The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Micro vascular free flaps used in head and neck reconstruction /certified fi...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Micro vascular free flaps used in head and neck reconstruction /certified fi...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
orthognathic surgery is very intresting and well knowing branch in oral surgery ....this presentation is dealing with jaw correction surgery in upper jaw.
Detailed discussion on diagnosis and management of TMJ ankylosis. Surgical anatomy and applied aspects of TMJ is discussed. Reconstruction of ramus-condyle unit is also discussed. Compications of TMJ surgery are also discussed
Space infection 2 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. There are four pairs of air sinuses making the boundaries of the nasal cavity. Maxillary sinus is the largest air cell. Anatomy and physiology of the maxillary sinus are given. Maxillary sinusitis is an inflammation of the sinus. Odontogenic causes represent nearly 30% of the etiology. Clinical and radiographic examinations are discussed together with treatment plan.
Oro-antral fistula is a rare complication of surgery at the posterior maxillary region. Several techniques for closure are presented. Additionally, information about sinus lift procedure is given.
Space infection /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
orthognathic surgery is very intresting and well knowing branch in oral surgery ....this presentation is dealing with jaw correction surgery in upper jaw.
Detailed discussion on diagnosis and management of TMJ ankylosis. Surgical anatomy and applied aspects of TMJ is discussed. Reconstruction of ramus-condyle unit is also discussed. Compications of TMJ surgery are also discussed
Space infection 2 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. There are four pairs of air sinuses making the boundaries of the nasal cavity. Maxillary sinus is the largest air cell. Anatomy and physiology of the maxillary sinus are given. Maxillary sinusitis is an inflammation of the sinus. Odontogenic causes represent nearly 30% of the etiology. Clinical and radiographic examinations are discussed together with treatment plan.
Oro-antral fistula is a rare complication of surgery at the posterior maxillary region. Several techniques for closure are presented. Additionally, information about sinus lift procedure is given.
Space infection /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Compartments of the head and neck /certified fixed orthodontic courses by I...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Space infection. by Dr. Amit T. Suryawanshi, Oral Surgeon, Pune All Good Things
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best.
Space infection. by Dr. Amit Suryawanshi .Oral & Maxillofacial Surgeon, Pun...All Good Things
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
Copy of sequlae of odontogenic infections / dental implant coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
INFRATEMPORAL FOSSA AND PTERYGOPALATINE FOSSA NEW.pptxSudin Kayastha
INFRA TEMPORAL FOSSA
Irregularly shaped space deep & inferior to zygomatic arch, deep to ramus of mandible & posterior to maxilla
Communicates with temporal fossa through interval between (deep to) zygomatic arch & (superficial to) cranial bones
Temporal fossa is superior to zygomatic arch In
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Leader in continuing dental education
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+919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Properties of Denture base materials /rotary endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Spaces of head&neck &infections /certified fixed orthodontic courses by Indian dental academy
1. SPACES OF
HEAD AND NECK
AND INFECTIONS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
3. INTRODUCTION
The infection in orofacial region does not
spread haphazardly through the loose
connective tissue, but tends to accumulate in
these potential spaces around the head and
neck. Many of these spaces communicate
with each other.
www.indiandentalacademy.com
4.
Fascia:- It is defined as a broad sheet of
dense connective tissue whose function is to
separate structure that must pass over each
other during movement such as muscles &
glands and serve as a pathway for the course
of vascular &neural structure
Definition:- Shapiro defined facial spaces as
“potential spaces between the layers of the
fascia”. These area are normally filled with
loose connective tissue which readily breaks
down when invaded by infection.
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5. Fascia is described under:1) Superficial fascia
2)Deep fascia
Superficial fascia:
-Similar to subcutaneous
tissue
-Ensheathes platysma
and muscles of facial
expression
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6.
Deep fascia:- In the neck the deep fascia upon
dissection forms several more or less distinct layers.
They are:a) Superficial or anterior or investing layer.
b) Middle or pretracheal layer.
c) Posterior or prevertebral layer.
d) Carotid sheath.
