This document discusses odontogenic infections and deep fascial space infections of the head and neck. It begins by explaining how infections from teeth can erode bone and spread to adjacent tissues, causing infections in various fascial spaces depending on the location of the dental infection. It then defines fascial spaces and provides details on the pathophysiology of deep fascial space infections. The rest of the document discusses specific fascial spaces like the vestibular, buccal, submandibular, and retropharyngeal spaces that can become infected from dental infections in the maxilla or mandible. It provides anatomical diagrams and describes clinical signs of infections in each space. The document also covers complications like Ludwig's angina and ne
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. There are four pairs of air sinuses making the boundaries of the nasal cavity. Maxillary sinus is the largest air cell. Anatomy and physiology of the maxillary sinus are given. Maxillary sinusitis is an inflammation of the sinus. Odontogenic causes represent nearly 30% of the etiology. Clinical and radiographic examinations are discussed together with treatment plan.
Oro-antral fistula is a rare complication of surgery at the posterior maxillary region. Several techniques for closure are presented. Additionally, information about sinus lift procedure is given.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. The Pathogenesis of infection in oro-facial region due to odontogenic origin is a common clinical issue. bacterial invasion to deeper tissues usually a spread from diseased dental pulp. Recent evidences indicated a multi-microbial nature. The spread of infection is governed by the thickness of the investing bone and the anatomical relation of the tooth root to the attached muscle. Infection could spread from one facial space to another, and the condition may be aggravated to life threatening situations.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
Classification of Impaction and Methods & Techniques of Third molar/Manidibular impaction removal,Flap designs of impaction removal techniques and more
Detailed description of diagnosis and management of maxillofacial and neck space infections. Discussion of anatomy of the spaces is also done in details. Drainage of such spaces are also discussed. Medical management is also discussed. Complications are also discussed.
Management of the infections of the masticatory spacesMohammed Alhayani
Student report about Management of the infections of the masticatory spaces gathered and collected by Mohammed Alhayani
References
- JR Hupp, E Ellis, MR Tucker. Contemporary oral and maxillofacial surgery. 7th ed. Missouri: Mosby Elsevier; 2008
- Deepak Kademani, Paul Tiwana. Atlas of Oral and Maxillofacial Surgery. Illustrated. Elsevier Health Sciences; 2015
- Louis H. Berman, Kenneth M. Hargreaves. Cohen's Pathways of the Pulp Expert Consult. 11th ed. Elsevier Health Sciences; 2015
- Fragiskos D. Fragiskos. Oral Surgery illustrated. Springer Science & Business Media; 2007
- A. Omar Abubaker, Din Lam. Oral and Maxillofacial Surgery Secrets. 3ed. Elsevier Health Sciences; 2015
- J Fagan, J Morkel. Surgical drainage of neck abscesses. The Open Access Atlas of Otolaryngology. 2017
- Moon-Gi Choi. Modified drainage of submasseteric space abscess. J Korean Assoc Oral Maxillofac Surg. 2017
Spread of Oral Infection (2009)
Copyright 2009 by Department of Oral Medicine
University of Dental Medicine, Yangon
Feel free to request to take it down this slide if you are copyright owner.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. There are four pairs of air sinuses making the boundaries of the nasal cavity. Maxillary sinus is the largest air cell. Anatomy and physiology of the maxillary sinus are given. Maxillary sinusitis is an inflammation of the sinus. Odontogenic causes represent nearly 30% of the etiology. Clinical and radiographic examinations are discussed together with treatment plan.
Oro-antral fistula is a rare complication of surgery at the posterior maxillary region. Several techniques for closure are presented. Additionally, information about sinus lift procedure is given.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. The Pathogenesis of infection in oro-facial region due to odontogenic origin is a common clinical issue. bacterial invasion to deeper tissues usually a spread from diseased dental pulp. Recent evidences indicated a multi-microbial nature. The spread of infection is governed by the thickness of the investing bone and the anatomical relation of the tooth root to the attached muscle. Infection could spread from one facial space to another, and the condition may be aggravated to life threatening situations.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
Classification of Impaction and Methods & Techniques of Third molar/Manidibular impaction removal,Flap designs of impaction removal techniques and more
Detailed description of diagnosis and management of maxillofacial and neck space infections. Discussion of anatomy of the spaces is also done in details. Drainage of such spaces are also discussed. Medical management is also discussed. Complications are also discussed.
