Fascial spaces are potential spaces that exist between the fasciae and underlying organs and other tissues.infection of orofacial & neck region, particularly those of odontogenic origin,have been one of the most common diseases in human being.

1. Fascial space infections

2. Fascial spaces are potential spaces that exist between the fasciae
and underlying organs and other tissues.infection of orofacial & neck
region, particularly those of odontogenic origin,have been one of the
most common diseases in human being.
 IT IS BASED ON THE ORIGIN OF THE INFECTION.
1. ODONTOGENIC:(I)PULP DISEASE, (II) PERIODONTAL DISEASE, (III) SECONDARILY INFECTED CYSTS
OR ODONTOMES, (IV) REMAINING ROOT FRAGMENT, (V) RESIDUAL INFECTION, AND (VI) PERICORONAL
INFECTION
2.TRAUMA.
3.TRAUMA FROM PENETRATING WOUNDS OF SOFT AND HARD TISSUES OF THE FACE CAN LEAD TO
OROFACIAL INFECTION.
4. RECONSTRUCTIVE SURGERY.
5.IMPLANT SURGERY.
ETIOLOGY

3. 5. Infections arising from contaminated needle punctures
 ON THE BASIS OF CAUSATIVE ORGANISMS:
1. BACTERIAL INFECTIONS
2. FUNGAL INFECTIONS
3. VIRAL INFECTIONS
 BASED ON THE MODE OF INVOLVEMENT
I. DIRECT INVOLVEMENT PRIMARY SPACES (A) MAXILLARY SPACES (B) MANDIBULAR SPACES.
II. INDIRECT INVOLVEMENT: SECONDARY SPACES.
 SPACES INVOLVED IN ODONTOGENIC INFECTIONS:
A. PRIMARY MAXILLARY SPACES: CANINE, BUCCAL, AND INFRATEMPORAL SPACES.
B. PRIMARY MANDIBULAR SPACES: SUBMENTAL, BUCCAL, SUBMANDIBULAR, AND
SUBLINGUAL SPACES.
C. SECONDARY FASCIAL SPACES: MASSETERIC, PTERYGOMANDIBULAR,
SUPERFICIAL AND DEEP TEMPORAL, LATERAL PHARYNGEAL, RETROPHARYNGEAL,
AND PAROTID SPACE.
Classification of Fascial Spaces

4.  Based on Clinical Significance:
I. FACE—BUCCAL, CANINE, MASTICATORY, PAROTID
II. SUPRAHYOID—SUBLINGUAL, SUBMANDIBULAR, LATERAL PHARYNGEAL.
III. INFRAHYOID—ANTEROVISCERAL (PRETRACHEAL)
IV. SPACES OF TOTAL NECK—RETROPHARYNGEAL, SPACE OF CAROTID SHEATH.

5. Buccal Space
• ANTEROMEDIALLY:BUCCINATOR MUSCLE
• POSTEROMEDIALLY:MASSETER OVERLYING THE ANTERIOR BORDER OF RAMUS OF
MANDIBLE
• LATERALLY:BY FORWARD EXTENSION OF DEEP FASCIA FROM THE CAPSULE OF
PAROTID GLAND AND BY PLATYSMA MUSCLE.
• INFERIORLY:LIMITED BY THE ATTACHMENT OF THE DEEP FASCIA TO THE MANDIBLE
AND BY DEPRESSOR ANGULI ORIS.
• SUPERIORLY:THE ZYGOMATIC PROCESS OF THE MAXILLA AND THE ZYGOMATICUS
MAJOR AND MINOR MUSCLES.
• BUCCAL PAD OF FAT.
• STENSON‘S (PAROTID )DUCT.
• FACIAL ARTERY.

6.  Infected maxillary & mandibular pre-molar & molars.
•OBLITERATION OF NASO-LABIAL FOLD
•ANGLE OF THE MOUTH SHIFTED TO OPPOSITE SIDE.
•SWELLING IN THE CHEEK EXTENDING TO CORNER OF
MOUTH
•BUCCAL SPACE ASSOCIATED WITH TEMPORAL SPACE-
DUMB BELL SHAPED APPEARENCE DUE TO LACK OF
SWELLING OVER ZYGOMATIC ARCH.
Etiology
Clinical Features:

7. infratemporal space
• SUPERIORLY-BY INFRATEMPORAL SURFACE OF GREATER WING OF
SPHENOID,AND BY ZYGOMATIC ARCH.
• INFERIORLY-LATERAL PTERYGOID MUSCLE.
•MEDIAL WALL-UPPER HALF OF LATERAL
PTERYGOID PLATE.
•LATERAL WALL-MEDIAL SURFACE OF THE
RAMUS OF MANDIBLE.
•ANT.WALL-POSTERIOR SURFACE OF MAXILLA.
•POST.WALL-PAROTID GLAND.
Boundaries:

8. •Mandibuar Nerve & its Branches.
•Maxillary Artery.
•Pterygoid Venous Plexus.
•INFECTED MAXILLARY 3RD MOLAR.
•INFECTED NEEDLE
 EXTRA ORAL SWELLING OVER SIGMOID NOTCH AREA.
 INTRA ORAL SWELLING IN TUBEROSITY AREA.
 TRISMUS
Content
Etiology
Clinical features

9. • Superiorly-Temporal space.
• Inferiorly-
pterygomandibular Space
↓
pterygoid Venous Plexus
↓
Brain(cavernous Sinus)
↓
Sigmoid sinus
↓
Jugular vein
↓
Superior vena cava
↓
heart
spread of infection:

