These areas are potential spaces between layers of fascia or compartments containing connective tissue

1. Presented by-
Dr. himanshu gorawat
Dental surgeon

2. Introduction to Fascial Spaces
 These areas are potential spaces
between layers of fascia or
compartments containing connective
tissue.

3. Organization of Cervical Fascia
 Superficial fascia
 Deep fascia
1. Superficial layer (anterior)
2. Pretracheal fascia (middle layer)
3. Prevertebral fascia (posterior deep
layer)

4. Classification of Fascial Spaces
 Based on mode of involvement:-
• Vestibular
• Buccal
• Canine
• Infratemporal
Maxillary
• Vestibular
• Submental
• Submandibular
• Sublingual
Mandibular
Masseteric space
• Superficial and deep
temporal
Pterygomandibular space
• Carotid sheath space
Lateral pharyngeal space
Retropharyngeal space

5. Based on Clinical
Significance:-
 Face – Buccal, Canine, Parotid, Masticatory.
 Suprahyoid- Sublingual, Submental,
Submandibular, Lateral pharyngeal,
Peritonsilar.
 Infrahyoid- Pretracheal.
 Spaces of total neck- Retropharyngeal,
space of Carotid Sheath.

6. Routes of Spread and Factors
Affecting
 By direct continuity
 By lymphatics
 By the blood stream
General factors
 Host’s resistance or immunocompetence of host.
 Virulence
Local factors
 Alveolar bone
 Periosteum
 Adjacent Muscles and Fascia

7. Host versus Microbe
Relationship

8. Functions of Fascia
 Acts as a Musculovenous Pump.
 Limits outward expansion of muscles as they
contract.
 Contraction of muscle compresses the
intramuscular veins.
 Determine the direction of spread of infection.

10. Canine Space
 It is the region between anterior surface of
maxilla and overlying levator muscles of upper lip
 Contents:- Angular artery and vein Infraorbital
nerve
 Neighboring spaces:- Buccal spaces
 Etiology :- Periapical abscess of maxillary canine
& 1st premolar infection & sometimes
mesiobuccal root of first molars.

11.  Boundaries :-
 Superiorly : Levator superioris , levator labii
superioris and zygomaticus minor muscle
 Inferiorly: caninus muscle
 Medially : anterolateral surface of maxilla
 Posteriorly : buccinator muscles
 Anteriorly : orbicularis oris muscle

12. Clinical features :-
1. Swelling of cheek, lower eyelid & upper lip.
2. Drooping of angle of mouth.
3. Nasolabial fold obliterated
4. Oedema of lower eyelids
5. Redness and marked tenderness of facial tissue.
6. Chronic stage– chronic fistula
7. Intraoral –mobile, tender to percussion

13. Treatment:-
 Antibiotic prophylaxis
 Incision is made intraorally high in the
maxillary labial vestibule.
 A curved mosquito forcep is inserted
 Pus is evacuated and drain is inseted and is
secured to one of the margins with a suture.

14. 2.Buccal space
 It is the potential space between buccinator
and masseter muscle.

15.  Etiology :-
 Infected mandibular & maxillary premolars and
molars.
 Boundaries
 Superiorly:- zygomatic process, zygomaticus
major and zygomaticus minor muscle.
 Inferiorly :- Inferior border of mandible and
depressor anguli oris.
 Laterally: forward extension of deep fascia from
parotid gland, latysma muscle.
 Anteromedially: buccinator muscle
 Posteriomedially:- masseter overlying the anterior
border of ramus of mandible.

17.  Contents:-
 Buccal fat pad
 Stenson’s duct
 Facial artery
 Clinical features :-
 Obliteration of nasolabial fold.
 Angle of mouth shifted to opposite side.
 Swelling in cheek extending to corner of
mouth.
 Buccal space associated with temporal space
– “Dumbell appearance” due to lack of swelling
over the zygomatic arch.

18.  Differential diagnosis:-
 Cellulitis
 Erysypelas
 Crohn’s disease (Recurrent Buccal Abscess)
 Neighboring spaces :-
 Infratemporal
 Pterygomandibular
 Infraorbital

19. Treatment:-
 Antibiotics prophylaxis
 Incision and drainage

20. Infratemporal space
 Boundaries:-
 Superiorly: infratemporal surfaces of greater
wing of sphenoid bone
 Inferiorly:- lateral pterygoid muscle
 Laterally:- temporalis tendon & coronoid process
 Medially :- lateral pterygoid plate & lateral
pharyngeal wall.
 Posteriorly:- condyle & lateral pterygoid muscles
 Anteriorly:-infratemporal surface of maxilla &
posterior surface of zygomatic bone.