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9. Midline layer:- it is the part of the anterior layer of
deep fascia that passes behind the strap muscles.
It is divided into 3 divisions:
1)sternohyoid – omohyoid
2)sternothyroid – thyrohyoid
3)visceral and buccopharyngeal
The 1st two divisions surround the corresponding strap
muscles of the neck between hyoid bone and
clavicle.
The primary surgical significance of these layers is
they must be divided in the midline in a surgical
approach to trachea or thyroid gland.
www.indiandentalacademy.com
10.
These are not usually involved in oro-facial
infections.
Third division has clinical significance because
- below the hyoid bone the visceral layer
surrounds the trachea oesophagus and thyroid
gland.
- above the hyoid bone the visceral fascia wraps
around the lateral and posterior side of the pharynx,
lying on the superficial side of pharyngeal constrictor
muscle – known as buccopharyngeal fascia.
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11.
The deep neck spaces –
1)retropharyngeal
2)lateral pharyngeal
3)pre tracheal spaces all lie on the
superficial side of visceral division of the
middle layer of the deep cervical fascia.
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12. Posterior layer:- the posterior layer of the deep
cervical fascia has two divisions
1) the alar
2) the prevertebral
The alar fascia passes through the transverse process
of the vertebrae on either side, posterior to the
retropharyngeal fascia.
In the vertical dimension the posterior layer extends
from the base of the skull to diaphragm.
The alar fascia fuses with retropharyngeal fascia at a
variable level between 6th cervical and 4th vertebrae.
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13.
This fusion forms the bottom of the retropharyngeal space.
Infection of the retro-pharyngeal space may
rupture the alar fascia, thus entering the
danger space , which is continuous with the
posterior mediastinum.
The prevertebral fascia surround the vertebra
and the attached postural muscles of the
neck & back
Prevertebral fascia is usually not invaded by
infection arising in maxillofacial regions.
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14. Carotid sheath:- Carotid sheath surrounding
IJV, CCA & vagus nerve is interposed
between the superficial and pretracheal layer
on the one hand and prevertebral layer on
the other.
Its anterolateral wall is infact the superior layer
of fascia deep to sternocleidomastoid muscle
and to a lesser extent, the pretracheal layer
where the infrahyoid muscle overlap the great
vessels.
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15.
The posterior wall is formed by a lamina
given off medially by the superficial layer as
the lather reaches the level of the vessels:
this lamina passes behind the vessels and
nerve to form the posterior wall of the sheath
and the medial wall of the sheath is then
completed by fascia passing from
anterolateral to the posterior wall between the
contents of the sheath and the trachea and
oesophagus.
The sheath is attached medially to the
prevertebral layer of fascia. The sympathetic
trunk lies behind it.
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16.
Spaces of the head and neck:Grodinsky and Holyoke in 1938, described these
potential spaces as follows:
1)Spaces 1- the potential space superficial and deep
to platysma muscle.
2)Spaces 2- the spaces behind the anterior layer of
deep cervical fascia.
3)Spaces 3- pretracheal spaces lies anterior to
trachea.
4)Spaces 3a- “lincoln’s highway”
5)Spaces 4- danger spaces is a potential spaces
between the alar &prevertebral fascia.
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17. Classification of fascial spaces:1. based on clinical significance:
a) Face – buccal, canine, maticatiory,
parotid.
b) Suprahyoid – sublingual, submandibular,
lateral pharyngeal, pretonsillar.
c) Infrahyoid – pretracheal.
d) Spaces of total neck – retropharyngeal,
space of carotid sheath.
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18. 2. Based on mode of involvement
a) direct involvement
primary spaces (i) maxillary spaces.
(ii) mandibular spaces.
b) indirect involvement: secondary spaces.
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19. MICROBIOLOGY OF ODONTOGENIC INFECTIONS:Usually the bacteria which causes infections are a
part of the indigenous flora and odontogenic infections
are no exception to this. 60% of all odontogenic
infections are caused by aerobic and anaerobic bacteria.
