oral medicine & Pathology

Tuberculosis of the masticator space: Imaging , clinical findings , pathology , treatment , epidemiology

 

 

    Tuberculosis of the masticator space

 

Epidemiology

  •  There is an increase in the number of tuberculosis cases in the United States as a result of the epidemic of acquired immune deficiency syndrome (AIDS).
  • This increase also includes an increase in the number of extrapulmonary manifestations.
  • It is believed that about 30% of patients with tuberculosis in the United States have AIDS.
  • Conversely, 5 to 9% of patients with AIDS have tuberculosis.
  • Tuberculosis with primary involvement of the masticator space is very rare.
  • The masticator space may be affected by lesions originating from adjacent structures..

Clinical Findings

  •  Tuberculosis of the masticator space may be overshadowed by the manifestations of AIDS or disseminated tuberculosis.
  • Signs and symptoms of secondary masticator space involvement depend on the site of the lesion.

Pathology

  •  Tuberculosis is caused by Mycobacterium tuberculosis, which can either be seen microscopically as acid-fast bacilli or demonstrated by culture.
  • In adults, tuberculosis is most often a postprimary infection, whereas in children it is usually a primary event.
  • In the head and neck, tuberculosis typically produces noncaseating granulomas in the lymph nodes, larynx, bones, or muscles.

Treatment

  •   Tuberculosis can be effectively treated with antibiotic combinations that include streptomycin, isoniazid, rifampin, and ethambutol.

Imaging Findings

CT

  •  CT findings depend on the site of involvement.
  • Tuberculous lymphadenitis offacial nodes or abscess with masticator space involvement shows the same features as infections due to other pyogenic organisms.
  • Contrast-enhanced CT shows an enhancing mass with or without areas of low density.
  • The adjacent bones may show erosions or increased marrow density.

MR

  •  Contrast-enhanced M R imaging may show necrotic facial nodes (for example, the malar group) with associated osteomyelitis of the zygoma and involvement of the suprazygomatic or infrazygomatic masticator space.
  • T2-weighted MR images with fat suppression can also reveal high signal intensity lesions involving nodes, bones, and muscles

Imaging Pearls

  • The facial nodes are usually divided into four groups: mandibular nodes, buccinator nodes, infraorbital nodes, and malar nodes.
  • Tuberculosis or metastasis may involve these facial nodes with extension to the adjacent bones or spaces .
  • There is an increase in incidence of extrapulmonary tuberculosis in AIDS. Therefore, a lesion involving bones and soft tissues should have tuberculosis included in the differential diagnosis.

 

 

Tuberculous involvement of zygoma and masticator space

 Tuberculous involvement of zygoma and masticator space

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