Archives of Orofacial Sciences (2007) 2, 59-60 59 CASE REPORT Submasseteric abscess: an unusual head and neck condition Sayuti R a , Baharudin A a* , Amran M b a Department of ORL-HNS, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. b Department of ORL-HNS, Hospital Kuala Terengganu, Jalan Sultan Mahmud, 20400 Kuala Terengganu, Terengganu, Malaysia. (Received 6 May 2007, revised manuscript accepted 23 October 2007) KEYWORDS Submasseteric abscess, head and neck, parotid abscess Abstract Submasseteric abscess is unusual in the head and neck region. Patients with this condition may be misdiagnosed as a parotid abscess due to the similarities in their presentation. Awareness and due recognition should be given to this unusual problem. Introduction Masseteric space is one of the important spaces in the head and neck region. As abscess involving this region is not common, the diagnosis of submasseteric abscess does not come readily as a main diagnosis or as a differential diagnosis when we come across patient with a painful head and neck swelling (Balatsouras et al., 2001). Due to its rarity the incidence is not really known (Jones et al., 2003). This paper highlights a case of a young adult male who presented with right submasseteric abscess with no previous history of dental problem. Initial diagnosis was right parotid abscess but submasseteric abscess was later diagnosed by computed tomography (CT) of the neck. Case report A 24 years old male with no previous medical illness presented to ORL-HNS clinic, with 2 weeks history of right facial swelling. Initially it was a small swelling started in the area of the right angle of mandible. It was associated with mild pain and low grade fever but there was no evidence of trismus. The swelling increased in size over time and the patient had sought treatment from a district clinic and was prescribed a week’s course of antibiotics. However, he claimed the swelling gradually continued to grow in size and was painful. There was no previous history of dental problem or trauma to the face. There was no previous history of recurrent swelling in the parotid region. On examination, there was a large diffuse swelling over the right extending from the lower border of the zygomatic arch down to the submandibular region. It was firm and tender to touch and no fluctuation elicited. Marked trismus was noted with mouth opening about one and a half finger-breadth. Intra-oral examination revealed no evidence of tooth caries. An urgent CT-scan (Figure 1) showed a heterogenous enlargement of right masseter muscle with the underlying hypodense area between the muscle and the ramus of the mandible indicating the presence of pus collection. The CT scan also didn’t show any periapical infection of the teeth or presence of an impacted third molar. Figure 1 CT scan showing the submasseteric abscess (arrow) An incision and drainage was performed under general anaesthesia with the patient in supine position and head turned to the left (Figure 2). The abscess was drained via a high * Corresponding author: Tel.: +609-766 4110 Fax: +609-765 3370. E-mail address: baharudin@kb.usm.my