Submasseteric Infection: A Rare, Deep Space Cheek Infection Causing Trismus.

Submasseteric space infections are rare at any age but particularly so in primary school children. The origin of the infection is usually odontogenic, from pericoronitis in a third molar. Submasseteric inflammation is a deep facial space inflammation, often progressing to mature abscess, and usually misdiagnosed as staphylococcal or streptococcal lymphadenitis or pyogenic parotitis. The hallmark of a masticatory space infection is trismus. The cardinal signs of this infection include a firm mass in the body of the masseter muscle with overlying cellulitis with trismus.

Loud clicking sounds associated with rapid soft palate muscle contractions.

An 8-year-old boy was seen by his primary care pediatrician with a chief complaint of "intermittent rapid vibrations of the epiglottis" that began several weeks prior. Intraoral examination revealed rapid, symmetrical bilateral contractions of the soft palate muscles (velum), accompanied by clicking sounds audible to physician (objective tinnitus) and patient. The patient was able to volitionally control the initiation and cessation of the palatal movements. The child's mother stated that there had been no clicking noises heard while the boy was sound asleep. Palatal "clonus" was tentatively diagnosed as the cause of the problem. A normal magnetic resonance imaging study with contrast enhancement confirmed that there was no anatomical basis for the localized movement disorder.Palatal myoclonus is an uncommon localized intraoral movement disorder. There are 2 distinct types, and our patient was diagnosed with the essential palatal myoclonus type. This type is characteristically associated with clicking tinnitus, heard by the affected person as well as those in close proximity. The clicking noise is not continuous, ceases during sleep, and is not lifelong.

Intranasal mucocele of the nasolacrimal duct: an important cause of neonatal nasal obstruction.

Anterior nasal obstruction secondary to cystic or solid masses is believed to be uncommon. Previous single or series case reports of intranasal mucoceles of the nasolacrimal duct have been published in otolaryngology, ophthalmology, or radiology journals but were not found in general pediatric journals. A 5-year retrospective chart review from our children's hospital found 10 previously unreported cases of intranasal mucocele of the lacrimal duct causing neonatal nasal obstruction. The purpose of this report is to familiarize pediatricians with this entity, which was the most common cause of anatomic anterior nasal obstruction at our hospital.