Download buccal space

CLASSIFICATION OF OROFACIAL
INFECTION & FASCIAL SPACES
INFECTION
AISHAH, RUHAIZAN, ANIS, SYAFIQAH
CLASSIFICATION
• Based on the organism causing the
infection
• Based on the tissues affected
• Based on the route of entry
• Based on the deep fascial spaces of
the head and neck infiltrated by
the infection
Based on the organism causing the infection

Bacterial infections:


The odontogenic infections encountered in orofacial region are
mostly bacterial infections
Nonodontogenic infections:




Fungal infections:


(i) Tonsillar
(ii) Nasal infections which are more common in children
(iii) Furuncle of overlying skin
These infections have slow rate of spread. These are difficult to
diagnose in early stages.
Viral infections:

The literature does not show sufficient reports about these
conditions of odontogenic origin.
Based on the tissues affected

Odontogenic infection










Caries in the dentin > spread to the pulp > pulpitis > spread to the
bone > PA abscess
Traumatic root fracture/pathological exposure due to tooth wear
Traumatic pulpal exposure including dental treatment
Through PD membrane and accessory root canal
Rarely by anachoresis i.e seeding of the organism directly into pulp
via pulpal blood supply during bacterimia
Trauma, cracks, decay under fillings
Periodontal disease > PA & periodontal abscess
Erupting teeth > operculitis & pericoronitis
RR
Non-odontogenic
Based on the route of entry

Pulpal

Periodontal

Pericoronal

Fracture

Tumour

Iatrogenic

Opportunistic
Based on the clinical presentation

Acute

Abscess


Cellulitis


spreading infection of loose connective tissues. It is a diffuse,
erythematous, mucosal or cutaneous infection. It is characteristically the
result of streptococci infection; and does not normally result in large
accumulation of pus
Fulminating infections


It is a circumscribed collection of pus in a pathological tissue space.
involves the secondary spaces involving vital structures, along the pathway
of least resistance
Chronic



