This document discusses potential spaces in the head and neck region where infections can develop from dental sources, and provides guidance on treating these infections. It outlines several key spaces that can become infected, including the buccinator space, sublingual space, submandibular space, and pterygomandibular space. Dangerous complications are described such as Ludwig's angina and cavernous sinus thrombosis. The document recommends empiric antibiotic therapy, incision and drainage of infected spaces, culture and sensitivity testing to identify the causative organism, focused antibiotic treatment, and removal of the infection source (such as teeth) for managing these infections.

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)

5. MYLOHYOID & ODONTOGENIC
INFECTIONS
Anteriors Posteriors
(Root apex below) (Root apex below)
Intraoral Extraoral
(Floor of the mouth) (submandibular)

6. SUBLINGUAL SPACE
SUBMANDIBULAR SPACE

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)

9. PTERYGOMANDIBULAR SPACE
Prime muscles of mastication
Infection
Trismus
(usually because of impacted tooth and
contaminated injection in to the space)

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)

13. HIGHWAY TO DANGER
• Pterygoid plexus
• Lincon’s highway
• Multispace infections

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

17. Ludwig’s Angina
Maintain Airway
(Tracheostomy)
Control Infection
Medically Surgically
(Systemic Antibiotics) (Tube Drain)

19. CAVERNOUS SINUS THROMBOSIS
Pterygoid plexus
Infraorbital fissure
Terminal part of inferior ophthalmic vein
Superior orbital fissure
Cavernous sinus
(Thrombosis)

20. MANAGEMENT
Antibiotic crossing blood brain barrier
(Chloramphenicol, Ciprofloxacin)
Anticoagulant therapy
(To prevent venous 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)

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)

25. DESCENDING NECK INFECTION
Superficial Deep
Mediastinitis Acute necrotizing fascitis
(malnourished & immuno-compromised
patients)
Pericarditis
(Stridor - fatal)

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)

29. INCISION & DRAINAGE
(Principle & Technique)

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

34. THANK YOU