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FACIAL SPACES
Potential spaces situated between the planes of fascia. Natural pathways along which infection can spread.
MANDIBULAR SPACES
Space for Body of mandible Submental space Sublingual Space Submandibular space Pterygomandibular space
SECONDARY SPACES Masseteric space Pterygomandibular space Superficial & Deep temporal space Lateral pterygoid space Retropharyngeal space Prevertebral space
CANINE SPACE
ANATOMY
LOCATION : B/w Anterior surface of maxilla & overlying levator labi superioris. BOUNDARIES Superiorly: Levator labi superioris Anteriorly : Orbicularis oris Posteriorly: Buccinator
SOURCE OF INFECTION
Maxillary Canine First Premolar
CLINICAL FEATURES
INTRAORAL LOCATION Labial sulcus Rarely , Palatal swelling
LOCATION OF SWELLING Lateral to nose Obliterate nasolabial fold Sometimes oedema of cheek & upper lip Severe cases infection extend to orbit
BUCCAL SPACE
ANATOMY
LOCATION : B/W Buccinator & Masseter muscle & lies superficial to Buccopharyngeal fascia.
BOUNDARIES Medially: Buccinator & Buccopharyngeal Laterally: Skin of cheek Anteriorly: Anterior border of Zygomatic bone & Depressor anguli oris Superiorly: Zygomatic arch Inferiorly: Mandible Posteriorly: Masseter &Pterygomandibular raphe
CONTENTS
Buccal pad of fat Stensons duct Anterior facial artery & vein Transverse Artery & vein
SOURCES OF INFECTION
Maxillary bicuspid Maxillary molars Mandibular molars Mandibular Bicuspids
CLINICAL FEATURES
LOCATION OF SWELLING lower border of mandible to level of Zygomatic arch SYMPTOM Facial swelling with Trismus SIGN Obvious, Dome Shaped
PAROTID SPACE
Enclosed by superficial layer of deep cervical fascia along with Parotid gland Extension of odontogenic infection is difficult.
CONTENTS
Parotid gland Extra glandular & intraglandular parotid lymph nodes External carotid artery Internal carotid artery Maxillary artery Superficial temporal artery
SOURCES OF INFECTION
Blood born Retrograde extension pharyngeal spacE
from lateral
CLINICAL FEATURES
LOCATION OF SWELLING Zygomatic arch to lower border of mandible Posteriorly extends upto retromandibular region Anteriorly ends at the end of anterior border of ramus
SIGNS
DIAGNOSIS : made by
Evertion of ear lobule No trismus Possible escape of pus from parotid duct on milking All signs of abscess
DIFFERENTIAL DIAGNOSIS
Submasseteric Space infection
INFRATEMPORAL SPACE
ANATOMY
LOCATION: LOCATION irregularly shaped space behind posterior surface of mandible
BOUNDARIES
Laterally: temporalis tendon, coronoid
process & ramus
Medially: Lateral plate of pterygoid process Posteriorly: Lateral pterygoid muscle, condyle &
temporalis
Anteriorly: Maxillary tuberosity Superiorly: Greater wing of sphenoid Inferiorly: communicates with
Pterygomandibular space
CONTENTS Pterygoid plexus Maxillary artery & vein Mandibular division of trigeminal nerve
SOURCES OF INFECTION
Maxillary molars Local infiltration of maxillary nerve
CLINICAL FEATURES
LOCATION OF SWELLING *Extraorally over the sigmoid notch & TMJ area *Intraorally in tuberosity
SYMPTOMS Trismus Swelling of eyelids in case of involvement of post zygomatic fossa SIGNS Entire cheek swollen; if buccal space involved
SOURCES OF INFECTION
Fracture or direct extension Dental caries Blood born
CLINICAL FEATURES
LOCATION OF SWELLING
Incisors, Canines & bicuspids Outer cortical plate involvement Inner cortical plate involvement Molars Perforation of infection above external oblique ridge: oblique swelling in the oral vestibules. Perforation below mylohyoid line: infection point in the skin
SUBMENTAL SPACE
ANATOMY LOCATION: LOCATION Midline b/w symphysis menti & hyoid bone BOUNDARIES:
Floor: Mylohyoid muscle Roof: Suprahyoid portion of investing layer of deep cervical fascia Lateral: Anterior belly of Digastric
SOURCE OF INFECTION