Management of the infections of the masticatory spacesMohammed Alhayani
Student report about Management of the infections of the masticatory spaces gathered and collected by Mohammed Alhayani
References
- JR Hupp, E Ellis, MR Tucker. Contemporary oral and maxillofacial surgery. 7th ed. Missouri: Mosby Elsevier; 2008
- Deepak Kademani, Paul Tiwana. Atlas of Oral and Maxillofacial Surgery. Illustrated. Elsevier Health Sciences; 2015
- Louis H. Berman, Kenneth M. Hargreaves. Cohen's Pathways of the Pulp Expert Consult. 11th ed. Elsevier Health Sciences; 2015
- Fragiskos D. Fragiskos. Oral Surgery illustrated. Springer Science & Business Media; 2007
- A. Omar Abubaker, Din Lam. Oral and Maxillofacial Surgery Secrets. 3ed. Elsevier Health Sciences; 2015
- J Fagan, J Morkel. Surgical drainage of neck abscesses. The Open Access Atlas of Otolaryngology. 2017
- Moon-Gi Choi. Modified drainage of submasseteric space abscess. J Korean Assoc Oral Maxillofac Surg. 2017
Spread of Oral Infection (2009)
Copyright 2009 by Department of Oral Medicine
University of Dental Medicine, Yangon
Feel free to request to take it down this slide if you are copyright owner.
Spaces of head and neck and infections /certified fixed orthodontic courses b...Indian dental academy
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Spaces of head&neck &infections /certified fixed orthodontic courses by India...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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INFRATEMPORAL FOSSA AND PTERYGOPALATINE FOSSA NEW.pptxSudin Kayastha
INFRA TEMPORAL FOSSA
Irregularly shaped space deep & inferior to zygomatic arch, deep to ramus of mandible & posterior to maxilla
Communicates with temporal fossa through interval between (deep to) zygomatic arch & (superficial to) cranial bones
Temporal fossa is superior to zygomatic arch In
a Topic from Chapter 9 of Proffitt's Orthodontics Edition 6, including the Mechanical Principles in Orthodontics.
In this Slide terminology of Biomechanics in Orthodontics is defined along with effects of wide & narrow bracket, with brief description of Moment & Couple used in Orthodontic Tooth Movement.
Notes made in my Final Year of Bachelor in Dental Surgery from Subject Oral & Maxillofacial Surgery. In this i have mentioned the 8 principles which are used in the treatment & prevention of odontogenic infection which are most common in dental practice. This documents is for professional dental undergraduates studying in their 4th year of BDS or DDS.
This Presentation tells 4th Stage of Comprehensive Orthodontic Treatment in Orthodontics, Retention, which is used to Prevent Relapse after Orthodontic Treatment.
A Topic from Subject of Maxillofacial Trauma written in my Final Year of Dentistry.
This Chapter is Clinical Based Review of Mandible Fracture, one of the most common fractures of Face during Road Traffic Accident.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Infection erodes thorough the thinnest adjacent bone and causes
infection in the adjacent tissue.
Infection from Tooth apex perforates below the muscle
attachment – vestibular abscess will occur. (most common
infection)
Infection from Tooth apex above the muscle attachment –
facial space will be infected.
DEEP FASCIAL SPACE INFECTION
DR. SARANG SURESH HOTCHANDANI 2
3. They are fascia lined tissue
compartments filled with loose,
areolar connective tissue.
The loose areolar tissue within these spaces serves to
cushion muscles, nerves, vessels, glands & other
structures.