Only anaerobic make up about 35% and pure
aerobes, 5% only.
The commonly isolated organisms are
Aerobes
:
Anaerobes :
Streptococci (70%)
Staphylococci(6%)
Peptococci (11%)
Peptostreptococci (11%)
Bacteroides (34%)
Fusubacteria (13%)
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20. Pathways of odontogenic infection:Invasion of dental pulp by bacteria
Inflammation, edema, lack of collateral supply
Avascular necrosis
Reservoir of bacterial growth
Spreading to the surrounding bone
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21. Fistula
Cellulitis
Bacteremia – septicemia
Acute, chronic
periapical infection
Intra oral soft tissue
abscess
Osteomylytis
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Deep facial space
infection
Ascending fascial
cerebral infection
23. The spread can vary based on:
1) number and virulence of organism
2) host resistence
3) Anatomy of the involved area
The microbial factors include VIRULENCE and QUALITY.
Virulence refers to the inherent ability of a microbe to cause
infection. It is the sum total of all microbial quality which are
harmful to the host. To cause an infection the micro-organism
should be able to:
a) enter the host
b) multiply with in the host
c) at least temporarily, resist or not stimulate host
defences
d) cause damage to the host
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24. QUALITY refers to the number of micro organisms that initially
colonize the host.
The host factor defences consists of
a) Local defences
b) Humoral component
c) Cellular component
LOCAL DEFENCES consists of:a) Epithelial lining
b) Secretions and drainage systems
c) Mucosal immune system
d) Microbial flora interference
HUMORAL COMPONENT consists of:a) Immuno globulins
b) complement system
CELLULAR COMPONENT consists of Polymorphs & Lymphocytes.
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25. Radiological Examination
Conventional radiography:-Iopa
-OPG
- LateraL OBLIQUE VIEW
other Diagnostic Aids:
C.T. – Gold Standard in head and neck
infections
1. Showing complete extent of inflammatory process.
2. Difference between myositis – facitis and abscess formation.
3. Demonstrates status of airway and involvement of lymph nodes
4. Abscess drainage and drain placement can be done by C.T.
guidance.
M.R.I
fine needle aspiration
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26.
Canine space:
boundaries:
superiorly – quadratus labii superiories
inferiorly – orbicularies ori
deep – anterior surface of maxilla
medially – levator labii alaeque nasii
laterally – zygomaticus major
contents:
- angular artery & vein
- infra orbital nerve
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28.
Source of infection:
- maxillary canine
- first premolar
c/f:- - swelling of cheek and upper lip
- obliteration of nasolabial fold
- odema of lower eye lid
Treatment of canine space abscess:Incise high in the maxillary labial vestibule.
Hemostat advanced through levator anguli oris
muscle.
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29. Differential diagnosis of upper face infections
Dacrocystitis with
minimal involvement
of nasolabial fold.
Odontogenic cellulitis.
The nasolabial fold is
affected.
www.indiandentalacademy.com
31. Source of infection:-
max. bicuspid
max. molars
mand. Molars
mand. Bicuspids
c/f:- obvious and dome shaped over the cheek
from the zygomatic arch to the lower border
of the mandible.
Spread:- pterygomandibular space
infratemporal space
submasseteric space
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32. Buccal space
Clinical evaluation: Examination of the patient with the buccal space infection
demonstrate swelling confined to the cheek with abscess forming beneath the
buccal mucosa and bulging into the mouth.
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33. Treatment of buccal space abscess:Intra oral: horizontal incision just above the
depth of vestibule. Hemostat advanced
through the buccinator.
Extra oral: when fluctuance occurs ,it should
be drained percutaneously. Cutaneous
drainage should be performed inferior to point
of fluctuance.
