A 45-year-old woman was referred with a complaint oflimited mouth opening. The restriction had progressivelyincreased after the removal of the right lower third molar 2months earlier. After tooth removal, the treatment for tris-mus consisted of analgesic, muscle relaxants, and mechan-otherapy. Past medical history revealed a left nephrectomy21 years ago and the loss of 15 kg during the past 4 months.There were no known drug allergies.On extraoral examination, a slight asymmetry was seenon the left side of the face. The tenderness on the body ofthe masticatory muscles was recorded on palpation. Theparotid glands were nontender and there were no masses.Whenthepatientwasreferredtoourclinic,maximalmouthopening was to 14 mm with right and left lateral excursionsof 7 and 3 mm, respectively. There was no temporoman-dibular joint tenderness, but a deviation was noted withmouth opening. There was a submandibular lymphadenop-athy. No sensory disturbance was noted.On intraoral examination, oral hygiene was poor and shehad periodontal problems. A mass was noted in the softtissues posterior and lateral to the right maxillary tuberosityand retromolar region. Palatinal mucosa was inflamed andfragile on the right upper third molar, and the tooth wasmobile (Fig 1).Panoramic radiography showed that there was no boneirregularity in the extraction socket of the right lower thirdmolar tooth, but marked resorption of alveolar bone sur-rounding the right upper third molar and tuber maxilla wasseen. The maintenance of bone extending from the ascend-ing ramus of mandible to the coronoid process with amarked change into trabecular structures of the bone wasnot observed (Fig 2). Contrast-enhanced axial computedtomography (CT) scan demonstrated a heterogeneous en-hancement with a large mass extending from the rightposterior wall of the nasopharynx that blocked the piriformsinus opening and obliterated the parapharyngeal fatty tis-sue on the oropharynx and inferiorly angulus mandible tosuperiorly infratemporal fossa (ITF). There was no bonedestruction (Fig 3).
