![]() ![]() In the present case, we could observe the air cell tract from the mastoid to the zygoma. Third, the persistent petrosquamous sinus (PSS) has been suggested as another pathway because the PSS arises from the dorsolateral portion of the transverse sinus, courses over the lateral superior surface of the petrous bone, and drains into the retromandibular vein via the foramen retroarticulare. Second, the petrotympanic fissure, also known as the ‘glaserian fissure’, can be a possible pathway because there are communications through the fissure to the infratemporal fossa. First, the infection passes directly from the attic vault to the diploe of the squama. Three possible routes have been suggested. However, sometimes there is no direct communication between the mastoid and zygoma. The path of the infection from the mastoid to the zygoma is generally along a preformed track of cells. Zygomatic mastoiditis is usually caused by suppurative otomastoiditis. Studies had documented zygomatic abscesses until about 70 years ago, and these studies introduced the term ‘zygomatic mastoiditis’. These air cells could serve as potential pathways for the spread of infection. The prevalence of ZACD on panoramic radiographs was reported to be 1.82%. This asymptomatic radiolucency with a cystic appearance noted on panoramic radiographs-the commonly employed imaging modality in dental clinics-is called a ‘zygomatic air cell defect (ZACD)’, and it may be confused with a pathologic condition. In 1985, Tyndall and Matteson used the term ‘pneumatization of the articular tubercle of the temporal bone’ to describe the extended air cells in the zygomatic process of the temporal bone, considering it a normal anatomic variation. Sometimes, as seen in the present case, air cells may extend to the articular tubercle of the temporal bone. ![]() In a few cases, it extends to the root of the zygomatic arch. The individual pneumatization of the temporal bone varies considerably during extension. Therefore, surgical intervention was planned for obtaining both aerobic and anaerobic cultures, draining the abscess, and removing the infected air cells in the zygomatic process. Previous studies reported that anaerobic infection can present like this and increase the risk of developing osteomyelistis. However, the preauricular swelling persisted and ultrasonography revealed an increase in the size and extent of the hypoechoic lesion. Moreover, the Creactive protein level and erythrocyte sedimentation rate normalized. After intravenous antibiotic therapy (ceftriaxone sodium) during hospitalization (11 days), her pain and tenderness improved. We selected the broad-spectrum antibiotics which should cover the invasive strains of bacteria and cross the blood-brain barrier. However, microbiology information was not available for selection of proper antibiotics. Initially, antibiotics were used to avoid further complications by zygomatic abscess with unknown origin. On the basis of these findings, she was diagnosed with zygomatic mastoiditis with extracranial complications. Fine-needle aspiration cytology showed no malignant cells, and the microorganism culture study revealed no growth of bacteria. PNS-MRI revealed soft tissue swelling with enhancement around the left zygomatic process, which suggested myositis and cellulitis ( Fig. TBCT revealed inflammatory findings around the root of the left zygoma with cortical bone destruction and scanty amount of soft tissue lesion in Prussak’s space ( Fig. For differential diagnosis, temporal bone computed tomography (TBCT) and paranasal sinus magnetic resonance imaging (PNS-MRI) were performed. Nevertheless, she was admitted for further evaluation and antibiotic therapy. She had no systemic symptoms such as fever or chill. Moreover, there were no specific findings in the nasal cavity, oral cavity, and larynx. Otoendoscopic examination of the tympanic membranes and audiograms showed normal findings. Otological examinations revealed no finding of otitis media. ![]()
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