1. The document describes various fascial spaces of the head and neck region, including the buccal space, submandibular space, sublingual space, and others. 2. Causes of infections in these spaces include odontogenic sources from infected or necrotic teeth, trauma, systemic diseases like diabetes, and more. Infections can spread between spaces through direct continuity, lymphatics, or veins. 3. Specific spaces like the buccal space, submandibular space, and sublingual space are described in more detail, including their boundaries, contents, blood supply, and clinical signs of infection within each space.

1. 

2. “
1. Buccal space
2. Masticator Space
3. submandibular space
4. The pharyngeal mucosal space
5. lateral pharyngeal space
6. Retrophanygeal space
7. Parotid space
8. Sublingual Space
9. Submental Space
10.prevertebralspace

5. "Classificationof Fascial Spaces"
• Primary spaces.
• Secondary spaces."
"Based on mode of involvement
• Canine
• buccal
• infratemporal"
"Primary maxillary
• submental
• sublingual
• buccal
• submandibular"
"Primary mandibular
• masseteric
• pterygomandibular
• superficial & deep temporal
• lateralpharyngeal
• retropharyngeal
• parotid
• prevertebral"
"Secondary spaces

6. “Causes of fascial Infections:
I - Odontogenic Causes
II - Traumatic Causes
III - Chemical Causes
IV - General Systemic Diseases
I- Odontogenic Causes
• 1 - Periapical infection from non vital tooth or roots
• 2 - Deep periodontal pockets
• 3 - Pericoronitis
• 4 - Infected dental cysts
• 5 - Odontogenic tumors
II - Traumatic Causes
• 1 -Improper use of surgical burs : necrosis , Sloughing & osteomyelitis
• 2 - Pressure type of anesthesia : In subperiosteal injections, the periosteum
is raised ,so cutting of the blood supply & necrosis occur .
• 3 - Compound fracture of the jaw: If there is infection between the fracture
site & the external environment; infection may occur.
III – Chemical Causes:
• Chemical materials used in dentistry such as arsenic used for pulp
mumification cause Pulp necrosis &Infection.
IV - General Systemic Diseases:
• Blood dyscrasis ( agranulocytosis)
• Uncontrolled diabetes
• Nutritional disorders
• Endocrine disturbances
• Malignancies
• Immunological disorders ( AIDS )”

7. “Propagation of fascial Infections:
1- The most frequent is spread by direct continuity .
2- Through lymphatic vessels resulting in metastatic inflammation of regional
lymph nodes.
3- By the involvement of the veins .

8.  “Maxillary Spaces
1- Base of upper lip
2- canine fossa
3- Buccal space
4- Palatal space
5- Postzygomatic & infratemporal space”
 “Mandibular spaces
1- Pterygomandibular
2- Submandibular
3- Sublingual
4- Submental
5- Submasseteric
6- Parapharyngeal
7- Parotid”

10. Abscess of the Buccal space:
Causes
 Spread of infection from the upper / lower
molars.
Surgical anatomy
 Anteriorly: Buccinator muscle
 Posteriorly: Anterior ramus of the mandible,
Masseter, Medial pterygoid muscles.
 Above: Zygomatic processof the maxilla
 Below: Deprossoranguli oris
Clinical signs
 Moderate swelling of the cheeck.
 Bulging of the buccal mucosa( gum boil )
 Swelling begin at the inferior border of the mandible and extend
upwards to the level of zygomatic arch”

12. “MAXILLARY SPACE INFECTION
I-Absess Of Base Of Upper Lip
Causes:
 Infection from upper incisors.
Anatomy :
Clinical signs:
1- Oedema & cellulitis of the upper lip
2- Extensive swelling of the entire lip and may project in a trunk like fashion .
3- Swelling of the side of the nose and lower eyelid.
Complications (FATAL FASCIAL SPACE)
 The infection may spread through the labial venous plexus to the facial vein & travel
upward through the ophthalmic vein ( they are valveless ) to the cavernous sinus causing
Cavernous sinus thrombosis”

13. “II-Abscess of the canine fossa:
Causes:
1. Infection from upper canine or premolars .
2. Occasionally spread of infection from the mesiobuccal root of the upper 1st molars
3. Maxillary sinusitis
Surgical anatomy:
.”

