A case of intractable cheek phlegmon arising from an odontogenic infection extending to the interpositional alloplastic material of the temporomandibular joint

We describe a case of intractable cheek phlegmon arising from an odontogenic infection that extended to the interpositional alloplastic material of the temporomandibular joint.A 75-year-old man was referred to our department because of a painful swelling in the right temporal region occurring after an acute odontogenic infection of right upper molar teeth. The past history revealed reconstruction surgery with iliac bone transplantation following a right hemimandibulectomy to treat an ameloblastoma about 26 years ago. Physical examination and imaging findings of CT and MM revealed a diffuse swelling in the temporobuccal region and a foreign body in the temporomandibular joint region. The clinical diagnosis was temporal cellulitis from an infection involving the interpositional alloplastic material of the temporomandibular joint. Initial chemotherapy was effective, and the swelling gradually disappeared. However, a fistula formed at the buccal region and pus discharge continued in spite of conservative therapy with irrigation. Under local anesthesia, we carried out curettage of the fistula two times, and the silicone-like foreign body, which might have been implanted at mandibular reconstruction surgery, was removed. Then, the symptoms of the infection rapidly and completely disappeared.