This document discusses the principles of treating abscesses and phlegmons in the maxillofacial region. It covers the definition of infection and types of infections like bacterial, fungal, and viral. The most common causes are odontogenic infections from dental issues. Key anatomical spaces discussed include the canine fossa, buccal space, and submental space. Treatment principles involve incision, drainage, determining bacteria, and antibiotic therapy. Specific techniques are described for accessing and draining infections in the canine fossa, buccal space, and submental region.

1. PRINCIPLES OF TREATMENT
OF ABSCESS AND
PHLEGMONS OF
MAXILLOFACIAL REGION
Kritika
Singh
Parth
Parmar

2. INFECTION
• Definition: Infection is the pathological state
resulting from the invasion of the body by
pathogenic microorganisms
.•The reaction of the tissues to the presence of
these microorganisms and the toxins generated
by them is INFLAMMATION

3. TYPES OF INFECTION
• Bacterial Infection: not only one particular
specie, but due to a mixture of species which
make up the oral flora
.• Fungal Infection: Actinomycosis
• Viral Infection: Not recognized because they
are complicated early by secondary bacterial
infection
.Parasitic infection: Very rare( ex. Lyshmoniasis)

4. ETIOLOGY OF INFECTION
The majority of oral, facial, and neck infections
are odontogenic in origin.
Although they may be caused by infections
from
• Antrum (maxillary sinus)
• Major salivary glands
• Specific Infections of jaws
(osteoradionecrosis, osteomyelitis)

5. ODONTOGENIC CAUSES OF
INFECTIONS
1. Decay (caries) reaching the dental pulp= pulpitis,
this in turn spreads to supporting bone resulting in
periapical abscess which in turn may spread
subperiosteally
2. Periapical abscess may occur in seemingly intact
but devitalized teeth (trauma, cracks or decay under
fillings)
3. Periodontal diseases
4. Erupting teeth (especially partially impacted lower
third molars) can result in inflammation and infection

6. PREDISPOSING FACTORS FOR
ACUTE ORAL INFECTIONS
1 Endocrine disturbances
II. Nutritional deficiency (decreases resistance)
III. Chemical compounds used in dentistry (arsenic)
IV. Blood disorders (leukemia, anemia)
V. General diseases (syphilis, TB)
VI. Immunological diseases (AIDS)
VII. Trauma - Fractures of jaw,Pressure type of
anesthesia, Improper use of surgical burs without
cooling

7. MICROBIOLOGY
Odontogenic infections are multimicrobial:
• Gram (+) cocci, aerobic and anaerobic:
• Streptococci and their anaerobic counterpart,
peptostreptococci
• Staphylococci, and their anaerobic counterpart, peptococci
• Gram (+) rods:
• Lactobacillus, diphtheroids, Actinomyces
• Gram (-) rods:

8. RATE OF SPREAD OF INFECTION
Rate depends on:
• Virulence of the invading microbes
• Dosage or number of these microbes
• Host resistanceSeverity of
infection=(Virulence x Dose)/Resistance

9. CLINICALLY ODONTOGENIC
INFECTIONS CAN BE
DISTINGUISHED IN THREE
PERIODS:
• Period of periapical of dento-alveolar abscess (in
which the initial lesion develops)
• Period of extension to the adjacent bone and facial
spaces
• Period of serious complications (embolism,
septicemia, pyemia)

10. ANATOMICAL FACTORS
INFLUENCING THE DIRECTION OF
SPREAD WITHIN TISSUE
1. The site of the source of infection (maxilla or
mandible and even the particular segment of the jaw)
.2. The point at which pus escapes from the bone and
discharges into the soft tissues (linguopalatally or
labiobuccally).
3. The natural barriers to the spread of pus in the
tissues, such as by layers of fascia or muscle or the
jaw bones themselves.

11. FACIAL SPACES
Fascial spaces are fascia-lined areas that can be
eroded or distended by purulent exudate
.• These areas are potential spaces that do not
exist in healthy people but become filled during
infections.

12. PRINCIPLES OF TREATMENT OF
OROFACIAL INFECTIONS
1. Remove the cause.
2.Establish drainage.
3.Institute antibiotic therapy.
4.Supportive care, including proper rest and nutrition.

