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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