FASCIAL SPACE FASCIAL SPACE INFECTIONINFECTION

Presented by- KAMALA

POUDEL ROLL NO- 31

BDS 1ST BATCH

CONTENTSCONTENTS IntroductionIntroduction Organization of cervical fasciaOrganization of cervical fascia Routes of spread and factors affectingRoutes of spread and factors affecting Function of fasciaFunction of fascia Canine spaceCanine space Buccal spaceBuccal space Pterygomandibular spacePterygomandibular space Infratemporal spaceInfratemporal space Submental spaceSubmental space Sublingual spaceSublingual space Submandibular spaceSubmandibular space

Masseteric spaceMasseteric space Temporal spaceTemporal space Lateral pharyngeal spaceLateral pharyngeal space Retropharyngeal spaceRetropharyngeal space Prevertebral spacePrevertebral space AntibioticsAntibiotics Complications Complications Ludwig’s AnginaLudwig’s Angina Conclusion Conclusion ReferencesReferences

Intoduction to Fascial SpacesIntoduction to Fascial Spaces

These areas are potential spaces between These areas are potential spaces between

layers of fascia or compartment containing layers of fascia or compartment containing

connective tissue.connective tissue.

Organization of cervical Organization of cervical fasciafascia

Superficial fasciaSuperficial fascia Deep fasciaDeep fascia

- superficial layer (anterior)- superficial layer (anterior)

- pretracheal fascia (middle - pretracheal fascia (middle layer)layer)

- prevertebral fascia (posterior - prevertebral fascia (posterior deep layer)deep layer)

Classification of Fascial SpacesClassification of Fascial Spaces Based on mode of involvement- Based on mode of involvement-

Primary Primary SecondarySecondary

Based on clinical significance-Based on clinical significance-

Face- Face- Buccal, canine, parotid, masticatory.Buccal, canine, parotid, masticatory.

Suprahyoid-Suprahyoid- Sublingual, submental, submandibular, Sublingual, submental, submandibular,

lateral pharyngeal, peritonsillar.lateral pharyngeal, peritonsillar.

Infrahyoid-Infrahyoid- Pretracheal. Pretracheal.

Spaces of total neck- Spaces of total neck- Retropharyngeal, space of Retropharyngeal, space of

carotid sheath.carotid sheath.

ROUTES OF SPREAD AND FACTORS ROUTES OF SPREAD AND FACTORS AFFECTINGAFFECTING By direct continuityBy direct continuity

By lymphatics By lymphatics By the blood streamBy the blood stream

GENERAL FACTORSGENERAL FACTORS Host’s resistance or immunocompetence of the hostHost’s resistance or immunocompetence of the host Virulence Virulence

LOCAL FACTORS : LOCAL FACTORS : intatct anatomical barrierintatct anatomical barrier

Alveolar bone Alveolar bone PeriosteoumPeriosteoum Adjacent muscles and fasciaAdjacent muscles and fascia

FUNCTIONS OF FASCIAFUNCTIONS OF FASCIA Acts as a musculovenousActs as a musculovenous pump.pump. Limits outward expansion of muscles Limits outward expansion of muscles

as they contract.as they contract. Contraction of muscles compresses Contraction of muscles compresses

the intramuscular veins (push the the intramuscular veins (push the blood towards the heart).blood towards the heart).

Determine the direction of spread of Determine the direction of spread of infection infection

Canine SpaceCanine Space It is the region between anterior surface of maxilla and It is the region between anterior surface of maxilla and

overlying levator muscles of upper lip.overlying levator muscles of upper lip.• Contents – Angular artery and vein

Infraorbital nerve • Neighboring spaces – Buccal space

Etiology-Etiology- Periapical abscess of maxillary canine & 1Periapical abscess of maxillary canine & 1stst premolar premolar

infection & sometimes mesiobuccal root of first molars.infection & sometimes mesiobuccal root of first molars.

Boundaries-Boundaries- Superiorly: Superiorly: levator superioris alaque nasi levator superioris alaque nasi

and levator labii superioris and and levator labii superioris and zygomaticus minor musclezygomaticus minor muscle

Inferiorly: Inferiorly: caninus musclecaninus muscle Medially: Medially: anterolateral surfaceanterolateral surface

of maxillaof maxilla Posteriorly: Posteriorly: buccinator mucsle.buccinator mucsle. Anteriorly: Anteriorly: orbicularis oris orbicularis oris

Clinical Features-Clinical Features- Swelling of cheek, lower eyelid & upper lip.Swelling of cheek, lower eyelid & upper lip. Drooping of angle of mouthDrooping of angle of mouth Nasolabial fold obliteratedNasolabial fold obliterated Odema of lower eyelidOdema of lower eyelid Redness and marked tendernessRedness and marked tenderness

of facial tissueof facial tissue Chronic stage – chronic fistulaChronic stage – chronic fistula Intraoral - mobile Intraoral - mobile

- tender to percussion- tender to percussion

TREATMENTTREATMENT

Antibiotic prophylaxis Antibiotic prophylaxis Incision is made intraorally high in the Incision is made intraorally high in the

maxillary labial vestibule.maxillary labial vestibule. A curved mosquito forceps is insertedA curved mosquito forceps is inserted Pus is evacuated and drain is inserted Pus is evacuated and drain is inserted

and is secured to one of the margins and is secured to one of the margins with a suture.with a suture.