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34. Infratemporal space or retro zygomatic space
Boundaries:Anteriorly – infratemporal surface of maxilla
posteriorly – mandibular condyle
superiorly – infra temporal crest of sphenoid
inferiorly – lateral pterygoid
medially – temporal tendon, coronoid process
laterally – lateral pterygoid plate
Contents:- pterygoid plexus
internal maxillary artery & vein
mandibular nerve
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36. Source of infection:max. molars
through infected needle
c/f:- swelling over the TMJ in front of the ear.
trismus.
intraoral swelling over the tuberosity area.
Spread:- extended upwards to involve temporal space.
inferiorly – pterygomandibular space.
upwards into cavernous sinus.
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37.
Treatment of infratemporal space abscess:Intra oral: Vertical incision is made just
lateral to the 3rd molar and medial to upper
extent of ramus.
Extra oral: horizontal incision parallel to the
junction of frontal & temporal processes of
zygoma (JUGAL POINT).
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41. c/f:- extra oral swelling confined to the
boundaries of masseteric muscle.
limitation of mouth opening
fluctuation is absent
pyrexia & malaise
Treatment of submasseteric space abscess:Intra oral: vertical incision along the external
oblique ridge.
Extra oral: incision made below and parallel
to angle of mandible.
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43. c/f: Trismus
Dysphagia
Midline of the palate is displaced to uneffected side,
uvula is swollen.
Medial displacement of lateral wall of pharynx.
Spread: Infra temporal fossa
Buccal space
Lateral & pterygoid space
Submandibular space
Treatment of pterygomandibular space abscess:
Intra oral: Incision along or medial to
pterygomandibular raphae.
Extra oral: Incision is made 1 inch below and
parallel to angle of mandible.
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44. Temporal space:It is secondary to the initial involvement of
pterygopalatine & infra temporal space.
Temporal pouches are facial spaces in relation to
the temporalis muscle.
They are two :(i) Superficial temporal space
(ii) Deep temporal space
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45. Contents:Superficial - Superficial temporal
vessel
Auriculo temporal nerve
Deep – deep temporal arteries & veins.
c/f:- Trismus
Swelling with in the outline of temporalis
Treatment of temporalis space abscess:Intra oral: Vertical incision is made just lateral to the 3 rd
molar and medial to upper extent of ramus.
Extra oral: horizontal incision parallel to the junction of
frontal & temporal processes of zygoma (JUGAL POINT).
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46. Parotid Space
Superficial layer of deep
fascia
Dense septa from
capsule into gland
Direct communication to
parapharyngeal space
Contains
External carotid artery
Posterior facial vein
Facial nerve
Lymph nodes
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47. Treatment of parotid space abscess:A retromandibular incision through the skin and super
fascia extending from inferior aspect of ear lobule to
angle of mandible.
Curved incision at the angle of the mandible.
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51. Contents:- Superficial lobe of submandibular salivary
gland.
Submandibular lymphnode
facial artery
c/f:- moderate trismus
dysphagia
mobility of teeth
sensitivity to percussion
Spread:- submental
submandibular space on contralateral side
sublingual
parapharyngeal space
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52. Treatment of submandibular space abscess:Two stab incision at the anterior and
posterior limit of the most dependent,
fluctuant portion of the swelling, placed in the
shadow of the mandible.
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53.
Submental:-
Boundaries:
lateral: lower border of mandible and anterior belly of digastric
muscle.
Superiorly: mylohyoid muscle
Inferiorly: deep fascia, platysma and skin
Contents: Submental lymphnodes – anterior jugular vein
c/f:- distinct ,firm swelling in midline, beneath the chin, skin
overlying the
fluctuation may be present
Treatment of submental space abscess:Two horizontal incisions placed at the most dependant fluctuant
portion of the swelling followed by placement through & through
rubber dam
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55. Sublingual:It is a v- shaped trough lying to muscle of tongue.
Boundaries:
Treatment of sublingual space abscess:Incision is placed intraorally at the base of the alveolar
process in the lingual sulcus. It pus is not obtained the
periosteum opp to the offending tooth must be incised
Sublingual abscess when accompanied by submandibular
abscess may be drained through a submandibular incision
with hemostat passing through mylohyoid muscle
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56. Prevertebral space:Boundaries:
superiorly: base of the skull
inferiorly: extends to the level of t7/t8
vertebra
anteriorly: alar fascia
posteriorly: prevertebral fascia
laterally: carotid sheath
Infections from this space have an unimpeded
progress toward the mediastinum.
