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July 15, 1988

Idiopathic Cellulitis of Facial Soft Tissue

Author Affiliations

Lyndhurst, Ohio

Lyndhurst, Ohio

JAMA. 1988;260(3):338-339. doi:10.1001/jama.1988.03410030054017

To the Editor.—  In the March 11 issue of JAMA, Dr Deutsch1 addressed a question to the QUESTIONS AND ANSWERS section. His letter described a 25-yearold woman who had a history of pain and swelling of the right side of her face. In addition, this patient had moderate trismus that prevented complete opening of her mouth. The described clinical workup was appropriate but not complete.The response by Dr Klein1 addressed several possible reasons for this patient's condition. However, these are not the most likely causes for this patient's symptoms and clinical findings.This patient may have an internal derangement of the temporomandibular joint meniscus or even a perforation of the meniscus. Appropriate workup of this condition would include a complete examination of the temporomandibular joint, noting specific muscle pain and measurement of limitation of mandibular opening. Based on the results of the clinical examination, appropriate radiographic studies might