Space infections of the head and neck are common in oral and maxillofacial practice. While most infections can be managed successfully with minimal complications, some can cause serious morbidity or death depending on the virulence of microorganisms and host resistance. Bacterial infections have the potential to spread beyond the bony confines of jaw bones into surrounding soft tissues. It is important for oral and maxillofacial surgeons to understand the anatomy of fascial spaces and spread of infection to properly manage infections and prevent complications.

2. Space infections of head and neck are very
common in Oral and maxillofacial practice. Although
most of the infections can be managed successfully
with minimal or no complication, some can produce
serious morbidity or even death.
Depending on the virulence of
microorganisms and host resistance, bacterial
infections have the potential to spread beyond the
bony confines of jaw bones into surrounding soft
tissues.

3.  Acts as a musculovenous pump-
 Limits outward expansion of muscles as they
contract.
 Contraction of muscles compresses the intramuscular
veins (push the blood towards the heart).
 Determine the direction of spread of infection

4. Definition -
The fascial spaces in head and neck are the
potential spaces between the various layers of
fascia normally filled with loose connective
Tissue and bounded by anatomical barriers, usually
of bone, muscle or fascial layers.

5. GRODINSKY AND HOLYOKE (1938)
Space 1 – Superficial to superficial fascia
Space 2 – Group of spaces surrounding cervical strap muscles
lying superficial to sternothyroid-thyrohyoid division
of middle layer of deep cervical fascia.
Space 3 – Space lying superficial to visceral division of middle
layer of deep cervical fascia
Space 3A – Carotid sheath space or viscerovascular space
(Lincoln’s High way)
Space 4 – Space lies between alar & prevertebral division of
posterior layer of deep cervical fascia (Danger space)
Space 4A – Posterior triangle space posterior to carotid sheath
Space 5 - Prevertebral space
Space 5A- Space enclosed by Prevertibral fascia.

6. 1. Direct Involvement. (Primary Spaces)
 Maxillary Spaces – Canine, buccal infratemporal
 Mandibular Spaces – Submental, Submandibular,
Sublingual, Buccal
2. Indirect involvement (Secondary Spaces)
 Masseteric
 Pterygomandibular
 Superficial and deep temporal
 Lateral and retro pharyngeal
 Prevertebral, parotid, carotid sheath,peritonsillar and
danger spaces.

8. BOUNDARIES:-
 ANTERIORLY :-Corner of mouth
 POSTERIORLY:-
Masseter muscle, Pterygomandibular
space
 SUPERFICIAL- skin and Subcutaneous
tissue
 DEEP- Buccinator muscle
 SUPERIORILY - Maxilla, Infraorbital
space
 INFERIORLY - Lower border of
mandible.
The buccal space occupies the portion of subcutaneous
space between the fascial skin and buccinator muscle.

9. Infection from maxillary premolars, molars and
mandibular premolars
Relation of root with buccinator muscle

10. Clinical features:
Dome shaped swelling on the
anterior aspect of cheek
extending anteroposteriorly
from corner of mouth to angle of
mandible and superoinferiorly
from level of zygomatic arch to
inferior border of mandible.
When pus accumulates on oral
side of muscle,gum boil is seen
in the vestibule.

11. CONTENTS OF BUCCAL SPACE:-
 Buccal pad of fat
 Stensons (Parotid duct)
 Anterior and transverse facial artery and vein.
MUSCLE RELATED – Buccinator muscle
Neighboring spaces- Infraorbital, pterygomandibular,
infratemporal space

12.  Antibiotic prophylaxis.
 Intra oral horizontal
vestibular incision.
 Extra oral incisions below
the lower border of the
mandible with No. 11 blade.
 Drainage – Hemostat is
passed from anterior incision
and taken out from the
posterior incision then the
rubber drain is inserted and
secured with pins and
dressing is done.