14. “III-infratemporal space/ Retro-zygomatic space:
Causes:
1- Infection of maxillary teeth extending above the buccinator muscle:
Infection spreads into the infratemporal space producing osteomyelitis of
the ascending ramus OR spreads into the postzygomatic space producing
osteomyelitis of the coronoid process .
2- Pericoronal infection of the mandibular 3rd molar: Infection originating
in the pterygomandibular space may ascend into the infratemporal fossa.
Surgical Anatomy :
- The infratemporal space lies below the horizontal plane of the zygomatic arch
- It is bounded by :
- It is transversed by :
 Internal maxillary artery
 Mand., myelohyoid , lingual nerves
 Pterygoid venous plexus (FATAL)
- The postzygomatic space is considered as a part of the temporal space
since it extends from it at the anterior medial angle .
- It is also called pterygomaxillary fossa .
- It lies directly behind the maxilla and zygomatic bone .
- It contains * The coronoid process

15. * The insertion of temporalis muscle”
“Complications:
It is a very dangerous space because :
- It contains the pterygoid venous plexus which has connecting valveless veins to
the cavernous sinus .
- Direct spread of infection through the foramen oval or foramen lacerum
(foramina present in the infratemporal fossa ) to the middle cranial fossa .”

16. MANDIBULAR SPACES
“
a. “Description:
 The masticator space are suprahyoid cervical spaces on each side of the
face represented as pairs. Each space is enclosed by the layer of the deep
cervical fascia.
 At the lower border of the mandible,the superficial layer of this fascia
separates into two layers:
 An inner layer related deeply to the medial pterygoid muscle and confers
to the skull base medial toforamen ovale.
 An outer layer covering masseter and temporalis muscles and on the
superior attaching to the parietal calvaria”

17. “Contents
 Masticator muscle.
 ramus and body of mandible”
“Blood and nerve supply:
 It is innervated by the mandibular division of the trigeminal nerve
(Vc)1 and inferior alveolar nerve.
 It is supplied by the inferior alveolar artery and vein”
c. “Boundaries and relations
 buccal space from the anterior surface.
 parotid space from the posterolateral surface.
 parapharyngeal space from the medial surface.”

18. d. “Communications
 Malignancy or cancerous tumors are initiated from the mandibular
division of the trigeminal nerve to the middle cranial fossa. The
corresponding spread is perineural.Related pathologies are revealed by
certain osteromyelities, odontogenic abscess and lymphoma and many
others.”

19. “
Causes
1- Infected lower 3rd molar particularly those of the distoangular
direction .
2- Fracture ramus of the mandible .
Surgical anatomy:
 Medially: Lateral surfaceof the ramus .
 Laterally: Middle partof masseter muscle .
 Posteriorly: Fibromuscular sheetseparating it from the parotid gland.
 Anteriorly:Anterior border of the ramus”

20. “
Causes:
1- Acute infection around a lower 3rd molar ( e.g. pericoronitis )
2- Backward spread of submandibular or sublingual space infections .
3- Posterior spreading of infection from pterygomandibular space .
4- Downward spreading of infection from infratemporal space to
pterygomandibular space to parapharyngeal space.
Surgical anatomy
 It is an inverted cone shape , it’s base is toward the skull & the apex is
at the greater horn of the hyoid bone .
Boundaries:
“Complications:
It is a fatal space because:
1- Brain abscess , meningitis , cavernous sinus thrombosis through spread of
the infection via the various foramina of the skull .
2- Lung abscess due to the involvement of the carotid sheath .
3- Thrombophlebitis of the internal jugular vein evident by repeated rigors .
4- Errosion of the common carotid artery.”