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60. Treatment of lateral pharyngeal space:
Intraoral:
Incision into the most prominent part of the soft plate
where fluctuation is maxilla.
Another incision is similar to one used for
pterygomandibular space but after the incision, hemostat
is advanced posteriorly and medial to the medial
pterygoid.
Extraoral:
Incision is placed 1cm below and behind the angle of
mandible.
Incision is made another 1cm inferiorly to angle of
mandible.
preparations for tracheostamy must be at hand because
edema of larynx may arise with suddeness
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61. Spaces of the body of the mandible:
This space is formed by the investing
fascia as it splits at its attachment to the base
of the mandible to become continuous with
the periosteum bordering the buccal lingual
aspects of the body of the mandible. This
space is continuous posteriorly with the
masticatory space.
Contents: body of the mandible.
inferior alveolar nerve, artery & vein
dento periodontal apparatus
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62. Management of facial space infections:“THE MORE SEVERE THE INFECTION, THE
MORE AGGRESSIVE SHOULD BE THE
MANAGEMENT”
1) Administration of appropriate antibiotics in
appropriate doses through the appropriate route.
2) Surgical removal of source of infection as early
as possible.
3) Surgical incision and drainage.
4) Constant evaluation and supportive therapy till
infection resolves.
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63.
PRINCIPLES OF INCISION AND DRAINAGE:1) Incisions are sited according to the location of pus.
2) Incision must be made over the most dependent of a
fluctuant area or over the most direct route to the pus.
3) Resist the temptation to incise over the thinnest point
of an abscess. This area would be ischaemic and
incision can lead to necrosis and unsightly scaring.
4) Incision must be large enough to permit egress of pus
and adequate drainage. The esthetic problem associated
with large incision in cervico facial areas may be
overcome by two stab incisions with a through and
through drainage between them.
5) The location of incision on the skin is also guided by
the direction of the langer’s lines and placement in
esthetically acceptable area such as with the shadow of
mandible.
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64. Who gets complications?
Older pts
Systemic dz
Immunodeficient pts
HIV
Myelodysplasia
Cirrhosis
DM
Most common systemic
Mbio – Klebsiella pneum. (56%)
33% with complications
Higher mortality rate
Prolonged hospital stay
20 days vs. 10 days
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66.
Ludwig’s angina:-
Ludwig’s angina may be described as an overwhelming
generalized septic cellulitis of submandibular region with
bilateral involvement of the submental, sublingual and
submandibular spaces.
The three “F”s evident are feared, rarely fluctuant and often
fatal.
Source of infection:
1.
Dental infection has been reported as the causative
factor in 90% of cases.
2.
Submandibular gland siladinitis, compound fracture of
mandible, puncture wound of oral floor, oral soft tissue
lacerations etc…
It is usually an extension of infection caused by streptococci,
staphylococci, gram –ve enteric organisms and anaerobic
including bactoroides and streptococci.
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68.
c/f:
Tissues are braway, indurated, flat-board like, non pitting
and non fluctuant.
Pt. has typical open mouthed appearance with protrusion of
tongue and elevation of floor of the mouth.
Tissue may become gangrenous and when cut may a
peculiar lifeless appearance.
Dysphagia, dyspnea may develop.
chills, fever, drooling at saliva may be present.
Sharp limitation between involved and uninvolved tissue.
Complication:
Immediate danger is edema of glottis with
asphyxation.
Septicemia
Mediastinitis
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70.
Meningitis:-
most common neurological complication.
c/f:- Headache
Fever
Stiffness of neck
Vomiting
Kernig’s sign
Brudzinski’s sign
Treatment:- combination of chloramphenicol and
penicillin-G.
Maintainence of hydration and electrolyte balance.
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74. 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.
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