Orofascial Space Infection

1. Primary FacialPrimary Facial
SpacesSpaces
Prepared By: Dr.Said Mir Shah HashemiPrepared By: Dr.Said Mir Shah Hashemi
SS

2. ContentsContents
 DefinitionDefinition
 ClassificationsClassifications
 Canine SpaceCanine Space
 Buccal SpaceBuccal Space
 Infratemporal SpaceInfratemporal Space
 Submandibular SpaceSubmandibular Space
 Submental SpaceSubmental Space
 Sublingual SpaceSublingual Space
 Medical ManagementMedical Management

3. Definition of Fascial SpacesDefinition of Fascial Spaces
 The fascial spaces are potential spacesThe fascial spaces are potential spaces
formed by the various fascial layer’sformed by the various fascial layer’s
division and different levels. They aredivision and different levels. They are
separated by pus, blood, drain or surgicalseparated by pus, blood, drain or surgical
instruments during surgery.instruments during surgery.

4. ClassificationClassification
 Topazian ClassificationTopazian Classification
1. Face1. Face
a)a) BuccalBuccal
b)b) CanineCanine
c)c) Masticatory ( Masseteric, Pterygoid,Masticatory ( Masseteric, Pterygoid,
Zygomaticotemporal)Zygomaticotemporal)
d)d) ParotidParotid

5. 2. Suprahyoid2. Suprahyoid
a)a) SublingualSublingual
b)b) Submandibular-submaxillary-submentalSubmandibular-submaxillary-submental
c)c) Lateral pharyngeal (pharyngomxillary)Lateral pharyngeal (pharyngomxillary)
d)d) PeritonsillarPeritonsillar

6. 3. Infrahyiod3. Infrahyiod
a)a) Anterovisceral(pretracheal)Anterovisceral(pretracheal)
b)b) RetrovisceralRetrovisceral

7. 4. Space of Total Neck4. Space of Total Neck
a)a) RetropharyngealRetropharyngeal
b)b) Danger spaceDanger space
c)c) Space of carotid sheathSpace of carotid sheath

8. According to involvement ofAccording to involvement of
spacesspaces
1. Primary Maxillary Spaces1. Primary Maxillary Spaces
a)a) Canine (infraorbital)Canine (infraorbital)
b)b) BuccalBuccal
c)c) InfratemporalInfratemporal

9. 2. Primary Mandibular Spaces2. Primary Mandibular Spaces
a)a) SubmentalSubmental
b)b) Sub mandibularSub mandibular
c)c) SublingualSublingual
d)d) BucallBucall

11. 3.3. Secondary Fascial SpacesSecondary Fascial Spaces
a)a) MassetericMasseteric
b)b) Superficial and deep temporalSuperficial and deep temporal
c)c) Lateral pharyngealLateral pharyngeal
d)d) RetropharyngealRetropharyngeal
e)e) PrevertebralPrevertebral

12. Canine spaceCanine space
Boundaries of Canine SpaceBoundaries of Canine Space
Superficial and Superior:Superficial and Superior: Quadratus labiiQuadratus labii
superiorissuperioris
Inferior:Inferior: Orbicularis OrisOrbicularis Oris
DeepDeep : Levator Anguli Oris, anteriior surface of max: Levator Anguli Oris, anteriior surface of max
Medial:Medial: Levator labii superioris alaeque nasiiLevator labii superioris alaeque nasii
Lateral:Lateral: Zygomaticus MajorZygomaticus Major

13. Areas of spread in infraorbitalAreas of spread in infraorbital
space infectionsspace infections

14. Angular artery & Vein
Infraorbital Nerve

15. Clinical FeaturesClinical Features
 Swelling of the cheek & Upper lipSwelling of the cheek & Upper lip
 Obliteration of the nasolabial foldObliteration of the nasolabial fold
 Oedema of the lower eyelidOedema of the lower eyelid

16. Surgical ManagementSurgical Management
 Incision IntraorallyIncision Intraorally
 Application of drainApplication of drain

17. Buccal SpaceBuccal Space
Superior:Superior: Zygomatic archZygomatic arch
Inferior:Inferior: Inferior border of mandibleInferior border of mandible
Anterior:Anterior: zygoma and dep anguli oriszygoma and dep anguli oris
Posterior:Posterior: masseter musclemasseter muscle
Medial:Medial: Buccinator Muscle & its fasciaBuccinator Muscle & its fascia
Lateral:Lateral: Skin and subcutaneous tissueSkin and subcutaneous tissue

18. Pathway of spread for buccalPathway of spread for buccal
space infectionspace infection

19. ContentsContents
 Adipose TissueAdipose Tissue
 Parotid DuctParotid Duct
 Anterior & Transverse Facial Artery & VeinAnterior & Transverse Facial Artery & Vein

20. Clinical Features:Clinical Features:
 Dome shape swellingDome shape swelling
Surgical Management:Surgical Management:
 Extra OralExtra Oral
 Intra OralIntra Oral

21. Infratemporal SpaceInfratemporal Space
 Superior:Superior: Skull base sphenoid crestSkull base sphenoid crest
 Inferior:Inferior: Lateral Pterygoid muscleLateral Pterygoid muscle
 Medial:Medial: Lateral Pterygoid plateLateral Pterygoid plate
 Lateral:Lateral: Temporal Muscle & tendonTemporal Muscle & tendon
 Anterior:Anterior: Maxillary tuberosityMaxillary tuberosity
 Posterior:Posterior: Mandibular CondyleMandibular Condyle

