The buccal space lies between the buccinator muscle and the overlying superficial fascia and skin. The maxillary 2nd and 3rd molars are the usual nidus of buccal space infections, eroding either superiorly through the maxillary alveolar bone or, rarely, inferiorly from the 3rd mandibular molar through the mandibular alveolar bone into the buccal space. Patients usually present with unilateral facial swelling, redness, and tenderness of the cheek. Trismus is generally not present. Parotid gland enlargement due to mumps and suppurative bacterial parotitis should also be considered. The former lacks erythema and warmth of the overlying skin, while the latter is accompanied by trismus and purulent drainage from Stensen’s duct. Inspection of all the maxillary and 3rd mandibular molar teeth is essential to make the diagnosis. A CT scan may help localize the infection.
Buccal Space Anatomy. The buccal space lies between the buccinator muscle and the overlying skin and superficial fascia. This potential space may become involved secondary to maxillary or mandibular molar infections. (Adapted with permission from Cummings C, Schuller D, eds. Otolaryngology Head and Neck Surgery. 2nd ed. Chicago, IL: Mosby-Year Book; 1993.)
Management and Disposition
Broad-spectrum parenteral antibiotic therapy, oral analgesics, and dental or oral surgical consultation for endodontic therapy, abscess drainage, and possibly dental extraction are indicated.
Odontogenic infections of the 2nd or 3rd maxillary molars are the most common source for buccal space abscesses.
Infection can spread from the buccal space to the cavernous sinus via the transverse facial vein. Care should be taken to evaluate for any signs of cavernous sinus thrombosis in patients with buccal space infections.
Buccal Space Abscess. Note the ovoid cheek swelling with sparing of the nasolabial fold. This finding, along with accompanying redness and tenderness, helps to identify buccal space abscess formation. (Photo contributor: Michael J. Nowicki, MD.)
Buccal Space Abscess. Note the marked facial asymmetry, slight overlying erythema, and flattening of the left nasolabial fold in this adult patient presenting with a left-sided buccal space abscess. (Photo contributor: R. Jason Thurman, MD.)