21. Submental space
 Boundaries:-
 Roof:- mylohyoid muscle
 Inferior:-deep cervical fascia, platysma,
superficial fascia & skin
 Laterally:- anterior belly of digastric
muscle.
 Posteriorly:- submandibular space

23.  Etiology:-
1. Infected mandibular incision
2. Anterior extension of
mandibular space
 Clinical features:-
1. Chin appears glossy and
swollen.
2. Pain & discomfort on
swallowing.
3. Anterior teeth are either
non-vital/fractured/carious.
4. TOP positive and mobile
tooth.

24. Treatment
 Antibiotic prophylaxis
 Incision and drainage

25. Sublingual Space
 Boundaries:-
 Superiorly:Mucosa of floor of mouth
 Inferior:mylohyoid muscle
 Posteriorly:body of hyoid bone
 Anteriorly & Laterally: inner aspect of
mandibular body.
 Medially: Geniohyoid, Styloglossus,
Genioglossus muscle

26.  Etiology:-
 Infected mandibular incisors, canines, premolars &
1st molars.
 Clinical features:-
1. Firm, painful swelling of floor of mouth.
2. Elevated tounge (pushed superiorly)
3. Pain and discomfort on swallowing.

27. Treatment:-
 Antibiotic prophylaxis
 Incision is made intraorally over lingual sulcus at
the base of the alveolar process.
 Hemostat is passed beneath sublingual gland in
an antero-posterior dissection and drain is
placed.
 When infection crosses midline, same incision is
made bilaterally, hemostat is passed through
floor of mouth from one side to other & drain is
placed.

28. Submandibular Space
 Boundaries:-
 Superiorly : mylohyoid muscles, inferior border of
mandible.
 Inferiorly: anterior & posterior belly of digastric
muscle.
 Laterally: hyoglossus, styloglossus, mylohyoid
muscle.
 Medially: deep cervical fascia, platysma,
superficial fascia & skin
 Anteriorly: submental space

30.  Etiology:-
1. Infected mandibular 3rd molar
2. Pericoronitis
3. Infected needles or contaminated LA solution
 Clinical features:-
1. Firm swelling in submandibular region.
2. Some degree of tenderness
3. Redness of overlying skin
4. Teeth sensitive to percussion
5. Dysphagia
6. Moderate trismus

31.  Spread of infection:-
 Superiorly to infra temporal spaces
 Medially to lateral pharyngeal space
 To submandibular space on contralateral side
 Submental space
 Clinical features:-
1. Swelling begins at lower border of mandible
extends to the level of hyoid bone in a shape
of inverted cone.

32. Submandibular space infection

33. • Temporal space:-
•Involvement is secondary to the initial
involvement of pterygopalatine and
infratemporal space.
•Anatomy:-
•Fascial spaces in relation to temporalis
muscle
 Two in number:-
 Supperficial temporal:- lies b/w temporal
fascia & temporalis muscle.
 Deep temporal:-lies deep to the temporalis
muscle and the skull.

34.  Clinical features:-
1. Trismus
2. Pain
3. Swelling below the temporal region may or
may not be present.

35. Parotid space
•The infection spread by 3 way:-
•Either blood-brone, or occur as retrograde infections through
the stenson’s duct.
•Gland is strongly connected with parotid fascia & there is very
little amount of loose connective tissue. This makes extension of
odontogenic infection in to the parotid space usually very
difficult.
•Gland is contiguous to submassetric, pterygomandibular and
lateral pharyngeal spaces; and on rare occasions the parotid
space can be involved by an odontogenic infection from one of
these spaces.

36. •ANATOMY:-
•Formed by splitting of the superficial layer of deep
cervical fascia surrounding the parotid gland,
• lies posterior to the masticatory space
•Inferiorly :- stylomandibular ligament, which
separates parotid space from the mandibular space.
 C/F:-
 Severe pain, referred to the ear and is accentuated by
eating.
 Swelling over the masseter muscle.
 There is escape of pus from the stenson’s duct, when
gland is milked.

37.  Spread:-Submasseteric space,
Pterygomandibular space,
Lateral pharyngeal space

38. Masticatory Spaces
 COMPRIES OF FOLLOWING SPACES:-
 1.PTERYGOMANDIBULAR
 2.SUBMASSETERIC
 3.TEMPORAL-SUPERFICIAL TEMPORAL
 4.DEPP TEMPORAL OR SUBTEMPORAL
ALL spaces are well differentiated and communicate
with buccal , submandibular , and parapharyngeal
spaces.