Buccal SpaceBuccal Space Potential space between buccinator and masseter muscle.Potential space between buccinator and masseter muscle.

Etiology-Etiology- Infected mandibular & maxillary premolars & molars.Infected mandibular & maxillary premolars & molars.

Boundaries-Boundaries- Superiorly: Superiorly: zygomatic process ,zygomaticus major and minor musclezygomatic process ,zygomaticus major and minor muscle Inferiorly: Inferiorly: inferior border of mandible and depressor anguli orisinferior border of mandible and depressor anguli oris Laterally: Laterally: forward extension of deep fascia from parotid gland, forward extension of deep fascia from parotid gland,

platysma muscleplatysma muscle Anteromedially: Anteromedially: buccinator muscle buccinator muscle Posteromedially: Posteromedially: masseter overlying the anterior boarder of ramus of masseter overlying the anterior boarder of ramus of

mandiblemandible

Contents-Contents- Buccal fat pad.Buccal fat pad. Stenson’s duct.Stenson’s duct. Facial artery.Facial artery.

Clinical Features-Clinical Features- Obliteration of nasolabial fold.Obliteration of nasolabial fold. Angle of mouth shifted to opposite side.Angle of mouth shifted to opposite side. ‘‘Gum boil’Gum boil’ Swelling in cheek extending to corner of mouth.Swelling in cheek extending to corner of mouth. Buccal space associated with temporal space – Buccal space associated with temporal space – Dumb bell shapedDumb bell shaped

appearance due to lack of swelling over zygomatic archappearance due to lack of swelling over zygomatic arch

Differential Differential diagnosisdiagnosis CellulitisCellulitis

ErysipelasErysipelas Crohn’s disease(Recurrent buccal Crohn’s disease(Recurrent buccal

abscess)abscess)

Neighbouring spacesNeighbouring spaces InfratemporalInfratemporal PterygomandibularPterygomandibular InfraorbitalInfraorbital

TREATMENTREATMENTT Antibiotic prophylaxisAntibiotic prophylaxis

INCISION AND DRAINAGEINCISION AND DRAINAGE Horizontal incision through the oral Horizontal incision through the oral

mucosa of cheek in the premolar , molar mucosa of cheek in the premolar , molar region region

If pus is lateral to muscl then the muscle If pus is lateral to muscl then the muscle is penetrated with curved mosquito is penetrated with curved mosquito focrceps to enter the buccal spacefocrceps to enter the buccal space

Drain is placed and secured with sutureDrain is placed and secured with suture

Pterygomandibular SpacePterygomandibular SpaceBoundaries-Boundaries- Superiorly: Superiorly: lower head of lateral pterygoid muscle.lower head of lateral pterygoid muscle. Laterally: Laterally: medial surface of ramus.medial surface of ramus. Medially: Medially: medial pterygoid muscle.medial pterygoid muscle. Posteriorly: Posteriorly: deep part of parotid.deep part of parotid. Anteriorly: Anteriorly: pterygomandibular raphe.pterygomandibular raphe.

Contents-Contents- Inferior alveolar neurovascular bundle.Inferior alveolar neurovascular bundle. Lingual & auriculotemporal nerves.Lingual & auriculotemporal nerves. Mylohyoid nerve & vessels.Mylohyoid nerve & vessels.

Etiology-Etiology- Infected mandibular 3Infected mandibular 3rdrd molars(mesioangular/horizontal) molars(mesioangular/horizontal) Pericoronitis.Pericoronitis. Infected needles or contaminated LA solution.Infected needles or contaminated LA solution.