FASCIAL SPACE (DEFINITION)
DR. SARANG SURESH HOTCHANDANI 3
5. SPACES WITH ANY TOOTH SPACES WITH MAXILLARY
TEETH
SPACES WITH
MANDIBULAR TEETH
SPACES OF NECK
Vestibular Infra orbital Body of mandible Lateral pharyngeal
Buccal Buccal Perimandibular space Retropharyngeal
Subcutaneous Infratemporal Submandibular Pre tracheal
Para nasal sinus Sublingual Danger space
Cavernous sinus thrombosis Submental Prevertebral
Masticator space
Pterygomandibular
Superficial temporal
Deep temporal
ANATOMIC SPACES INVOLVED IN
ODONTOGENIC INFECTION
DR. SARANG SURESH HOTCHANDANI 5
6. Severity Score Anatomic Space
Severity Score = 1
Little threat to airway or vital structures
Vestibular
Buccal
Sub periosteal
Space of body of mandible
Infra orbital
Severity Score = 2
Moderate severity – hindered access to airway by
causing trismus or elevation of tongue
Submandibular
Submental
Sublingual
Pterygomandibular
Sub masseteric
Superficial temporal
Deep temporal (or infratemporal)
Severity score = 3
High risk to airway & vital structures – directly
compress & deviate the airway
Lateral pharyngeal
Retropharyngeal
Pretracheal
Severity Score = 4
Extreme risk to airway & vital structures
Danger space (space 4)
Mediastinum
Intracranial infection
Cavernous sinus thrombosis
Necrotizing fasciitis – flesh eating bacterial infection
CLASSIFICATION OF DEEP FASCIAL SPACE
INFECTION BASED ON S E V E R I T Y
DR. SARANG SURESH HOTCHANDANI 6
7. ANATOMY OF DEEP FASCIAL SPACES OF
HEAD & NECK
DR. SARANG SURESH HOTCHANDANI 7
8. ANATOMY OF DEEP FASCIAL SPACES OF
HEAD & NECK
DR. SARANG SURESH HOTCHANDANI 8
9. RELATIONS OF DEEP FASCIAL SPACE
INFECTIONS OF HEAD & NECK
DR. SARANG SURESH HOTCHANDANI 9
10. RELATIONS OF DEEP FASCIAL SPACE
INFECTIONS OF HEAD & NECK
DR. SARANG SURESH HOTCHANDANI 10
12. Palatal space (sub periosteal space) – maxillary
lateral, premolar & molar.
Infra – orbital space
Swelling of anterior face
Nasolabial fold obliterated
Spontaneous drainage of this space infection occurs near to
medial or lateral canthus of the eye.
INFECTIONS ARISING FROM MAXILLARY TEETH
DR. SARANG SURESH HOTCHANDANI 12
13. Buccal Space
Swelling below zygomatic arch &
above the inferior border of
mandible.
Buccal space infection follows the
extension of the buccal fat pad into
the infraorbital, periorbital &
superficial temporal space.
Dimpled appearance over the
zygomatic arch.
Zygomatic arch and inferior border of
mandible remain palpable in buccal
space infection.
INFECTIONS ARISING FROM MAXILLARY TEETH
A, Buccal space lies between buccinator muscle and overlying skin
and superficial fascia. This potential space may become involved via
maxillary or mandibular molars (arrows).
B, Typical buccal space infection, extending from the level of the
zygomatic arch to the inferior border of the
mandible and from the oral commissure to the anterior border of the
masseter muscle. DR. SARANG SURESH HOTCHANDANI 13
14. It is the bottom portion of deep temporal space & lies posterior to maxilla.
Boundaries;
Medial – lateral pterygoid plate of sphenoid bone
Superior – base of skull
Lateral & superiorly – continuous with deep temporal space
Contents;
Branches of internal maxillary artery
Branches of pterygoid Venus plexus – emissary veins
Infra temporal space is the origin of the posterior route by which infection
spread to cavernous sinus.
It is rarely infected, if infection occurs; it is mostly from maxillary 3rd molar.
INFECTIONS ARISING FROM MAXILLARY TEETH
DR. SARANG SURESH HOTCHANDANI 14
15. The masticator space is bounded by the
fascia overlying the masseter muscle,
medial pterygoid muscle, temporalis
muscle, and the skull.
The superficial and deep temporal
spaces are separated from each other
by the temporalis muscle.
The lateral pterygoid muscle divides the
Pterygomandibular space from the
infratemporal portion of the deep
temporal space, and
the zygomatic arch divides the sub
masseteric space from the superficial
temporal space.
