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Oral and maxillofacial spaces of infection

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Oral and maxillofacial spaces of infection

  1. 1. Oral and maxillofacial infection Mandibular spaces of infection Done by: ‫الجواد‬ ‫عبد‬ ‫محمد‬ ‫آل ء‬
  2. 2. Mand. Space Infections involve: 1. Submental space 2. Submand. Space 3. Submasseteric space 4. Sublingual space 5. Ptrygo-mand. Space 6. Parapharyngeal space
  3. 3. For each fascial space: Etiology Boundaries Contents Clinical picture treatment
  4. 4. Submental Space infection  Etiology: 1. Lymphatic drainage of infected lower anterior teeth. 2. spread of infection from other anatomic spaces.
  5. 5. Submental Space infection Boundaries : SUPERIORLY : MYLOHYOID MUSCLE INFERIORLY: INVESTING LAYER OF DEEP CERVICA FASCIA, PLETYSMA, SUPERFACIAL FACIA,SKIN LATERALLY: ANTERIORLY BELLY OF DIAGESTRIC MUSCLE POSTERIORLY: HYOID BONE
  6. 6. Submental Space infection  Contents: 1. sub mental limph node 2. anterior jugular veins  Clinical picture: 1. painful submental edema 2. Generalized constitutional symptoms.
  7. 7. Submental Space infection  Treatment: 1. Local anesthesia 2. incision on the skin is made beneath the chin 3. Blunt dissection 4. Rubber drain 5. A/B administration
  8. 8. Sublingual space infection  Etiology: 1. Infection of lower incisors and premolars 2. Spread of infection from other spaces
  9. 9. Sublingual space infection Boundaries: INFERIORLY: MYLOHYOID MUSCLE MEDIALLY: GENIOHYOID, GENIOGLOSSUS LATERALLY: BODY OF MANDIBLE SUPERIORLY: FLOOR OF THE MOUTH POSTERIORLY: HYOID BONE
  10. 10. Sublingual space infection  Contents: 1. Sub man gland duct(warttons duct) 2. Sub lingual gland 3. Hypoglssal n. 4. Lingual artery.
  11. 11. Sublingual space infection  Clinical picture 1. Raised tongue 2. Sublingual swelling 3. Dysphagia 4. Enlarged painful submental and subman. Lymph nodes
  12. 12. Sublingual space infection  Treatment 1. Incision ( intraorally lateral to the sublingual duct ) 2. Drainage 3. Rubber drain 4. A/B administration
  13. 13. Submandibular space infection  Etiology: 1. Infection in lower molars 2. Pricoronitis ( lower wisdoms ) 3. Fracture angle 4. Indirect infection ( spread from other spaces)
  14. 14. Submandibular space infection Boundaries: INFERIORLY: ANTERIOR & POSTERIOR BELLY OF DIAGASTRIC SUPERIORL: MEDIAL ASPECT OF MYLOHYIOD ANTERIORLY: MYLOHYIOD SPACE POSTERIORLY: HYIOD BONE
  15. 15. Submandibular space infection  Contents: 1. Submandibular salivary gland, duct and L.Ns 2. Facial artery 3. Lingual N 4. Hypoglossal N
  16. 16. Submandibular space infection  Clinical picture: 1. Painful swelling obliterating the angle of the jaw 2. Tenderness 3. Generalized constitutional symptoms.
  17. 17. Submandibular space infection  Treatment: 1. Incision ( extraorally below lower border of the mandible ) 2. Blunt dissection 3. Rubber drain 4. A/B administration 5. Fluid replacement ( rehydration ) 6. Bed rest
  18. 18. Submandibular space infection
  19. 19. Buccal space infection Etiology Infected upper or lower molars ( depends on buccinator muscle attachment )
  20. 20. Buccal space infection  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
  21. 21. Buccal space infection  Contents: 1. Buccal bad of fats 2. Facial lymph nodes
  22. 22. Buccal space infection  Clinical picture: 1. Intra oral bulging 2. Extra oral swelling confined to cheek 3. Throbbing pain 4. General constitutional symptoms
  23. 23. Buccal space infection  Treatment: 1. Incision and drainage:  Intraorally 2. A/B administration 3. Rehydration 4. Bed rest
  24. 24. Submasseteric space infection  Etiology: 1. Lower molar teeth 2. Pericoronitis 3. Buccal space infection posterior spread
  25. 25. Submasseteric space infection Boundaries: Medial: lat. surface of the ramus Lateral: Masseter ms. Posterior: Parotid gland Superiorly: zygomatic arch
  26. 26. Submasseteric space infection  Clinical picture: 1. Deep seated, severe throbbing pain 2. Swelling over the angle and ramus 3. Marked trismus
  27. 27. Submasseteric space infection  Treatment: 1. Incision and drainage  Intraoral  only submasseteric space  Extraoral  multiple spaces 2. A/B administration 3. Rehydration 4. Bed rest
  28. 28. Pterygomandibular space infection  Etiology:  Odontogenic  Lower third molar  Infected needle  Gun shot wounds or compound fracture  Orthognathic surgery  Downword spread of infratemporal space.
  29. 29. Pterygomandibular space infection  Boundaries: Medial: medial pterygoid ms. Lateral: meadial surface of ramus Ant: pterygomandibular raphae Posterior: parotid gland Superior: lateral pterygoid ms.  infra-temporal space