Clinical Features-Clinical Features- Absence of extra-oral swelling.Absence of extra-oral swelling. Severe trismus.Severe trismus. Difficulty in swallowing.Difficulty in swallowing. Anterior bulging of half of soft palate & tonsillar pillars with deviation of uvula Anterior bulging of half of soft palate & tonsillar pillars with deviation of uvula

to unaffected side.to unaffected side. Medial displacement of lateral wall of pharynx Medial displacement of lateral wall of pharynx Redness and edema around the 3Redness and edema around the 3rdrd molar molar

Spread of Infection-Spread of Infection- Superiorly to infratemporal space and beneath the Superiorly to infratemporal space and beneath the

temporal fascia.temporal fascia. Posteriorly to lateral pharyngeal space and then to Posteriorly to lateral pharyngeal space and then to

retropharyngeal space.retropharyngeal space. Buccal spaceBuccal space To submandibular space.To submandibular space.

TREATMENTTREATMENTIncision Incision intra oral incision in the mucosal intra oral incision in the mucosal area between medial aspect of ramus and area between medial aspect of ramus and the pterygomandibular raphae.the pterygomandibular raphae.Blunt dissection using hemostat.Blunt dissection using hemostat.Drainage.Drainage.

Extra oral incision is made below the angle Extra oral incision is made below the angle of mandible.of mandible.A sinus forcep is inserted towards medial A sinus forcep is inserted towards medial sode of ramus in upward and backward sode of ramus in upward and backward direction.direction.Pus is evacuated and drain is inserted from Pus is evacuated and drain is inserted from an intraoral approach and sutured in position.an intraoral approach and sutured in position.

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

Etiology-Etiology- Infected mandibular incisors.Infected mandibular incisors. Anterior extension of Anterior extension of

submandibular space.submandibular space.

Clinical Features-Clinical Features-• Chin appears glossy & swollen.Chin appears glossy & swollen.• Pain & discomfort on swallowing.Pain & discomfort on swallowing.• Anterior teeth are either nonvital fractured or carious.Anterior teeth are either nonvital fractured or carious.• Offending teeth - tenderness to percussionOffending teeth - tenderness to percussion

- mobility- mobility

TREATMENTTREATMENT

Incision and DrainageIncision and Drainage

- Performed by making transverse - Performed by making transverse incision on the skin below incision on the skin below symphysis.symphysis.

- Blunt dissection is carried out by - Blunt dissection is carried out by inserting a inserting a Kelly’s forceps Kelly’s forceps through through this incision upward and backward. this incision upward and backward.

- Drain & dressings are placed.- Drain & dressings are placed.

Sublingual SpaceSublingual SpaceBoundaries-Boundaries- Superiorly:Superiorly: mucosa of floor of mouth. mucosa of floor of mouth. Inferior:Inferior: mylohyoid muscle. mylohyoid muscle. Posteriorly:Posteriorly: body of hyoid bone. body of hyoid bone. Anteriorly & laterally: Anteriorly & laterally: inner aspect of mandibular body.inner aspect of mandibular body. Medially: Medially: geniohyoid,styloglossus,genioglossus muscle.geniohyoid,styloglossus,genioglossus muscle.

Etiology-Etiology- Infected mandibular incisors, canines, premolar & 1Infected mandibular incisors, canines, premolar & 1stst

molar.molar.

Clinical Features-Clinical Features- Firm, painful swelling of floor of mouth.Firm, painful swelling of floor of mouth. Elevated tongue (pushed superiorly) Elevated tongue (pushed superiorly) Pain & discomfort on swallowing.Pain & discomfort on swallowing.

TREATMENTTREATMENT• Antibiotic prophylaxis

• Incision is made Intraorally over lingual sulcus at the base of the alveolar process.

• Haemostat 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

Submandibular SpaceSubmandibular SpaceBoundaries-Boundaries- Superiorly: Superiorly: mylohyoid muscle, inferior border of mandible.mylohyoid muscle, inferior border of mandible. Inferior: Inferior: anterior & posterior belly of digastric.anterior & posterior belly of digastric. Laterally: Laterally: deep cervical fascia, platysma, superficial fascia & skin.deep cervical fascia, platysma, superficial fascia & skin. Medially: Medially: hyoglossus,styloglossus,mylohyoid muscle.hyoglossus,styloglossus,mylohyoid muscle. Posteriorly: Posteriorly: to hyoid bone.to hyoid bone. Anteriorly: Anteriorly: submental space.submental space.

Submandibular Space Infection Submandibular Space Infection

Etiology-Etiology- Infected mandibular 3Infected mandibular 3rdrd molars(mesioangular/horizontal) molars(mesioangular/horizontal) Pericoronitis.Pericoronitis. Infected needles or contaminated LA solution.Infected needles or contaminated LA solution.