DR. SARANG SURESH HOTCHANDANI 15
16. • anteriorly via
the inferior or
superior
ophthalmic vein
or
• posteriorly via
emissary veins
from the
pterygoid
plexus.
HEMATOGENOUS
SPREAD OF
INFECTION FROM
THE JAW TO THE
CAVERNOUS
SINUS MAY
OCCUR
DR. SARANG SURESH HOTCHANDANI 16
17. Maxillary Sinus Infections
20% case of maxillary sinusitis are odontogenic
Odontogenic maxillary sinus infections may also spread superiorly through
ethmoid sinus or the orbital floor and cause secondary periorbital or orbital
infection.
Clinical Features of Periorbital or Orbital Infections;
Redness & swelling of eyelids
Displacement of pupil
Cavernous Sinus Thrombosis
Routes mentioned above.
Most vulnerable structure in cavernous sinus thrombosis – abducens 6th
cranial nerve.
INFECTIONS ARISING FROM MAXILLARY TEETH
DR. SARANG SURESH HOTCHANDANI 17
19. SUBMAXILLARY SPACES or PERIMANDIBULAR SPACE
It is one large space made of;
Submandibular
Sublingual
Submental space
Sublingual & submandibular spaces are infected by lingual perforation of
mandibular molars & premolars
If the perforation occurs above the mylohyoid muscle – sublingual space infection will
occur.
If the perforation occurs below the mylohyoid muscle – submandibular space infection
will occur.
Mostly infected by mandibular 3rd molar
INFECTIONS FROM MANDIBULAR TEETH
DR. SARANG SURESH HOTCHANDANI 19
20. Sublingual Space;
Little or no extra oral swelling in floor of mouth
Mostly bilateral infection
Elevated tongue.
INFECTION FROM MANDIBULAR TEETH
A, The sublingual space lies between
the oral mucosa and the mylohyoid
muscle. The space is primarily involved
by infection from mandibular premolars
and first molar.
B, Severe sublingual space abscess that
has elevated the tongue into the palate
such that only the ventral
surface of the tongue and floor of the
mouth are visible.
DR. SARANG SURESH HOTCHANDANI 20
21. Submandibular space (figure
17 – 15)
Swelling that look like an inverted
triangle
Base - inferior border of mandible
Sides – anterior & posterior bellies
of digastric muscle
Apex – hyoid bone
INFECTION FROM MANDIBULAR TEETH
The submandibular space lies between the mylohyoid muscle and
anterior layer of the deep cervical fascia, just deep to the platysma
muscle, and includes the lingual and inferior surfaces of the mandible
below the mylohyoid muscle attachment.
DR. SARANG SURESH HOTCHANDANI 21
24. Bilateral involvement of Perimandibular spaces.
Rapidly spreading cellulitis that can obstruct
airway and
Spread posteriorly to deep fascial spaces of
neck
LUDWIG ANGINA
DR. SARANG SURESH HOTCHANDANI 24
25. Sever swelling
Elevation & displacement of tongue
Tense, hard, bilateral induration of submandibular region superior to
hyoid bone.
Trismus, drooling, difficulty swallowing & breathing.
Upper airway obstruction
LUDWIG ANGINA CLINICAL FEATURES
DR. SARANG SURESH HOTCHANDANI 25
26. Compartments of masticators space;
Sub masseteric space
Pterygo mandibular space
Superficial temporal space
Deep temporal space
MASTICATOR SPACE
DR. SARANG SURESH HOTCHANDANI 26
27. b/w the masseter muscle & lateral surface of ascending ramus
Infected by;
buccal space infection
pericoronitis
mandibular angle fracture
Clinically
moderate to severe trismus due to inflammation of masseter muscle.
Obscured ear lobe due to swelling b/w the masseter muscle & lateral surface of
ascending ramus
SUB MASSETERIC SPACE
DR. SARANG SURESH HOTCHANDANI 27
28. b/w medial pterygoid muscle & medial surface of ascending ramus.
It is the site into which LA is given in IAN block.
Clinically
Trismus without swelling is diagnostic of Pterygomandibular space infection
Swelling and erythema of anterior tonsillar pillar on the affected side.
