title: Unusual parapharyngeal extension of peritonsillar abscess to the masticator space: successfully drained by extraoral and intraoral endoscopic approaches.
abstract: OBJECTIVE
  The object was to describe 2 novel cases of peritonsillar abscess showing peculiar extension to the masticator space.
  
  
  METHODS
  The methods included clinical case records, including computed tomography and surgical approaches.
  
  
  RESULTS
  Both patients we encountered were suffering from systematic diseases, with case 1 involving a 75-year-old man with diabetes mellitus and case 2 involving a 90-year-old woman taking immunosuppressive medications. The abscesses were peritonsillar in origin, extending primarily to the parapharyngeal space, with unusual secondary extension to the masticator space. Extraoral drainage conducted in case 1 was useful for assessing the masticator space and surrounding spaces, but endoscopy-assisted intraoral drainage in case 2 was less invasive, obviating the need for identifying the facial nerve.
  
  
  CONCLUSIONS
  It is important to bear in mind that patients suffering from systemic diseases may display unusual extension of deep head and neck infections, and enhanced computed tomography is a useful modality for evaluating such extensions.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hidaka
authors.forename: Eiichi
authors.initials: E
authors.lastname: Ishida
authors.forename: Takahiro
authors.initials: T
authors.lastname: Suzuki
authors.forename: Sachiko
authors.initials: S
authors.lastname: Matsutani
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Shoki
authors.initials: S
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications; D004322:Drainage / Q000379:methods*; D004724:Endoscopy; D005154:Facial Nerve; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D008410:Masticatory Muscles / Q000473:pathology; D009061:Mouth Mucosa / Q000601:surgery; D000039:Peritonsillar Abscess / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed
chemical_list: D007166:Immunosuppressive Agents
keywords: deep neck infection; drainage; endoscopy; masticator space; peritonsillar abscess