Oral and maxillofacial spaces of infection

Oral and maxillofacial infection

Mandibular spaces of infection

Done by:

الجواد عبد محمد آالء

Mand. Space Infections involve:

1. Submental space

2. Submand. Space

3. Submasseteric space

4. Sublingual space

5. Ptrygo-mand. Space

6. Parapharyngeal space

For each fascial space :

EtiologyBoundariesContentsClinical picturetreatment

Submental Space infection

Etiology:

1. Lymphatic drainage of infected lower anterior teeth.

2. spread of infection from other anatomic spaces.


Boundaries :

SUPERIORLY : MYLOHYOID MUSCLE

INFERIORLY: INVESTING LAYER OF DEEP CERVICA FASCIA, PLETYSMA, SUPERFACIAL FACIA,SKIN

LATERALLY: ANTERIORLY BELLY OF DIAGESTRIC MUSCLE

POSTERIORLY: HYOID BONE


Contents:

1. sub mental limph node

2. anterior jugular veins

Clinical picture:

1. painful submental edema

2. Generalized constitutional symptoms.


Treatment:

1. Local anesthesia

2. incision on the skin is made beneath the chin

3. Blunt dissection

4. Rubber drain

5. A/B administration

Sublingual space infection

Etiology:

1. Infection of lower incisors and premolars

2. Spread of infection from other spaces


Boundaries:

INFERIORLY: MYLOHYOID MUSCLE

MEDIALLY: GENIOHYOID, GENIOGLOSSUS

LATERALLY: BODY OF MANDIBLE

SUPERIORLY: FLOOR OF THE MOUTH

POSTERIORLY: HYOID BONE


Contents:

1. Sub man gland duct(warttons duct)

2. Sub lingual gland

3. Hypoglssal n.

4. Lingual artery.


Clinical picture

1. Raised tongue

2. Sublingual swelling

3. Dysphagia

4. Enlarged painful submental and subman. Lymph nodes


Treatment

1. Incision ( intraorally lateral to the sublingual duct )

2. Drainage

3. Rubber drain


Submandibular space infection

Etiology:

1. Infection in lower molars

2. Pricoronitis ( lower wisdoms )

3. Fracture angle

4. Indirect infection ( spread from other spaces)


Boundaries:

INFERIORLY: ANTERIOR & POSTERIOR BELLY OF DIAGASTRIC

SUPERIORL: MEDIAL ASPECT OF MYLOHYIOD

ANTERIORLY: MYLOHYIOD SPACE

POSTERIORLY: HYIOD BONE


Contents:

1. Submandibular salivary gland, duct and L.Ns

2. Facial artery

3. Lingual N

4. Hypoglossal N


Clinical picture:

1. Painful swelling obliterating the angle of the jaw

2. Tenderness

3. Generalized constitutional symptoms.


Treatment:

1. Incision ( extraorally below lower border of the mandible )

2. Blunt dissection3. Rubber drain4. A/B administration5. Fluid replacement ( rehydration )6. Bed rest


Buccal space infection

Etiology

Infected upper or lower molars

( depends on buccinator muscle attachment )


Boundaries:

Antero medialy: buccinator muscle

Postero medialy: masseter & anterior border of the ramus & internal ptegoid muscle

Lateraly: platysma & deep fascia

Above: zygomatic process

Below: deep fascia of mandible


Contents:

1. Buccal bad of fats2. Facial lymph nodes


Clinical picture:

1. Intra oral bulging

2. Extra oral swelling confined to cheek

3. Throbbing pain4. General constitutional symptoms


Treatment:

1. Incision and drainage: Intraorally


3. Rehydration

4. Bed rest

Submasseteric space infection

Etiology:

1. Lower molar teeth

2. Pericoronitis

3. Buccal space infection posterior spread


Boundaries:

Medial: lat. surface of the ramus

Lateral: Masseter ms.

Posterior: Parotid gland

Superiorly: zygomatic arch


Clinical picture:

1. Deep seated, severe throbbing pain

2. Swelling over the angle and ramus

3. Marked trismus


Treatment:

1. Incision and drainage Intraoral only submasseteric space Extraoral multiple spaces


3. Rehydration

4. Bed rest

Pterygomandibular space infection

Etiology: Odontogenic

Lower third molar Infected needle

Gun shot wounds or compound fracture Orthognathic surgery Downword spread of infratemporal space.


Boundaries:

Medial: medial pterygoid ms.

Lateral: meadial surface of ramus

Ant: pterygomandibular raphae

Posterior: parotid gland

Superior: lateral pterygoid ms. infra-temporal space


Contents:

1. Inferior alv. Bundle

2. Lingual n.

3. Internal maxillary artery

4. Pterygoid plexus of veins

5. Posterior temporal artery


Clinical picture:1. Severe trismus ( med. & lat. pterygoid ms. )

2. Intraoral swelling medial displacement of lateral pharyngeal wall

3. Dysphagia

4. Uvula displacement to the opposite side

5. Air hunger

6. General constitutional symptoms


Spread:

Upward infratemporal space Below submandibular space Medial lateral pharyngeal space


Treatment:1. Incision and drainage: Intraoral only pterygomandibular space:

along the mesial temporal crest Extraoral multiple spaces

2. Rubber drian insertion3. Rehydration4. A/B administration5. Bed rest

Parapharyngeal space infection

Etiology:

1. Infection of lower wisdoms

2. Posterior spread of pterygoman. abscess


Boundaries

BASE: skull base

APEX: hyoid bone

MEDIALLY: superior constrictor muscle

LATERALLY: medial pterygoid m.

