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Clinical Challenge
Radiology
May 2017

Left-Sided Facial Pain, Fullness, and Trismus

Author Affiliations
  • 1Department of General Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
  • 2Department of Otolaryngology–Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
JAMA Otolaryngol Head Neck Surg. 2017;143(5):519-520. doi:10.1001/jamaoto.2016.3292

A previously healthy young man in his late teens presented to his dentist with a 3-week history of left-sided facial pain, fullness, and trismus. He underwent a third maxillary molar extraction and attempted incision and drainage of the area with no improvement in symptoms. No purulence or clinically significant bleeding was identified. A contrast-enhanced computed tomographic (CT) scan was performed (Figure, A), and the patient was referred to the otolaryngology clinic. On presentation, he also reported decreased acuity in his left lower visual field, continued swelling with increasing pain, and worsening trismus. Physical examination revealed mild tenderness over a mass that extended inferiorly to the zygoma into the buccal cavity and posterolaterally to the left superior molars. The patient also reported hypoesthesia of the left maxillary division of the trigeminal nerve. Fiber-optic scope of the nasopharynx revealed a small lesion posterior to the left middle turbinate. Contrast-enhanced magnetic resonance imaging of his head, neck, and brain was performed (Figure, B and C).

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