10. Canine Space
Content
Etiology
Clinical Features

11. levator labi superioris alaque nasi, levator labi superioris
Boundaries-

12. •Roof:mylohyoid muscle.
•floor:anterior & posterior belly of digestric
muscle.
•laterally:superiorly- medial surface of the
body of mandible below mylohyoid line.
•medially:mylohyoid & hyoglossus muscle.
•Inferiorly :Skin & Platyzma.
submandibular space infection
BOUNDARIES

13. •sub mandibular gland.
•facial vein & artery.
•infected mandibular 2nd & 3rd molars.
•sub lingual spaces.
•ACROSS MIDLINE TO CONTRALATERAL SPACE.
•To contiguous pharyngeal space
CONTENTS
ETIOLOGY
SPREAD OF
INFECTION

14. •ROOF:Lateral pterygoid muscle.
•FLOOR:Medial pterygoid muscle.
•MEDIAL WALL:lower portion of lateral
pterygoid plate
•LATERAL WALL:Medial wall of the ramus
of the mandible.
•ANT.WALL:pterygomandibular raphy
•POST.WALL:parotid gland
•Infected mandibular 3rd molar
•Pericoronitis.
pterygomandibular space
BOUNDARIES
ETIOLOGY:

15. •Inferior alveolar nerve
•Lingual Nerve & Artery
•Superiorly-Infra Temporal Space
•nferiorly-Sub Mandibular Space
•absence of extra oral swelling.
•Severe Trismus.
•Difficulty in Swallowing.
CONTENTS:
Spread of infection
Clinical Features:

16. •Superiorly:Mucosa of floor of Mouth.
•Inferiorly:Mylohyoid Muscle.
•Posteriorly:Body of Hyoid bone.
•Anteriorly & laterally:Inner Aspect of
Mandibular Body.
•Medially:Geniohyoid,Genioglossus,
Styloglossus Muscle.
SUBLINGUAL SPACE
BOUNDARIES

17. •Deep Part of submandibular gland
•wharton's duct
•Sublingual Gland
•Terminal Branches Of Lingual Artery.
•Infected Mandibular Premolar &1st Molar.
•Swelling Of Floor Of Mouth.
•Elevated Tongue
•Pain & Discomfort On Swallowing.
Contents:
Etiology
Clinical
Feature

18. •Rubor-(Redness)Cutaneoussurface involved due to vasodilation
effect of inflammation.
•Tumor-(swelling)Due to the accumulation of pus or fluid exudate.
•Calor-(Heat)Is the result of increased blood flow to the area due to
the vasodilation.
•Dolor-(Pain)Results from pressure on sensory nerve endings from
tissue distention caused by edema or infection.
•Functiolaesa-(loss of function)Problem th Function.
Clinical features

19. •Lymphadenopathy.
•Halitosis.
•Fever & Headache.
•Presence of Draining Sinuses/Fistula.
•Increase Salivation.
•Trismus.
•Difficulty in Swallowing.
•Changes in Phonation.

20. Specific Labratory Investigations:
-OPG
-skull view of the mandible
-CT Scan
-Culture Sensitivity
Routine Labratory Investigations:
-CBC
-ESR
-S.Electrolyte
-RBS
investigation

21. -Correction of Dehydration.
-Administration of emperical antibiotic
-Culture Sensitivity
-Incision & Drainage(source should be removed)
-Specific Antibiotic
-Hospitalization (If Not Corrected)
TREATMENT

22. •parenteral Penicillin.
•Metronidazole in combination with penicillin can be used in severe infections.
•Clindamycin for Penicillin Allergy Patients.
•Cephalosporins.
•Causes for clinical failure include inadequate Drainage or Antibiotic
Resistance.
SELECTION OF ANTIBIOTIC THERAPY

23. •Primary Goal-In surgical management is to remove
cause of infection.
•Secondary Goal-Is to provide drainage of accumulated pus
& necrotic debris.
Extraction Provides both removal of couse of infection and
drainage of pus & debris.
SURGICAL MANAGEMENT

24.  Incision & Drainage Hepls-
•To get rid of toxic purulent material.
•To Decompress Odematous Tissue.
•To allow better perfusion of blood,Containig
Antibiotics & DEfensive Elements.
•To Increase Oxygenation of infected Area.
Removal Of The Couse :Such As Infected Tooth.A Segment of Necrotic
Bone,a foreign body should be done at the time of Incision & Drainage
Procedure
Incision & Drainage

25. •Topical anaesthesia:Topical anesthesia is achieved with the help of
ethyl chloride spray.
•Stab Incision:Made Over A Point Of Maximum Fluctuation in The most
dependent area along the skin creases, through skin & Subcutaneous
tissue.
•If pus is Not encounterd,further deepening of surgical site is achieved
with sinus forcep.
•Closed forceps are pushed through the tough deep fascia and
advanced towards the pus collection.
•Abcess cavity is entered and forceps opened in a direction parallel to
vital structure.
•pus flows along side of the beaks.
•Explore the entire cavity for additional loculi.
Hilton's Method Of Incision & Drainage

26. •Placement of drain:A corrugated rubber drain is inserted into the
depth of the cavity and fixed with the help of suture.
•Drain left for atleast 24 hours.
•Dressing:Dressing is applied over the site of incision taken
extraorally without pressure.

27. •Canine,Sublingual abscesses are Drained Intraorally.
•Messeteric,Pterygomandibular,Buccal & Lateral Pharyngeal space
abscesses Can Be Drained With Combination Of Intraoral & Extraoral
Drainage.
•Temporal,Submandibular,Submental,Retropharyngeal & Parotid Space
Abcesses May Mandate Extraoral Incision and Drainage.
Drainage of Facial Spaces