Chronic fistulous tract or sinus formation
Chronic osteomyelitis
Cervicofacial actinomycosis
Based on the deep fascial spaces
of the head and neck infiltrated
by the infection
mandible
Sublingual space
Buccal Space
submassenteric
Space
Secondary spaces
Pterygomandibular
Space
Temporal Space
Primary Maxillary Spaces
Primary spaces
Submandibular
space
Other spaces
Submental Space
Canine Space
Buccal Space
Infratemporal
space
Deep Neck
Spaces
Lateral
Pharyngeal Space
Retropharyngeal
space
Prevertebral
space
PRIMARY MANDIBULAR SPACES
Submental space
Causes
Contents
Location
Mandibular anterior teeth
Anterior jugular vein
Lymph nodes
Laterally: between the anterior bellies of
the digastric muscle
• Deeply: by the mylohyoid muscle, and
• Superiorly: by the deep cervical fascia,
the platysma muscle, the superficial
cervical fascia and the skin
• Posteriorly: hyoid bone
•
•
•
•
Submandibular space
Causes
Contents
•
•
•
•
Mandibular molars
Submandibular gland
Facial artery
Lymph nodes
Location
• Superior- mylohyoid muscle and inferior border
of the mandible
• Anteriorly- anterior belly of the digastric muscle
• Posteriorly- posterior belly of the digastric
muscle
• Inferiorly- hyoid bone
• Superficially- platysma muscle and superficial
layer of the deep cervical fascia
Sublingual space
Causes
Contents
Location
•
•
•
•
•
•
•
•
•
•
•
•
•
Mandibular premolars
Mandibular molars
Trauma
Sublingual glands
Wharton’s duct
Sublingual artery & nerve
Lingual nerve
Anterior – lingual surface of mandible
Posterior – body of hyoid bone
Medial – muscle of the tongue
Lateral – lingual surface of mandible
Superior- oral mucosa
Inferior- mylohyoid muscle
BUCCAL SPACE
Boundaries
• Anteromedially: Buccinator muscle
• Posteromedially: Masseter overlying the anterior
border of ramus of mandible
• Laterally: By forward extension of deep fascia from the
capsule of parotid gland and by platysma muscle.
• Inferiorly: Limited by the attachment of the deep fascia
to the mandible and by depressor anguli oris.
• Superiorly: The zygomatic process of the maxilla and
the zygomaticus major and minor muscles.
Contents
Buccal pad of fat, Stenson‘s (parotid ) duct, anterior and
transverse facial artery and vein
Source of
infection
Maxillary and mandibular bicuspid
Maxillary and mandibular molar
Mandibular Secondary spaces
Submasseteric space
Causes
• Mandibular 3rd molars
Contents
Location
• Masseteric artery & vein
• Anterior – buccal space, parotidomasseteric
fascia
• Posterior – parotid gland and its fascia
• Medial – ramus of the mandible
• Lateral – masseter muscle
• Superior- zygomatic arch
• Inferior- inferior border of mandible
Temporal space
Causes
• Involvement is secondary to the initial
involvement of pterygopalatine and infratemporal
space.
Componen • Superficial temporal space: located between
ts
temporal fascia and temporalis muscle
• Deep temporal space: located between the
temporalis muscle and the temporal bone
• Continuous with the infratemporal space
Primary Maxillary Spaces
BUCCAL SPACE
Boundaries
• Anteromedially: Buccinator muscle
• Posteromedially: Masseter overlying the anterior
border of ramus of mandible
• Laterally: By forward extension of deep fascia from the
capsule of parotid gland and by platysma muscle.
• Inferiorly: Limited by the attachment of the deep fascia
to the mandible and by depressor anguli oris.
• Superiorly: The zygomatic process of the maxilla and
the zygomaticus major and minor muscles.
Contents
Buccal pad of fat, Stenson‘s (parotid ) duct, anterior and
transverse facial artery and vein
Source of
infection
Maxillary and mandibular bicuspid
Maxillary and mandibular molar
CANINE SPACE
Boundaries
Contents
Source of
infection
• Superiorly:
levator labii superioris alaque nasi, levator labii
superioris, and zygomaticus minor muscles.
• Inferiorly, caninus muscle
• Anteriorly, orbicularis oris,
• Posteriorly, buccinator muscle
• Medially, anterolateral surface of maxilla.
Angular artery and vein
Infraorbital nerve
-Maxillary canine
-First upper premolar
INFRATEMPORAL SPACE
Boundaries
Content
Source of
infection
Anteriorly: Posterior pharyngeal wall
Posteriorly: prevertebral fascia
Superiorly: Base of skull
Inferiorly: Mediastinum
Medially: Common space, no wall
Laterally: Communicates with the lateral
pharyngeal space
• No major structure
•
•
•
•
•
•
• Suppurative adenitis
• Dental infection diffusing through contiguous
spaces
• Nasal and pharyngeal infections through
pharyngeal trauma or foreign bodies
Other spaces
LATERAL PHARYNGEAL SPACE
Boundaries
•Anteriorly:
Superior and middle pharyngeal constrictor muscle
•Posteriorly: Carotid sheath, stylohyoid, Styloglossus and
Stylopharyngeus
•Superiorly: base of skull
•Inferiorly: Hyoid bone
•Medially: superior pharyngeal constrictors
•Laterally: medial pterygoid muscle and capsule of parotid
gland
Content
Carotid artery
Internal jugular vein
Vagus nerve
Cervical sympathetic chain
Likely source
of infection
Mandibular third molar
Tonsilar infection
Pharyngitis
Parotitis
DEEP NECK SPACES

Uncommon infection beyond the primary spaces of
maxilla and mandible

Possible sequelae: compromise upper airway and
descending mediastinitis

Pterygomandibular space infection spread posteriorly to
the lateral pharyngeal space
PREVERTEBRAL SPACE
Boundaries:
Infection causes
• Superiorly: skull base
• Space between alar and prevertebral
layers
• Mediastinitis
RETROPHARYNGEAL SPACE
Boundaries
•Anteriorly: Posterior pharyngeal wall
•Posteriorly: prevertebral fascia
•Superiorly: Base of skull
•Inferiorly: Mediastinum
•Medially: Common space, no wall
•Laterally: Communicate with the lateral
pharyngeal space
Content
Likely source
of infection
•No major structure
•Suppurative adenitis
•Dental infection diffusing through contiguous
spaces
•Nasal and pharyngeal infections through
pharyngeal trauma of foreign bodies