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Space infection
- 1. ODONTOGENIC INFECTION OF HEAD AND NECK PRESENTED BY Sauvik Singh PG RESIDENT HDCH
- 2. CONTENTS • INTRODUCTION • DEFINITION • DEEP FASCIA • CLASSIFICATION • PATHWAY OF SPREAD • SPACES: PRIMARY & SECONDARY • COMPLICATION • BIBLIOGRAPHY
- 3. Introduction • Fascia- dense connective tissue which separates structures during movement • Fascial spaces -Pathway of least resistance for spread of infections.
- 4. Fascia • Anterior • Middle • Posterior 1)Investing fascia 2)Parotidomassetric 3)Temporal Muscular 1.Sternohyoid-omohyoid division 2.Sternothyroid-thyrohyoid division Visceral 1.Buccopharyngeal Fascia 2.pretracheal 1) Alar division 2) Prevertebral division SuperficialDeep
- 6. MODE OF INVOLVEMENT 1º maxillary spaces 1º mandibular spaces 2º fascial spaces • Submental • Submandibular • Sublingual • Buccal • Massetric • Pterygomandibular • Sup. & deep temp. • Lateral pharyngeal • Retropharyngeal • Prevertebral • Parotid space •Canine • Buccal • Infratemporal
- 8. Microbiology
- 9. PATHWAYS • PERIODONTAL PATHWAY • PERIAPICAL PATHWAYS • PERICORONAL ORIGIN
- 10. STAGES OF INFECTION • INOCULATION • CELLULITIS • ABSCESS • RESOLUTION
- 11. Antibiotics • Out patient – Pencillin – Clindamycin – Cephalexin • Inpatient – Clindamycin – Ampicillin+metranidazole – Ampicillin+sulbactum • Newer antibiotic – Moxifloxacin – Macrolides(azithromycin)
- 14. VESTIBULAR SPACE • space between the vestibular mucosa and the underlying muscles of facial expression • EXTRACTION/RCT • INCISION OVER THE MAIN BODY OF THE EDEMATOUS TISSUE
- 15. • BETWEEN PALATINE MUCOSA AND PALATINE BONE • ARISES FROM PALATAL ROOTS OF MAXILLARY PREMOLARS AND MOLARS • WELL LOCALISED SWELLING • EXTRACTION/RCT • INCISION
- 24. TRISMUS
- 40. Lateral pharyngeal space • Suprahyoid • or Parapharyngeal space • Superior—skull base • Inferior—hyoid • Anterior—ptyergomandibular raphe • Posterior—prevertebral fascia • Medial—buccopharyngeal fascia • Lateral—superficial layer of deep fascia
- 42. Lateral pharyngeal space • Communicates with several deep neck spaces. – Parotid – Masticator – Peritonsillar – Submandibular – Retropharyngeal
- 43. Treatment • Absolute airway control • Aspiration • Anterior compartment drained via trans oral approach • Posterior also involved extra oral submandibular approach
- 44. Retropharyngeal Space • Entire length of neck. • Anterior border - pharynx and esophagus (buccopharyngeal fascia) • Posterior border - alar layer of deep fascia • Superior border - skull base • Inferior border – superior mediastinum – Combines with buccopharyngeal fascia at level of T1-T2 • Midline raphe connects superior constrictor to the deep layer of deep cervical fascia. • Contains retropharyngeal nodes.
- 45. CLINICAL FEATURES • DYSPHAGIA • DYSPNOEA • BULGING OF POSTERIOR PHARYNGEAL WALL • NECK STIFFNESS
- 46. Treatment • Extraoral through carotid triangle through lateral aspect of thyroid cartilage medial to carotid sheath • Intraoral through vertical incision in mucosa of pharyngeal wall and blunt dissection through superior pharyngeal constrictor and into the space
- 47. Danger Space • Entire length of neck • Anterior border - alar layer of deep fascia • Posterior border - prevertebral layer • Extends from skull base to diaphragm • Contains loose areolar tissue.
- 48. Clinical features • Dyspnoea • Chest pain • Hot potato voice • Pleural effusion • Mediastinal abscess formation • Empyema • pericarditis
- 49. Treatment • Same as retropharyngeal space • Once in the space advance dissection through the alar fascia
- 50. Carotid sheath abscess • Extends from jugular foramen and carotid canal to mediastinum • Tender swelling on lateral aspect of neck • Complications include spread to chest and septic venous thrombosis • Drainage is from incision in anterior lateral neck and exploration of carotid sheath
- 52. (A) Gillies incision; (B) submental incision; (C) submandibular incision; (D) anterior sternocleidomastoid muscle (SCM) incision; (E) transcervical mediastinum incision; and (F) posterior SCM incision
- 53. Principles of DRAINAGE • MOST DEPENDENT PART • IF IT IS MOST PROMINET PART THEN COUNTERINCION ON MOST DEPEDENT PART • PASSIVE DRAINAGE • BREAK THE LOCULE VIA SINUS FORCEP OR INDEX FINGER • DRAIN • C AND ST
- 54. COMPLICATION Ludwigs angina • Involves submandibular ,sublingual and submental spaces bilaterally. • Characeristically brawny hard swelling • Floor of the mouth elevated • Difficulty with respiration • Edema of the glottis
- 55. Treatment • Early airway establishment • Bilateral drainage of the spaces • OLDER • NEWER • BROAD SPECTRUM ANTIBIOTICS • DEXA-CONTOVERSY
- 57. • ROUTES Cavernous sinus thrombosis
- 58. Cavernous sinus thrombosis • C/F-
- 60. Treatment • Early high dose of antibotics • Heparinization-CONTROVERSY
- 62. Necrotizing fascitis CAUSE C/F T/t REMOVAL OF GANGENROUS TISSUE HYDROGEN PEROXIDE+BETADINE
- 63. Mediastinitis CAUSE- Radiograph Drainage through cervicomediastinal route And trans thoracic approach
- 66. In 1999, FLYNN and collegues
- 67. CONCLUSION • Early recognition of orofacial infections and prompt appropriate therapy is absolutely essential. A through knowledge of anatomy of face and neck is necessary to predict pathways of spread of infection and drain the spaces adequately. Otherwise the infection spread to such an extent causing considerable morbidity and occasional death.
- 68. Bibliography • Surgical pathology ---fonseca • Oral and maxilloacial infections—topazian • Principles of oral and maxillofacial surgery— peterson • Textbook of oral surgery –daniel laskin • Clinics of north america –space infection