-Amoxiclav, Ampicillin,
Cotrimoxazole, Ertapenem, Imipinem, Meropinem and Piptazobactam. He was
started on antibiotic and physical therapy for mastication, referred to
Infectious Disease for co-management. Resolution achieved with regained
temporomandibular joint motion after 10 days of treatment.
Masticator space is a deep fascial component in the infratemporal fossa
that contains muscles of mastication. Lesions of various origins affect
the area and exhibit similar symptoms namely trismus, facial swelling
and referred ear pain. Thus, exercising due diligence in diagnosis and
management is significant. |