13. Boundaries –
Anteriorly –orbicularis oris
Posteriorly- Buccinator
Medially – anterolateral
surface of maxilla
Superiorly – levator labii
superioris,levator labii
superioris alaque nasi
&zygomaticus minor
muscles
Inferiorly - caninus muscle

14.  Maxillary canine, rarely from maxillary first
premolar.
 Rarely from nasal & upper lip infections.

15.  Clinical features:
 Swelling lateral to the
nose over cheek.
 Obliteration of the
nasolabial fold,
 Swelling of the upper
lip,
 Oedema occurs in lower
eyelid leading to closure
of eye.

16. Contents – Angular artery and vein,
Infraorbital nerve
Neighboring spaces – Buccal space

17.  Antibiotic prophylaxis
 Incision is made intraorally high in the
maxillary labial vestibule.
 Small hemostat is inserted through levator
anguli oris into abcess cavity.
 Drainage with drain secured.

18. Boundaries –
 Superiorly & Laterally  Temporal fascia
 Inferiorly – Zygomatic arch
 Medially Lateral surface Temporalis
muscle
Cause
 Infection from maxillary and mandibular
molars.

19. Clinical evaluation:
•swelling above &
below the zygomatic
arch causing a dumbell
shaped
appearance
• Severe pain & trismus

20.  Contents- Temporal fat pad, temporal
branch of the facial nerve.
 Neighboring spaces – Buccal , Deep
temporal.

21. Intraorally vertical incision made medial to the
upper extent of the anterior border of the
mandibular ramus.
 Haemostat  passed superiorily along the lateral
aspect of the coronoid process to enter superficial
temp. space
 Intra oral approach  good
 Extra-oral incision  horizontal incision
 Haemostat is passed medially to enter superficial
temporal space.
 Drainage  drain is placed, dressing is given.

22. Boundaries -
 Laterally  medial surface of temporalis m.
 Medially  Temporal bone
 Below the level of zygomatic arch both the
spaces communicate with each other and with
the infratemporal space.
Cause:Infection from maxillary molars

23. Mild swelling over temporal
Region.
Difficult to diagnose.

24.  Contents
 Pterygoid plexus, Internal maxillary artery and
vein.
 Neighboring Spaces
 Buccal, superficial temporal, inferior petrosal
sinus

25.  Intraorally vertical incision made medial to the
upper extent of the anterior border of the
mandibular ramus.
 Haemostat  passed supero-medially to enter
deep temporal space.
 Through blunt dissection deep temporal space
is approached through temporalis muscle
 Drainage  drain is placed, dressing is given.

26. BOUNDARIES
 Anteriorly, -Infratemporal surface of the maxilla
 Posteriorly,- parotid gland
 Superiorly, - Greater wing of the sphenoid below
the infratemporal crest
 Inferiorly, - lateral pterygoid muscle
 Medially - medial pterygoid plate,medial pterygoid
muscle,lateral pterygoid muscle
 Laterally, - Ramus of mandible,temporalis muscle

27.  Infection from maxillary molars

28.  Clinical features :
 Marked Trismus
 swelling of face in front of ear, over TMJ &
zygomatic arch
 Eye is closed and proptosed

29.  Contents
 Pterygoid plexus, Internal maxillary
artery and vein.
 Neighboring Spaces
 Buccal, superficial temporal, inferior petrosal
sinus

30.  Intraoral and extraoral approach
 Intraorally, incision is made into buccolabial
fold lateral to maxillary third molar.
(Kruger)
 Curved hemostat is inserted behind max.
tuberosity superomedially within the cavity
and drain is inserted.
 Intraorally vertical incision made medial to
the upper extent of the anterior border of the
mandibular ramus.(Laskin)
 Curved hemostat is passed superiorly into
infratemporal region and drain is inserted.

31.  Extraoral approach in presence of severe
trismus.
It consists of horizontal incision above the
zygomatic arch and then curved hemostat is
directed in inferior and medial direction to
enter infratemporal space followed by
insertion of drain.

32. Plain film. MRI

33.  Osteomyelitis
 Mediastenitis
 Brain abcess
 Meningitis
 Cavernous sinus thrombosis
 Scar formation
 Sinus tract formation

34. We being Oral & maxillofacial surgeons must
understand anatomy of fascial spaces, spread of
infection and proper management for the
prevention of further complications and betterment
of health of the patient.