A case of cicatricial contracture of the masseter muscle caused by mandibular osteomyelitis in a patient with severe, long-term trismus
A case of cicatricial contracture of the masseter muscle caused by mandibular osteomyelitis in a patient with severe, long-term trismus
复制标题
严重长期牙关紧闭患者下颌骨骨髓炎致咬肌瘢痕挛缩1例
DOI：
10.5794/jjoms.54.8
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Y. Kitagawa
中科院分区：
文献类型：
--
作者：
Michiko Terada;W. Suda;A. Satoh;K. Notani;M. Shindoh;Y. Kitagawa
一名30岁妇女因严重的牙关而被转介到我们医院，这已经存在了14年。就诊时，患者主诉左侧咬肌有压痛肿块，张嘴仅限15mm。全景x线片显示左下第二磨牙尖周透光。CT显示皮质骨颊面糜烂破坏，左支硬化改变，提示下颌骨骨髓炎。CT也显示咬肌内肿块靠近皮质骨缺损。MR证实肿块为肿瘤，信号强度为t1 -低和t2 -高。虽然拔除了左下第二磨牙，但症状没有改善，开口缩小到5mm。患者接受手术治疗，包括切除瘢痕组织、切开咬肌筋膜、磨耗颞肌，临床过程良好，开口大于40mm。根据临床病程和组织病理学结果，最终诊断为肌内慢性炎症所致的牙关紧闭，这是由牙源性感染引起的，随后是长期骨髓炎和咬肌瘢痕挛缩。
A 30-year-old woman was referred to our hospital because of severe trismus, which had beenpresent for 14 years. At presentation, she complained of a mass with tenderness in the left masseter muscle, and mouth opening was limited to 15 mm. Panoramic radiograpy showed a periapical radiolucency at the left lower second molar. CT disclosed erosion and destruction of the buccal surface of the cortical bone and sclerosing changes of the left ramus, suggesting osteomyelitis of the mandible. CT also showed a mass inside the masseter muscle adjacent to the cortical bone defect. On MR the mass was confirmed to be a tumorous lesion with T1-low and T2-high signal intensity. Although the left lower second molar was extracted, symptoms did not improve, and mouth opening decreased to 5 mm. The patient underwent surgical therapy, including excision of the scar tissue, incision of the masseteric fascia, and abradement of the temporal muscle, which led to a good clinical course with mouth opening of more than 40 mm. On the basis of the clinical course and histopathological findings, the definitive diagnosis was trismus due to intramuscular chronic inflammation, which was caused by odontogenic infection followed by longstanding osteomyelitis, and cicatricial contracture of the masseter.