39.  ANATOMY:-
 Space is diveded in to 2 by the ramus of
mandible:-
 1.lateral compartment
 2. medial compartment
 Superficial layer lies along lateral surfaces
of masseter and lower half of temporalis
muscles.
 It is also attached with periosteum of
zygoma and temporalis fascia and
pterygoid muscles than base of skull.
 Also borders the number of spaces like;
 Parotid space
 Parapharyngeal
 Submandibular & sublingual spaces.

40. Sub Masseteric space:-
•Masseter muscle has 3 layers which are fused anteriorly.
•Space is present b/w middle and deep heads, while bony insertion
is firm above and below, the intermediate fibers have only a loose
attachment.
•This fibers easily separated from bone by the accumulation of
pus at the site.
•When the pus is accumulated b/w ramus of mandible and
masseter muscle, it produce a submasseteric space abscess.
•INVOLVEMENT:-
•Infection orignates from lower 3rd molar
•Either resulting from:-
• 1.) pericoronitis related with vertical or distoangular 3rd molar
•2.)periapical abscess spreads subperiosteally in a distal direction.

41. ANATOMY:-
•Anterior:- anterior border of masseter and buccinator
•Posterior:- parotid gland and posterior part of masseter
•Inferior:- attachment of the masseter to the lower border of
mandible.
•Medial:- lateral surface of the ramus of mandible.
•Lateral:- medial surface of the masseter muscle.
•C/F:-
•External facial swelling is moderate in size and is confined to the
outline of the masseter muscle.
•Tenderness over the angle of the mandible.
•Almost complete limitation of mouth opening.
•Pyrexia and malaise
•Necrosis of the muscle

42. Pterygomandibular Space:-

 Involvement:-
 1.)Pericoronitis related to mandibular 3rd
molar.
 2.)Use of contaminated needle for an
inferior alveolar nerve block.
 3.)Originate from the maxillary 3rd molar
by PSA nerve block.

43.  ANATOMY:-
 Lateral:- medial surface of ramus
 Medial:-lateral surface of medial pterygoid
muscle.
 Posterior:-parotid gland
 Anterior:- pterygomandibular raphae.
 Superior:-lateral pterygoid muscle forms
roof to the pterygomandibular space.

44. Clinical features:-
1. Severe degree of limitation of mouth
opening.
2. Dysphagia
3. Medial displacement of the lateral wall of
pharynx,redness and edema of the area
around the 3rd molar.
4. Midline of the palate is displaced to the
unaffected side and the uvula is swollen.
5. Difficulty in breathing.

45. 6.Parapharyngeal spaces:-
•They include lateral pharngeal and retropharngeal spaces. These
are the major pathways for spread of head and neck infections.
•Communicate directly with both submandibular spaces
anteroinferiorly and retromandibular space posteriorly.
•
 Lateral pharyngeal space:-
 It is a potential cone shaped space or cleft with its base
uppermost at the base of skull and its apex at the greater
horn of hyoid bone
 Divided in to two by styloid process, as anterior and
posterior compartment.

46. Involvement:-
 It is involved from abscess extending from
lower 3rd molar.
 Then it spread from sublingual,
submandibular , and pterygomandibular
space infection.
 Lateral spread from tonsillar abscess.Due to
the surgical displacement of mandibular 3rd
molar distally and its root dislodged into the
space.

47. Clinical Features
 Generalized septicemia and respiratory embarrassment
due to edema of larynx.
 Malaise and pyrexia.
 Anterior compartment:-
 1.Extraoral:-
 brawny induration of the face, above the angle of the
mandible. Induration may spread.
 2.Intraoral:-
 Anterior part of the lateral pharyngeal wall may be swollen,
 Trismus
 Sever pain(collection of pus b/w medial pterygoid and
superior constrictor.)
 Dysphagia

48. •Posterior compartment:-
•Septicemia
•Slight pain
•Little or no trismus
•External swelling present
•Swelling of lateral part of neck
•Internal swelling involves the lateral wall of
pharynx

49.  SPREAD:-
 BRAIN ABSCESS, MENINGITIS OR SINUS THROMBOSIS.
 SPREAD IN TO CAROTID SHEATH TOWARDS MEDIASTINUM, A
PATHWAY WHICH MOSHER CALLED THE ”LINCHOLN’S
HIGHWAY” OF THE NECK.