Odontogenic Infection Pathway to the Parapharyngeal Space: CT Imaging Assessment



Parapharyngeal space infection may lead to severe and potentially life-threatening complications. The aim of this study was to assess the odontogenic infection pathway to the parapharyngeal space using CT imaging.

Materials and Methods

Nineteen patients in mandibular odontogenic infections with abscess who underwent contrast-enhanced CT were evaluated in this study. We reviewed the location of abscess and spread of odontogenic infections to the different components of the buccal space, submandibular space, sublingual space, masticator space and parapharyngeal space using CT imaging. The location of abscess and spread of odontogenic infections were analyzed with the Pearson Chi-square test.


Regarding the odontogenic infection pathway to parapharyngeal space, the masticator space (100%) was the most frequent, followed by the buccal space (85.7%), submandibular space (85.7%) and sublingual space (57.1%), while those without parapharyngeal space, the submandibular space (83.3%) was the most frequent, followed by the buccal space (75.0%), masticator space (58.3%) and sublingual space (33.3%). The masticator space was significant space in patients with/without parapharyngeal space infection (P = 0.047).


CT imaging could be an effective method in assessment of odontogenic infection pathway to the parapharyngeal space. The odontogenic infection in masticator space tends to display spread of parapharyngeal space.

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  1. 1.

    Rzepakowska A, Rytel A, Krawczyk P, Osuch-Wojcikiewicz E, Widlak I, Deja M, Niemczyk K (2019) The factors contributing to efficiency in surgical management of purulent infections of deep neck spaces. Ear Nose Throat J. https://doi.org/10.1177/0145561319877281

    Article  PubMed  Google Scholar 

  2. 2.

    Wang B, Gao BL, Xu GP, Xiang C (2014) Images of deep neck space infection and the clinical significance. Acta Radiol 55(8):945–951

    CAS  Article  Google Scholar 

  3. 3.

    Maroldi R, Farina D, Ravanelli M, Lombardi D, Nicolai P (2012) Emergency imaging assessment of deep neck space infections. Semin Ultrasound CT MR 33(5):432–442

    Article  Google Scholar 

  4. 4.

    Sichel JY, Dano I, Hocwald E, Biron A, Eliashar R (2002) Nonsurgical management of parapharyngeal space infections: a prospective study. Laryngoscope 112(5):906–910

    Article  Google Scholar 

  5. 5.

    Simard RD, Socransky S, Chenkin J (2019) Transoral point-of-care ultrasound in the diagnosis of parapharyngeal space abscess. J Emerg Med 56(1):70–73

    Article  Google Scholar 

  6. 6.

    Bertossi D, Barone A, Iurlaro A, Marconcini S, Santis DD, Finotti M, Procacci P (2017) Odontogenic orofacial infections. J Craniofac Surg 28(1):197–202

    Article  Google Scholar 

  7. 7.

    Mardini S, Gohel A (2018) Imaging of odontogenic infections. Radiol Clin N Am 56(1):31–44

    Article  Google Scholar 

  8. 8.

    Ogle OE (2017) Odontogenic infections. Dent Clin N Am 61(2):235–252

    Article  Google Scholar 

  9. 9.

    Moghimi M, Baart JA, Karagozoglu KH, Forouzanfar T (2013) Spread of odontogenic infections: a retrospective analysis and review of the literature. Quintessence Int 44(4):351–361

    PubMed  Google Scholar 

  10. 10.

    Shakya N, Sharma D, Newaskar V, Agrawal D, Shrivastava S, Yadav R (2018) Epidemiology, microbiology and antibiotic sensitivity of odontogenic space infections in central India. J Maxillofac Oral Surg 17(3):324–331

    Article  Google Scholar 

  11. 11.

    Ariji Y, Gotoh M, Kimura Y, Naitoh M, Kurita K, Natsume N, Ariji E (2002) Odontogenic infection pathway to the submandibular space: imaging assessment. Int J Oral Maxillofac Surg 31(2):165–169

    CAS  Article  Google Scholar 

  12. 12.

    Schuknecht B, Stergiou G, Graetz K (2008) Masticator space abscess derived from odontogenic infection: imaging manifestation and pathways of extension depicted by CT and MR in 30 patients. Eur Radiol 18(9):1972–1979

    CAS  Article  Google Scholar 

  13. 13.

    Bassiony M, Yang J, Abdel-Monem TM, Elmogy S, Elnagdy M (2009) Exploration of ultrasonography in assessment of fascial space spread of odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107(6):861–869

    Article  Google Scholar 

  14. 14.

    Ogura I, Iizuka N, Ishida M, Sawada E, Kaneda T (2017) Spread of odontogenic infections in the elderly: prevalence and characteristic multidetector CT findings. Int J Diagn Imaging 4(1):28–33

    Article  Google Scholar 

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This work was supported by JSPS KAKENHI Grant Number JP 18K09754.

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Correspondence to Ichiro Ogura.

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The study was approved by institutional review board. Informed written consent was obtained from the patients for participation in the study.

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Ogura, I., Minami, Y., Sugawara, Y. et al. Odontogenic Infection Pathway to the Parapharyngeal Space: CT Imaging Assessment. J. Maxillofac. Oral Surg. (2020). https://doi.org/10.1007/s12663-020-01401-3

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  • Odontogenic infection
  • Fascial spaces
  • Parapharyngeal space
  • Masticator space
  • CT