Spread of oral infection 1/ dental implant courses

Spread of Oral Infection
-Department of oral pathology and
microbiology
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

LEARNING OBJECTIVES
At the end of the lecture student should be able to
describe
- routes of spread of infection.
– etiology, clinical features, histopathological
features of cellulitis.
– important spaces in the maxillofacial region.
– anatomical relations and boundaries of all the spaces.

• Routes of spread of infection
– Lymphatic system
– Bloodstream
– Directly through tissues

• Factors affecting the ability of infection to
spread depend on
– The type & virulence of the organism
– General health of the patient
– Anatomical site of initial infection
• Anatomic features determine the direction
that the infection may take

Definition:
A diffuse inflammation of soft tissues which is
not circumscribed or confined to one area, but
which, in contradistinction to the abscess, tends
to spread through tissue spaces and along
fascial planes.
Cellulitis (Phlegmon)

• Infection by microorganisms that
produce
– Streptokinase
– Hyaluronidase
– Fibrinolysins
• Breakdown or dissolve hyaluronic acid
and fibrin
•

• Cellulitis of face & neck-
• From dental infection as a sequela of an
apical abscess or osteomyelitis
• Periodontal infections
• Pericoronitis
• Tooth extraction, injection either with an
infected needle or through an infected area,
jaw fracture

C/F-
• Moderately ill with elevated
temperature.
• Painful swelling of involved
soft tissue that are firm and
brawny.

• Maxilla: Perforation of outer cortical plate
above buccinator- Swelling initially of the
upper half of face.
• Diffuse spread involves entire facial area
• Extension towards eye- cavernous sinus
thrombosis

• Mandible: Perforation below buccinator-
swelling of lower half of face.
• Later superior & cervical spread
• Infection frequently tends to become
localized- facial abscess
• Discharge upon a free surface

• Potential spaces situated between planes of
fascia that form natural pathways along which
infection may spread, producing cellulitis, or
within which infection may become localized
with actual abscess formation.
Infection of specific tissue
spaces

Lower jaw
• Submental space
• Submandibular space
• Buccal space
• Submasseteric space
• Parotid space
• Pterygomandibular space
• Pharyngeal space
• Peritonsillar space
Important spaces in maxillofacial
region

Upper jaw
• Within the lip
• Within canine fossa
• Palatal subperiosteal interval
• Buccal space
• Maxillary anrtum
• Infratemporal space
Important spaces in maxillofacial
region

Boundaries-
Anteriorly- Infratemporal surface of maxilla
and posterior surface of zygomatic bone
- Posteriorly- Lateral pterygoid muscle,
Condyle, Temporal bone
Infratemporal Space

Laterally- Tendon of temporal muscle, Coronoid
process
Medially- Lateral pterygoid plate, Inferior belly of
lateral pterygoid muscle

Contents
• The pterygoid plexus
• Internal maxillary artery
• Mandibular, mylohoid, lingual, buccinator and
chorda tympani nerves
• External pterygoid muscle
Infratemporal Space

Clinical features
 Swelling E/O over sigmoid notch
 I/O in tuberosity region
 Trismus
 Swelling of eyelids
 Dysphagia
 Pain or pressure sensation
in area of infection
Infratemporal Space

• The inferior portion of Infratemporal space is
called the Pterygomandibular Space and lies in
between the internal pterygoid muscle and the
ramus of the mandible
• Postzygomatic space extends anteromedially from
the infratemporal space and considered a part of
it.
Pterygomandibular Space

Clinical features
 Pericoronitis of mandibular third molar
 Injection of LA in this space
 Severe trismus
 Extreme radiating pain
 No facial swelling
 Swelling of lateral posterior portion of soft
palate
Pterygomandibular Space

Boundaries
• Anteriorly-Buccoopharyngeal aponeurosis,
Parotid gland, Pterygoid muscle
• Posteriorly- Prevertebral fascia
• Laterally- Carotid sheath
• Medially-Lateral wall of pharynx
Lateral pharyngeal space

Clinical features
• Source of infection- third molar
• Difficulty in swallowing and breathing
• Tonsillar pillars & tonsils displaced medially
• Trismus
• Differentiated from peritonsillar abscess
Lateral pharyngeal space

Boundaries
• Anteriorly-Wall of pharynx
• Posteriorly- Prevertebral fascia
• Laterally- Lateral pharyngeal space and
carotid sheath
Retropharyngeal space

Clinical features
• Infection results from medial extension from lateral
pharyngeal space.
• Displacing the buccopharyngeal fascia forward
impinging on the pharynx.
• Pain, dysphagia, & dyspnoea.
Retropharyngeal space

Boundaries
• Posteriorly- Behind the ramus of mandible
• Medially- between the masseter and internal
pterygoid muscle .
Parotid space

Contents
• Parotid gland
• Facial nerve
• Auriculotemporal nerve
• Posterior facial vein
• External carotid, Internal maxillary, Superficial
temporal arteries
Parotid space

Clinical features
• Infection from lateral
pharyngeal space or
by retrograde
extension along the
parotid duct.
• Elevation of ear lobe
• Escape of pus from
duct when the gland is
milked.
Parotid space

Summary
– etiology, clinical features, histopathological
- features of cellulitis.
– important spaces in the maxillofacial region.
– anatomical relations and boundaries of all the spaces.

BIBLIOGRAPHY
• Text book of oral pathology Shafer's, 5 & 6th
edition
• Color Atlas of Oral Diseases Cawson, R. 2nd
edition
• Oral and Maxillofacial Pathology Neville, Brad
W. 2nd
• Lucas’s Pathology Of Tumor’s of the Oral
Tissues
• Cawson, R. A., Bennie, W. H 5th
edition
• Text Book of Microbiology Ananthanarayan R 7th
Edition

•Thank you

Spread of oral infection 1/ dental implant courses

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