23. “
a. Description
 The submandibular space is a U-shaped compartment of the suprahyoid neck that is
enclosed by the superficial layer of the deep cervical fascia.
b. Boundaries
It is bounded by :
 Medially Mylohyoid, hyoglossus &
styloglossus muscles
 Laterally Skin , superficial fascia & platysma
 Inferiorly Digastric muscle
 Superiorly Medial aspect of the mandible &
Attachment of mylohyoid muscle
a. Contents
 superficial portion of the submandibular
gland
 it is supplied by the facial artery and vein
 fat
 submandibular lymph nodes
 It is innervated by the inferior loop of the hypoglossal nerve.
b. Relations
 Medially: submental space
 Superiorly the sublingual space is detached by the mylohyoid muscle, the
submandibular space is continuous with the sublingual space around the posterior
edge of mylohyoid
 Related pathologies are revealed by certain types of abscess,diving ranula…”

24. “

25. “Causes of submandibular infection:
1- Infection from lower molars particularly the 3rd molar and often the 2nd
molar because ( their roots are under the myelohyoid muscle )
2- Fracture of the angle of the mandible.
3- Backward extension from submental space or sublingual space.
4- Lymphatic spread from submandibular lymph nodes.”
Differential diagnosis:
1- Branchial cyst is a developmental non odontogenic Cyst .
2- Malignant involvement of lymph nodes ( hard & fixed ).
3- Hodgkin’s disease & leukemia”

26. Causes:
1- Itis not infected directly fromdental sepsis, itmay be involved in septic
fractures of the ascending ramus of the mandible .
2- Secondary infection fromparapharyngealspace.
Surgical anatomy:

27. “
Causes:
 Odontogenic infection from lower incisors , canine or premolars because Their
roots pass above the myelohyoid muscle .
Surgical anatomy :
 It lies above the myelohyoid muscle .
 It contains the sublingual salivary gland.
It is bounded by :
 Medially: Geniohyoid muscle &Genioglossus
muscle
 Laterally: Lingual side of the mandible
Differential Diagnosis:
1- Ranula Retention cyst due to the obstruction or
stenosis of the main salivary gland duct .
2- Dermoid cyst
3- Developmental cyst”

28. “
Causes
 Odontogenic infection from lower anteriors and premolars below the myelyhyoid
muscle .
 Lymphatic spread from submental lymph nodes.
Surgical anatomy:
 It contains the submental lymph nodes & communicates posteriorly with the
submandibular lymph nodes .
It is bounded by :
 Above: Myelohyoid muscle
 Below: Deepfascia , platysma muscle
 Laterally : Anterior bellies of digastric
Differential diagnosis
1- Dermoid cyst
2- Thyroglossal duct cyst”

29.  It is a diffuse facial cellulitis of the submental , sublingual & submamdibular spaces
bilaterally.
 It might be caused by dental infection or an extraoral infection such as infected wounds
or cuts in the skin .
True Ludwig’s angina
 Bilateral involvement of submental , sublingual
&Submandibular spaces
 Prognosis is unfavorable
False Ludwig’s angina ( pseudo)
 Unilateral involvement of submental , sublingual
&submandibular spaces
 The prognosis is favorable

30. Complications
• The infection may spread to :
 Posteriorly Parapharyngeal &
Pterygomandibular spaces .
 Lateral Submasseteric space .
 Downward Submandibular space .

31. “
Causes:
1- Necrotic pulp of a dead tooth or root .
2- Deep periodontal pockets through gingival crevice .
 The infection will spread in all directions but preferring the least
resistance pathway .
 The infection penetrate the medullary bone of the jaw to the cortical bone
then to the periosteum Abscess is then formed either intra or extraorally
according to the muscle attachment affected .
 Infection from mandibular 1st molar penetrate the periosteum lingually
affecting the myelohyoid muscle :
• If infection is above the muscle Intraoral abscess
• If infection is below the muscle Extraoral abscess
 Infection from maxillary 1st molar penetrate the periosteum buccally
affecting the buccinator muscle :
- If infection is below the muscle Intraoral abscess
- If infection is above the muscle Extraoral abscess”