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Fig. 1 depicts the panoramic x-ray taken on admission to the hospital. Periapical radiolucencies are evident within teeth numbers 14, 15, 18, and 19 (white arrows).
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The panoramic image (Fig. 1) revealed mandibular condyles in the fossa and clear maxillary sinuses.
Fig. 2 depicts a maxillofacial CT in axial view that identifies multifocal fluid collections with diffuse gas associated with the submasseteric, pterygomandibular, and lateral pharyngeal spaces (white arrows).
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The maxillofacial CT scan (Fig. 2, Fig. 3) showed multifocal abscesses of the left masseteric, parotid, submandibular and parapharyngeal spaces with reactive left cervical lymphadenopathy and enlargement of the left submandibular gland.
Fig. 4 is a sagittal CT view that identifies the location of penrose drains placed into the spaces mentioned in Fig. 3 above (white arrows).
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The patient was taken back to the operating room for repeat incision and drainage and all penrose drains were replaced (Fig. 4).
Fig. 5 depicts a CT Soft Tissue Axial View. A focal fluid collection is present along the left mandibular body and in the left masseter muscle without significant wall enhancement. Edematous enlargement of the left masseter and pterygoid musculature are evident (white arrows).
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Another CT of the head and neck was ordered on Post op day 13 to document resolution of the infection (Fig. 5).