Mandibular anterior teeth
CLINICAL FEATURES
LOCATION OF SWELLING Chin SWELLING: SYMPTOMS: SYMPTOMS Dyspnoea, Dysphagia SIGNS: SIGNS -Grossly swollen cheek -Firm -Erythematous
SUBMANDIBULAR SPACE
ANATOMY
LOCATION: LOCATION Lateral to submental space BOUNDARIES: Laterally
Submandibular skin Superficial fascia Platysma Superficial layer of deep cervical fascia Lower border of mandible
Medially Mylohyoid Hyoglossus styloglossus Inferiorly Anterior & Posterior belly of digastric Posteriorly Hyoid bone
CONTENTS
Superficial part of Submandibular salivary gland & lymph nodes Facial artery Whartons duct Lingual & hypoglossal nerve Facial vein
SOURCES OF INFECTION
Second & Third Molars
CLINICAL FEATURES
LOCATION: LOCATION Near angle of jaw SIGNS Brawny Edematous After some days swelling becomes soft & cystic
SOURCES OF INFECTION
Directly from perforation of lingual cortical plate From submandibular space
CLINICAL FEATURES
LOCATION: Floor of mouth, close to mandible
&spreads towards midline or beyond
SYMPTOMS
Elevation of tongue Dysphasia Dyspnoea
SIGNS
Brawny Erythematous Tender
SUBMASSETERIC SPACE
ANATOMY
BOUNDARIES Anteriorly: body of mandible Posteriorly: Parotid space Medially: Lateral pharyngeal space Superiorly: continuous with superficial & deep temporal pouches
SOURCES OF INFECTION
- Mandibular 3rd molars
CLINICAL FEATURES
LOCATION - External: brawny induration over ramus & angle of mandible - Internal: Sublingual region & pharyngeal wall SYMPTOMS -Excruciating pain -Radiates to ear -Dysphagia -Trismus
TEMPORAL SPACE
ANATOMY
LOCATION: LOCATION Superficial & deep temporal BOUNDARIES Anteriorly- Maxillary tuberosity Posteriorly- Lateral pterygoid, condyle, temporalis Laterally- Lateral pterygoid plate, inferior belly of lateral pterygoid
CLINICAL FEATURES
LOCATION
Infection with superficial temporal space Swelling is limited below by zygomatic arch Laterally by outline of superficial temporal line Deep temporal abscess Produce less swelling Lies deep to temporalis muscle Less fluctuant
DUMBELL SHAPED APPEARANCE : with buccal space involvement SYMPTOMS Pain severe Trismus
PTERYGOMANDIBULAR SPACE
ANATOMY
LOCATION - Well defined - b/w ramus & pterygoid muscle CONTENTS - Fat - Inferior alveolar nerve - Maxillary artery
BOUNDARIES Lateral wall: Inner surface of ramus Medial wall: Medial pterygoid muscle Roof : Lateral pterygoid Posterior : Retromandibular space Anterior : Deep tendon of temporalis
CLINICAL FEATURES
LOCATION : No external evidence Intraorally anterior bulging of soft palate : Deviation of tongue to affected SIGNS side SYMPTOMS : Severe trismus & Dysphagia
LUDWIGS ANGINA
DEFINITION
ARCHER: ITS A BILATERAL, ACUTE, RAPIDLY SPREADING, SEPTIC, INFLAMMATORY, INDURATED, WOODEN HARD CELLULITIS OF FLOOR OF MOUTH
MOST IMPORTANT COMPLICATION OF SPACE INFECTIONS INCLUDES SUBMANDIBULAR, SUBMENTAL & SUBLINGUAL SPACES BILATERALLY.
MEDICAL TREATMENT
ANTIBIOTICS & ANALGESICS Penicillin Amoxicillin Ornidazole cephalosporin
SUPPORTIVE THERAPY
Adequate hydration Rich nutritional supplements Rx of pre existing disease
EXTRACTION
Extraction of offending tooth
TECHNIQUE
Preparation of skin Aseptic manner prepared area is draped with sterile towels Local anesthesia Site of incision Most dependent part of abscess than the centre. - This provides dependent drainage & avoids puckering of skin & excessive scar contracture - Incision should be in cosmetically & functionally acceptable place
Dissection - Extended to alveolar process overlying the roots of involved tooth i.e.; the source of infection.
AN INFECTED TOOTH SHOULD ALWAS BE GIVEN DUE IMPORTANCE TO PREVENT THE ABOVE FURTHER COMPLICATIONS !!!!!!
REFERENCES
Text book of Oral medicine- ANIL GHOM Textbook of Oral Pathology Shaffers Textbook of oral surgery BALAJI Textbook of Anatomy CUNNIGHAM Google images