1. SPACE INFECTIONS
CLINICAL FEATURES & TREATMENT
Dr V.RAMKUMAR
CONSULTANT DENTAL&FACIOMAXILLARY SURGEON
REG N0:4118-TAMILNADU-INDIA(ASIA)
2. POTENTIAL SPACES FOR INFECTION
1. Vestibular abscess
2. Buccal space
3. Palatal abscess
4. Sublingual space
5. Submandibular
space
6. Maxillary sinus
3. BUCCINATOR & ODONTOGENIC
INFECTION
In maxilla Above the attachment
Root apex Extraoral
Below the
attachment
Intraoral swelling
(In Mandible it is vice versa)
4.
5. MYLOHYOID & ODONTOGENIC
INFECTIONS
Anteriors Posteriors
(Root apex below) (Root apex below)
Intraoral Extraoral
(Floor of the mouth) (submandibular)
7. SUBMASSETRIC SPACE
(MASSETER & ODONTOGENIC INFECTION)
3- Layers (superficial, middle and deep)
Infection spreads between these three layers
Swelling less, pain is more
(Infection is usually caused by impacted mandibular,
pulpally or periodontally involved third molars)
8.
9. PTERYGOMANDIBULAR SPACE
Prime muscles of mastication
Infection
Trismus
(usually because of impacted tooth and
contaminated injection in to the space)
10.
11. TEMPORAL SPACE
(Superficial and Deep Temporal space
with Buccal space)
Dumb-bell shaped swelling
Trismus
(usually through PSA nerve blocks, infection from maxillary
molars, spread of infection from other spaces)
14. THE DANGER ZONES
• Cavernous sinus thrombosis
• Ludwig’s Angina (Multispace infection)
• Mediastinitis
15. ROOT CAUSE FOR DANGER
• Brain infection
• Respiratory obstruction
• Descending neck infection (mediastinitis,
pericarditis)
16. LUDWIG’S ANGINA
(Sublingual, Submental and Sub mandibular
space infection)
Swelling in the floor of the mouth
Lifting of the tongue
Obstruction of airway
Creating an emergency situation
19. CAVERNOUS SINUS THROMBOSIS
Pterygoid plexus
Infraorbital fissure
Terminal part of inferior ophthalmic vein
Superior orbital fissure
Cavernous sinus
(Thrombosis)
22. RETROPHARYNGEAL SPACE
Retropharyngeal space
Danger space
(space between the alar and prevertebral layer
of the deep cervical fascia)
Mediastinitis/ Carotid sheath infection
(FATAL)
23.
24. MANAGEMENT
Incision and Drainage
(along the anterior border of he sternocleidomastoid
muscle at the level of the hyoid bone and the middle
third respectively)
26. MANAGEMENT
DESCENDING NECK INFECTION
Acute necrotizing fascitis Deep
Control infection
(Appropriate systemic antibiotics)
Debridement, local antibiotic dressing, reconstruction
of the necrosed skin with graft or flap
27. If retropharyngeal space is
involved, posterosuperior
mediastinum may also become
infected secondarily. If
prevertebral space is infected,
the inferior boundary is
diaphragm, so entire
mediastinum is at risk.
28. TREATMENT OF SPACE INFECTION
• Empirical antibiotic therapy
• Incision and Drainage
• Culture and Sensitivity
• Appropriate antibiotic therapy
• Removal of the cause (teeth if odontogenic)
• Supportive therapy
• Physiotherapy (to improve mouth opening)
31. PRINCIPLE OF
ANTIBIOTIC THERAPY
• Identification of causative organism
• Determination of antibiotic sensitivity
• Use of specific narrow spectrum antibiotic
• Use of least toxic antibiotic
• Patient drug history
• Use of bactericidal rather than bacteriostatic drug
32. PRINCIPLE OF
ANTIBIOTIC ADMINISTRATION
• Proper dosage
• Proper time interval
• Proper route of administration
• Combination antibiotic therapy
• Patient monitoring
– Response to treatment
– Development of adverse reaction
– Superinfection and recurrent infection
33. THERAPEUTIC USE OF ANTIBIOTICS IN
MAXILLOFACIAL INFECTION
• Penicillin
– Acute dentoalveolar abscess
– Cellulitis
– Acute pericoronitis
• Osteomyelitis
– Culture sensitivity
– Antibiotic therapy is for longer period
• Infected soft tissue wounds
– Wound debridement with topical antibiotic
– Amoxycillin with clavulanic acid
– Metronidazole for anaerobic infection