22. ContentsContents
 Internal Maxillary ArteryInternal Maxillary Artery
 Pterygoid venous plexusPterygoid venous plexus
 Mandibular division of trigeminal nerveMandibular division of trigeminal nerve

23. Neighboring SpaceNeighboring Space
 Buccal SpaceBuccal Space
 Superficial Temporal SpaceSuperficial Temporal Space
 Inferior Petrosal Sinus SpaceInferior Petrosal Sinus Space

24. Clinical FeaturesClinical Features
 SwellingSwelling
 TrismusTrismus
 Proptosed eyeProptosed eye

25. Surgical ManagementSurgical Management
 Extraoral ApproachExtraoral Approach
 Intraoral ApproachIntraoral Approach

26. Submandibular SpaceSubmandibular Space
 Lateral:Lateral: Skin, Fascia & PlatysmaSkin, Fascia & Platysma
 Medial:Medial: Mylohoid, Hyoglo, Stylo & Sup.Mylohoid, Hyoglo, Stylo & Sup.
CoCo
 Superior:Superior: Mandible & MylohyoidMandible & Mylohyoid
 Inferior:Inferior: DigastricDigastric

27. Pathways of spread of submandibularPathways of spread of submandibular
space infection from mandibular molarspace infection from mandibular molar

29. ContentsContents
 Submandibular salivery gland &lymphSubmandibular salivery gland &lymph
nodesnodes
 Facial ArteryFacial Artery
 Lingual ArteryLingual Artery

30. Neighboring SpacesNeighboring Spaces
 SublingualSublingual
 SubmentalSubmental
 Lateral PharyngealLateral Pharyngeal
 BuccalBuccal

31. Clinical FeaturesClinical Features
 SwellingSwelling
 Restriction of Mouth OpeningRestriction of Mouth Opening

32. Surgical ManagementSurgical Management
 IncisionIncision
 DrainageDrainage

33. Submental SapceSubmental Sapce
 Superior:Superior: Mylohoid MuscleMylohoid Muscle
 Inferior:Inferior: Skin & Subcutaneous tissue,Skin & Subcutaneous tissue,
platysma & deep cervical fasciaplatysma & deep cervical fascia
 Medial:Medial: Single Medline SpaceSingle Medline Space
 Lateral:Lateral: Ant. Belly of digastric (bilateral)Ant. Belly of digastric (bilateral)
 Anterior:Anterior: MandibleMandible
 Posterior:Posterior: Hyoid boneHyoid bone

34. Contents:Contents:
 No Vital StructuresNo Vital Structures
 Lymph Nodes & Ant. Jugular VeinsLymph Nodes & Ant. Jugular Veins
Neighboring SpaceNeighboring Space
 Submandibular SpaceSubmandibular Space

35. Clinical FeaturesClinical Features
 SwellingSwelling

36. Surgical ManagementSurgical Management
 Bilateral IncisionBilateral Incision
 DrainageDrainage

38. Sublingual SpaceSublingual Space
 Superior:Superior: Mucosa of the floor of the mouthMucosa of the floor of the mouth
 Inferior:Inferior: Sup. surface of mylohyoid muscleSup. surface of mylohyoid muscle
 Medial:Medial: Medline RaphaeMedline Raphae
 Lateral:Lateral: Medial surface of mandibleMedial surface of mandible

39. Contents:Contents:
 Submandibular & Sublingual Glands & theirSubmandibular & Sublingual Glands & their
draining ductsdraining ducts
 Lingual NerveLingual Nerve
Neighboring Spaces:Neighboring Spaces:
 Submandibular spaceSubmandibular space
 Lateral Pharyngeal SpaceLateral Pharyngeal Space

40. Clinical Features:Clinical Features:
 SwellingSwelling

41. Surgical ManagementSurgical Management
 Intraoral IncisionIntraoral Incision
 Extraoral IncisionExtraoral Incision
 DrainageDrainage

42. Medical ManagementMedical Management
 PenicillinPenicillin
 ClindamycinClindamycin
 CephalosporinCephalosporin

43. Antibiotic therapy, con’tAntibiotic therapy, con’t ..
 ErythromycinErythromycin
 MetronidazoleMetronidazole
 AugmentinAugmentin

44. Supportive CareSupportive Care
 To ensure the patient’s maximumTo ensure the patient’s maximum
immune response:immune response:
 Increase fluid intake (16 ounces/hour).Increase fluid intake (16 ounces/hour).
 Nutritional intake (soups, protein drinks,Nutritional intake (soups, protein drinks,
solids) with three meals/day.solids) with three meals/day.
 May need to see patient daily, untilMay need to see patient daily, until
resolution has begun.resolution has begun.

45. ReferenceReference
 S.M Balaji 2013. Text book of Oral &S.M Balaji 2013. Text book of Oral &
Maxillofacial Surgery. In: Head and NeckMaxillofacial Surgery. In: Head and Neck
Space infection. 2Space infection. 2ndnd
edi. A division of Reededi. A division of Reed
Elsevier India. Pp. 477-495:24.Elsevier India. Pp. 477-495:24.