POSTERIORLY: parotid glad and carotid sheath


Contents:

1. deep cervical L.Ns2. Accessory N3. Glossopharyngeal N4. Hypoglossal N5. Carotid sheath6. Facial artery


Clinical picture:

1. dysphagia

2. Severe trismus

3. Ear and neck ache

4. Shifted tonsils and pharyngeal wall

5. Uvula is pushed medially


Traetment:

1. Incision and drainage: Intraoral: vertical incision lateral and parallel to

pterygman. Fold Extraoral ( multiple spaces )

2. Rubber drain insertion3. A/B administration4. Rehydration5. Bed rest

Retropharyngeal space abscess

Retropharyngeal abscess (RPA) is an abscess located in the tissues in the back of the throat behind the posterior pharyngeal wall. It extends from the base of the skull to a variable level between the T1 and T6 vertebral bodies.

they are difficult to diagnose by physical examination alone. Early diagnosis is key, while a delay in diagnosis and treatment may

lead to death. Parapharyngeal space communicates with retropharyngeal space

and an infection of retropharyngeal space can pass down behind the oesophagus into mediastinum

Most commonly seen in infants and young children, RPAs can also occur in adults of any age.

RPA can lead to airway obstruction or sepsis - both life-threatening emergencies.



Boundaries:

anterior margin: middle layer of the deep cervical fascia 1

posterior margin: alar fascia, which separates the retropharyngeal space from the danger space

lateral margins: deep layer of the deep cervical fascia 1 superior margin: the clivus inferior margin: the point at which the alar fascia fuses

with the middle layer of the deep cervical fascia, typically around the T4 vertebral body 3


The retropharyngeal space is:

1. anterior to the danger space

2. posterior to the pharyngeal mucosal space

3. anteromedial to the carotid space

4. posteromedial to the parapharyngeal space


contents:

1. areolar fat

2. lymph nodes (lateral and medial retropharyngeal)

3. small vessels


etiology:

1. bacterial infection originating from the nasopharynx, tonsils, sinuses, adenoids or middle ear. Any Upper Respiratory Infection (URI) can be a cause. RPA can also result from a direct infection due to penetrating injury or a foreign body.

2. Odontogenic cause


Clinical picture:

1. stiff neck (limited neck mobility or torticollis)2. some form of palpable neck pain (may be in "front of

the neck" or around the Adam's Apple)3. Malaise4. difficulty swallowing5. fever, stridor6. drooling7. croupy cough8. enlarged cervical lymph nodes.


Management:Management:

1. A tonsillectomy approach is typically used to access/drain the abscess.

2. Antibiotic administration

3. Rehydration

4. Bed rest

Carotid sheath abscess

The carotid space is a roughly cylindrical space that extends from the skull base through to the aortic arch. It is circumscribed by all three layers of the deep cervical fascia, forming the carotid sheath :

1. Pretracheal2. Prevertebral3. investing


Boundaries:

1. superior margin: lower border of jugular foramen

2. inferior margin: aortic arch

3. Anterolateral : sternocleidomastoid muscle


Relations:

1. Suprahyoid carotid space:

2. anteriorly: masticator space; parapharyngeal space

3. laterally: parotid space

4. posteriorly: perivertebral space


Contents:

1. common carotid artery inferiorly and internal carotid artery superiorly

2. internal jugular vein3. glossopharyngeal nerve (CN IX)4. vagus nerve (CN X)5. accessory nerve (CN XI)6. hypoglossal nerve (CN XII)7. sympathetic nerves8. deep cervical lymph node chain


Etiology:

1. Infection usually arises from thrombosis of the internal jugular vein or from infection of those deep cervical lymph nodes that lie within the sheath ·

2. Thrombosis of the jugular vein from a deep infection of the neck is probably not due to direct infection of the carotid sheath, but rather to the fact that infectious material follows tributaries of the internal jugular vein to reach the sheath. ·

3. Drug use (Heroin) usually use carotid route to obtain a fast high.


Clinical picture:

1. Swelling extend to the neck

2. Localized pain along the course of the vessels


Management:

Incision and drainage along the anterior border of sternomasoid muscle.

If the external jugular vien is indurated and thrombosed it must be ligated to prevent farther spread.

Abscess of the parotid space

It is a rare condition to occur due to dental sepsis, but it may occur due to:

• Septic parotitis• Septic fracture of the ascending ramus• Indirect spread from the parapharyngeal and

submandibular space


Anatomy :The parotid space lies between the two

layers of the superficial layer of fascia, these tow layers are situated medially and anteriorly . It is bounded laterally by superficial layer of deep cervical fascia, it is in direct continuation with the submasseteric space, submandibular space, parapharyngeal space


Contents:1.Parotid gland and its duct2.Facial nerve and its branches3.Auricalotemporal nerve4.Superficial temporal artery and

vein5.Parotid lymph node6.Posterior facial vein


Clinical picture:1. Swelling at the parotid region2. elevating the ear lobules3. Severe pain in the parotid area, may be

referred to 4. ear and temporal region5. Pain during mastication6. Some Trismus may be observed7. Pus from parotid duct when milked 8. General constitutional symptoms



D.D:

1. Mumps (young age, bilateral)

2. Parotitis (discharge is turbid and purulent)

3. Parotid sialolithiasis

4. Cyst of the parotid salivary gland

5. Tumor


Management:

Incision and drainage (Blair’s incision)

Drain is inserted

A/B administration

Supportive measures

Thank you

Health & Medicine

Oral and maxillofacial spaces of infection