Spreading type of infection

• Into soft tissue –intra oral or extra oral swelling or abscess depending on muscle attachments.

• Spread into adjacent surgical spaces along facial planes – cellulitis.

• More dangerous distant spread

• Maxillary teeth– Molars

• PALATAL ABSCESS• BUCCAL VESTIBULAR/ SULCULAR ABSCESS • FACIAL SWELLING OR ABSESS – which may

lead to cellilitis.

– Anterior & Premolars.• Palatal abscess.• Labial abscess.

Cellulitis from maxillary teeth cause swelling of upper half of face direction towards eye may cause dangerous complication – CAVERNOUS SINUS THROMBOSIS.

• Mandibular premolars and molars.– Labial or buccal vestibular / sulcular abscess.– Lingual palate perforation – depending on

mylohyoid muscle – infection or pus or exudation may involve submandibular/ sublingual spaces – LUDWIG’S ANGINA.

• Mandibular anterior teeth.– Incisors or canines.

• If pus perforate above mentalis – labial abscess.• Below insertion of mentalis cause subcutaneous

abscess. Most often between two mentalis muscles.

• Usually odontogenic infection remained confined in the peri apical area or periodontal pockets.

• Peri apical infections may perforate cortex and form local abscess or spread intra medullary chronic infection or focal osteomyelitis.

• But depending on;– The number and virulence of micro

organisms, type and severity of mechanical or chemical irritant and defense of the host;

– Or initial PAI is not completely or adequately treated.

• It may lead to spreading type of infection– Cellulitis.

• Or may spread to adjacent facial and cervical or distant spaces

FACIAL SPACES

• Fascia–lined areas-- potential spaces that do not exist in healthy persons.

• They become filled by pus or exudation during infection.

• Some contain neurovascular structure– compartments.

• Others filled with loose areolar CT-- Clefts

Primary facial spaces

• Primary spaces are adjacent to tooth bearing area & are directly involved by infection.

• Primary maxillary spaces.» Canine

» Buccal

» Infratemporal.

• Primary mandibular spaces.» Submental.

» Buccal.

» Submandibular.

» Sublingual.

Secondary Facial Spaces

• Secondary spaces are away or lie more posteriorly tooth bearing area and are lined with a CT fascia which has poor blood supply.

• Involvement of these spaces produce more complicated infective conditions.

• They are;

• Masseteric.

• Pterygomandibular.

• Superficial & deep temporal.

This group is also known as the MASTICATOR SPACE because muscle & fascia of mastication bound them.

Cervical Facial Spaces

– Uncommon occurrence.– But spread to deep cervical spaces may have

life threatening sequelae. • Lateral pharyngeal.• Retropharyngeal.• Prevertebral.

PRIMARY MAXILLARY SPACES

Primary mandibular spaces 1

• When bilateral submandibular, sublingual & submental spaces become involved --- Ludwig's angina.

• It is a rapidly spreading cellulitis and commonly spread to secondary mandibular spaces.

• This usually produce life threatening condition.

Cervical Facial Spaces

Principles of management• Determine the severity of infection

• Evaluate the state of patient’s host defense mechanism

• Determine , whether treated by GDP or refer to specialist

• Appropriate antibiotic & their proper administration

• Treat infection surgically

• Diet & i-v fluids

• Evaluate pts frequently

MANAGEMENT

• Proper diagnosis.• Antibiotics.• Other Adjuncts.• I & D