Deviation of uvula on opposite side of infection.
On CT examination, fluid collection detected b/w medial pterygoid muscle and the
mandible.
Airway is compressed & deviated
PTERYGO MANDIBULAR SPACE
DR. SARANG SURESH HOTCHANDANI 28
29. Rarely infected
Clinical Features;
Swelling in temporal region, superior to
zygomatic arch and posterior to lateral orbital
rim
Hourglass shape in frontal view.
SUPERFICIAL & DEEP TEMPORAL INFECTION
DR. SARANG SURESH HOTCHANDANI 29
30. The lateral pharyngeal space is located between the medial
pterygoid muscle laterally and the superior pharyngeal constrictor
medially.
The retropharyngeal and danger spaces lie between the pharyngeal
constrictor muscles and the prevertebral fascia.
The retropharyngeal space lies between the superior constrictor muscle and the
alar fascia.
The danger space lies between the alar layer and the prevertebral fascia.
DEEP CERVICAL FASCIAL SPACE INFECTION
DR. SARANG SURESH HOTCHANDANI 30
31. Infection usually comes from
Pterygomandibular, submandibular, sublingual
space.
Is made of two compartments;
Anterior compartment – loose C.T
Posterior compartment – carotid sheath, cranial
nerves (9th, 10th, 12th)
LATERAL PHARYNGEAL SPACE INFECTION
DR. SARANG SURESH HOTCHANDANI 31
32. Trismus – inflammation of medial pterygoid muscle
Lateral swelling of neck – b/w angle of mandible & S.C.M
Bulge toward midline – swelling of lateral pharyngeal wall
Difficulty swallowing, high temperature.
swelling of the anterior tonsillar pillar and blunting of the palate-vulvar fold.
Thrombosis of internal jugular vein
Erosion of carotid sheath
Airway is deviated to opposite side of infection.
LATERAL PHARYNGEAL SPACE INFECTION
(CLINICAL FEATURES)
DR. SARANG SURESH HOTCHANDANI 32
33. The retropharyngeal and the alar fascia fuse at a variable level
between the C6 and T4 vertebrae, which forms a pouch at the inferior
extent of the retropharyngeal space.
If infection passes through the alar fascia to the danger space, the
Postero-superior mediastinum will most likely soon become involved.
The inferior boundary of the danger space is the diaphragm, which
puts the entire mediastinum at risk.
This space contains only loose C.T and lymph nodes, so it provides
little barrier to spread of infection from one lateral pharyngeal space to
the other to encircle the airway.
The infection can rupture the alar fascia posteriorly to enter the danger
space
Prevertebral infections are usually caused by osteomyelitis of
vertebrae.
RETRO PHARYNGEAL SPACE
DR. SARANG SURESH HOTCHANDANI 33
34. This infection causes skin vesicle and then
a dusky purple discoloration of overlying
skin due to ischemia.
Later frank necrosis and undermining of
skin occur which require surgical
debridement of large areas of skin.
NECROTIZING FASCIITIS –
FLESH EATING BACTERIAL INFECTION
DR. SARANG SURESH HOTCHANDANI 34
Whether this infection become vestibular or deep fascial space abscess; it is determined by the relationship of attachment of nearby muscle to the point at which the infection perforate the facial cortical plate.
During an infection, the areolar connective tissue become greatly edematous in response to the exudation of tissue fluid (inoculation stage) and then become indurated when PMN leukocytes, lymphocytes, and macrophages migrate from blood into the infected fascial space. (cellulitis stage) Ultimately liquefactive necrosis of WBC and this connective tissue leads to abscess formation. (abscess stage).
Spontaneous or surgical drainage leads to resolution.
Buccal space is a portion of the subcutaneous space, which extend from head to toe. Thus a long standing buccal space abscess tends to drain spontaneously through skin at its inferior extent near the inferior border of mandible.
(A, Adapted from Flint PW Haughey BH, Lund VJ et al, editors:
Cummings otolaryngology: Head and neck surgery, ed 5, Philadelphia, PA, 2010, Mosby. B, From Flynn TR: The swollen face. Emerg Med Clin North
Am 15:481–519, 2000.)