13. BASIC PRINCIPLES OF LOCAL
TREATMENT
Surgical treatment of abscess and phlegmon is based
on the pus drainage, and therefore in all cases the
following steps should be followed.
1. Incision
2. Opening the abscess
3.Taking of smear to determine the bacteria
4.Drainage of abscess

14. ABSCESS OF OROFACIAL SPACES

15. CANINE FOSSA(INFRA-ORBITAL)
Borders:
• Superior: inferior margin of the orbit
• Inferior: alveolar process of maxilla
Mesial: margin of periform aperture
• Lateral: zygomatic-maxillary suture

16. CANINE FOSSA INFECTION
Odontogenic origin:
maxillary canines and premolars
Nonodontogenic:
• Skin infections
• TraumaHematoma
Infection can be superficial (due to dermatologic
infections) or can be deep (between muscles and
bone-odontogenic infection), and the infections
quickly spreads from superficial to deep and vice

17. CLINICAL PRESENTATION (CANINE
FOSSA)
Edema, localized in the infraorbital region, which
spreads towards the lower eyelid and side of the nose
as far as the corner of the mouth
.• There is also obliteration of the nasolabial fold, and
somewhat of the mucolabial fold.
• The edema at the infraorbital region is painful and
there is fluctuation during palpation, and later on the
skin becomes taut and shiny due to suppuration, while
its color is reddish(fig)

18. TREATMENT OF CANINE FOSSA
ABSCESS
1. The incision for drainage is performed intraorally at
the mucobuccal fold (parallel to the alveolar bone), in
the canine region.
2. A hemostat is then inserted, which is placed at the
depth of the purulent accumulation until it comes into
contact with bone, while the index finger of the
nondominant hand palpates the infraorbital margin.
3. Finally, a rubber drain is placed, which is stabilized
with a suture on the mucosa.

19. BUCCAL SPACE
Borders:
• Superior: inferior margin of zygomatic arch
Inferior: Inferior margin of mandible
Anterior: Corner of the mouth
Posterior: anterior margin of Masseter muscle
Internal: Buccinator muscle
Layers:
• SkinSuperficial fascia
Buccinator muscle

20. BUCCAL SPACE INFECTION
Odontogenic: (most frequently)maxillary and
mandibular posterior teeth.
Nonodontogenic: adenophlegmon of facial lymph
nodes.
*Secondary spread of infection:
• Superiorly: pterygopalatine space
• Inferiorly: pterygomandibular space

21. CLINICAL PRESENTATION OF
BUCCAL ABSCESS
• Swelling of the cheek, which extends from the
zygomatic arch as far as the inferior border of the
mandible, and from the anterior border of the ramus
to the corner of themouth
.• The skin appears taut and red, with or without
fluctuation of the abscess.
• There can be intraoral bulging.

22. TREATMENT OF BUCCAL SPACE
ABSCESS
Access to the buccal space is usually intraoral for three main
reasons:
1. Because the abscess fluctuates intraorally in the majority of
cases.
2 . To avoid injuring the facial nerve.
3. For esthetic reasons.
The intraoral incision is made at the posterior region of the
mouth, in an anteroposterior direction and very carefully in
order to avoid injury of the parotid duct. A hemostat is then
used to explore the space thoroughly.
An extraoral incision is made when intraoral access would not

23. SUBMENTAL SPACE
Borders:
• Lateral: anterior bellies of the right and left Digastric
muscles
• Anterior: internal border of corpus of mandible
• Posterior: Hyoid bone
• Roof: Mylohoid muscle
• Lower margin: Skin and Platysma muscle

24. SUBMENTAL SPACE INFECTION
Odontogenic: from frontal teeth of the mandible
Nonodontogenic: adenophlegmon or trauma
*Secondary spread: from submandibular or sublingual
spaces

25. CLINICAL PRESENTATION OF
SUBMENTAL ABSCESS
Edema in submental region which can spread to
submandibular space.
• Palpation is painful and fluctuation is present
• Hyperemia of skin
• Functional disturbances in protrusion of the jaw
• Dysphagia or discomfort while swallowing can be
present.

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