  30. 30. Pterygomandibular space infection  Contents: 1. Inferior alv. Bundle 2. Lingual n. 3. Internal maxillary artery 4. Pterygoid plexus of veins 5. Posterior temporal artery
  31. 31. Pterygomandibular space infection  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
  32. 32. Pterygomandibular space infection Spread:  Upward  infratemporal space  Below  submandibular space  Medial  lateral pharyngeal space
  33. 33. Pterygomandibular space infection  Treatment: 1. Incision and drainage: Intraoral  only pterygomandibular space: along the mesial temporal crest Extraoral  multiple spaces 2. Rubber drian insertion 3. Rehydration 4. A/B administration 5. Bed rest
  34. 34. Parapharyngeal space infection  Etiology: 1. Infection of lower wisdoms 2. Posterior spread of pterygoman. abscess
  35. 35. Parapharyngeal space infection  Boundaries BASE: skull base APEX: hyoid bone MEDIALLY: superior constrictor muscle LATERALLY: medial pterygoid m. POSTERIORLY: parotid glad and carotid sheath
  36. 36. Parapharyngeal space infection  Contents: 1. deep cervical L.Ns 2. Accessory N 3. Glossopharyngeal N 4. Hypoglossal N 5. Carotid sheath 6. Facial artery
  37. 37. Parapharyngeal space infection  Clinical picture: 1. dysphagia 2. Severe trismus 3. Ear and neck ache 4. Shifted tonsils and pharyngeal wall 5. Uvula is pushed medially
  38. 38. Parapharyngeal space infection  Traetment: 1. Incision and drainage:  Intraoral: vertical incision lateral and parallel to pterygman. Fold  Extraoral ( multiple spaces ) 2. Rubber drain insertion 3. A/B administration 4. Rehydration 5. Bed rest
  39. 39. 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.
  40. 40. Retropharyngeal space abscess
  41. 41. Retropharyngeal space abscess  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
  42. 42. Retropharyngeal space abscess  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
  43. 43. Retropharyngeal space abscess  contents: 1. areolar fat 2. lymph nodes (lateral and medial retropharyngeal) 3. small vessels
  44. 44. Retropharyngeal space abscess  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
  45. 45. Retropharyngeal space abscess  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. Malaise 4. difficulty swallowing 5. fever, stridor 6. drooling 7. croupy cough 8. enlarged cervical lymph nodes.
  46. 46. Retropharyngeal space abscess  Management:Management: 1. A tonsillectomy approach is typically used to access/drain the abscess. 2. Antibiotic administration 3. Rehydration 4. Bed rest
  47. 47. 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. Pretracheal 2. Prevertebral 3. investing
  48. 48. Carotid sheath abscess  Boundaries: 1. superior margin: lower border of jugular foramen 2. inferior margin: aortic arch 3. Anterolateral : sternocleidomastoid muscle
  49. 49. Carotid sheath abscess  Relations: 1. Suprahyoid carotid space: 2. anteriorly: masticator space; parapharyngeal space 3. laterally: parotid space 4. posteriorly: perivertebral space
  50. 50. Carotid sheath abscess  Contents: 1. common carotid artery inferiorly and internal carotid artery superiorly 2. internal jugular vein 3. glossopharyngeal nerve (CN IX) 4. vagus nerve (CN X) 5. accessory nerve (CN XI) 6. hypoglossal nerve (CN XII) 7. sympathetic nerves 8. deep cervical lymph node chain
  51. 51. Carotid sheath abscess  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.
  52. 52. Carotid sheath abscess  Clinical picture: 1. Swelling extend to the neck 2. Localized pain along the course of the vessels
  53. 53. Carotid sheath abscess 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.
  54. 54. 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
  55. 55. Abscess of the parotid 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
  56. 56. Abscess of the parotid space  Contents: 1.Parotid gland and its duct 2.Facial nerve and its branches 3.Auricalotemporal nerve 4.Superficial temporal artery and vein 5.Parotid lymph node 6.Posterior facial vein
  57. 57. Abscess of the parotid space  Clinical picture: 1. Swelling at the parotid region 2. elevating the ear lobules 3. Severe pain in the parotid area, may be referred to 4. ear and temporal region 5. Pain during mastication 6. Some Trismus may be observed 7. Pus from parotid duct when milked 8. General constitutional symptoms
  58. 58. Abscess of the parotid space
  59. 59. Abscess of the parotid space  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
  60. 60. Abscess of the parotid space Management: Incision and drainage (Blair’s incision) Drain is inserted A/B administration Supportive measures
  61. 61. Thank you

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