Clinical Features-Clinical Features- Firm swelling in submandibular regionFirm swelling in submandibular region Some degree of tendernessSome degree of tenderness Redness of overlying skinRedness of overlying skin Difficulty in swallowingDifficulty in swallowing Teeth sensitive to percussion, mobileTeeth sensitive to percussion, mobile DysphagiaDysphagia Moderate trismusModerate trismus

Spread of Infection-Spread of Infection- Superiorly to infratemporal space.Superiorly to infratemporal space. Medially to lateral pharyngeal space.Medially to lateral pharyngeal space. To submandibular space on contralateral siteTo submandibular space on contralateral site submental spacesubmental space

Clinical Evaluation:Swelling begins at lower border of mandible extends to the level of hyoid bone in a shape of inverted cone.

TREATMENTTREATMENT

• .

Antibiotic prophylaxisAntibiotic prophylaxis INCISION AND DRAINAGE :INCISION AND DRAINAGE : An incision about 1.5-2cm length made 2cm below, An incision about 1.5-2cm length made 2cm below,

in skin creasesin skin creases Skin and subcutaneous tissue incisedSkin and subcutaneous tissue incised Sinus forcep inserted superiorly and posteriorly on Sinus forcep inserted superiorly and posteriorly on

the lingual side of the mandible below the mylohyoid the lingual side of the mandible below the mylohyoid to release pus from submandibular space.to release pus from submandibular space.

Corrugated rubber drain inserted in the abscess Corrugated rubber drain inserted in the abscess cavity and is secured with a suture and dressing is cavity and is secured with a suture and dressing is applied. applied.

Infratemporal SpaceInfratemporal SpaceBoundaries-Boundaries- Superiorly: Superiorly: infratemporal surface of infratemporal surface of

greater wing of sphenoid.greater wing of sphenoid. Inferiorly: Inferiorly: lateral pterygoid muscle.lateral pterygoid muscle. Laterally: Laterally: temporalis tendon & temporalis tendon &

coronoid process.coronoid process. Medially: Medially: lateral pterygoid plate & lateral pterygoid plate &

lateral pharyngeal wall.lateral pharyngeal wall. Posteriorly: Posteriorly: condyle & lateral condyle & lateral

pterygoid muscles.pterygoid muscles. Anteriorly: Anteriorly: infratemporal surface of infratemporal surface of

maxilla & posterior surface of maxilla & posterior surface of zygomatic bone.zygomatic bone.

Masseteric SpaceMasseteric Space

Boundaries-Boundaries- Superiorly: Superiorly: zygomatic arch.zygomatic arch. Inferiorly: Inferiorly: inferior border of mandible.inferior border of mandible. Laterally: Laterally: masseter muscle.masseter muscle. Medially: Medially: ramus of mandible.ramus of mandible. Posteriorly: Posteriorly: parotid gland & its fascia.parotid gland & its fascia. Anteriorly: Anteriorly: buccal space buccal space

and buccopharyngeal fascia.and buccopharyngeal fascia.

Temporal SpacesTemporal Spaces Superficial temporal-Superficial temporal- Laterally: temporalis fascia.Laterally: temporalis fascia. Medially: temporalis muscle.Medially: temporalis muscle. Deep temporal-Deep temporal- Laterally: temporalis muscle.Laterally: temporalis muscle. Medially: temporal bone & greater wing of sphenoid.Medially: temporal bone & greater wing of sphenoid.

Etiology-Etiology- From infratemporal or pterygomandibular space.From infratemporal or pterygomandibular space.

Clinical Features-Clinical Features- Superficial temporal- Superficial temporal- swelling limited by outline of temporalis swelling limited by outline of temporalis

fascia. Trismus. Severe pain.fascia. Trismus. Severe pain. Deep temporal- Deep temporal- less swelling, difficult to diagnose. Trismus.less swelling, difficult to diagnose. Trismus.

Temporal Space InfectionTemporal Space Infection

Lateral Pharyngeal SpaceLateral Pharyngeal Space

Boundaries-Boundaries- Shape of an Shape of an inverted cone or pyramidinverted cone or pyramid, the base is at sphenoid , the base is at sphenoid

bone and the apex at hyoid bone. bone and the apex at hyoid bone. Anteriorly: Anteriorly: pterygomandibular raphe. pterygomandibular raphe. Posteriorly: Posteriorly: extends to prevertebral fascia.extends to prevertebral fascia. Laterally: Laterally: fascia covering medial pterygoid muscle, parotid & fascia covering medial pterygoid muscle, parotid &

mandible.mandible. Medially: Medially: buccopharyngeal fascia on lateral surface of buccopharyngeal fascia on lateral surface of

superior constrictor muscle.superior constrictor muscle. Styloid process divides the space into Styloid process divides the space into anterior muscular anterior muscular and and

posterior vascular posterior vascular compartment.compartment.

Retropharyngeal SpaceRetropharyngeal Space

Posteromedial to lateral pharyngeal space and anterior to the Posteromedial to lateral pharyngeal space and anterior to the prevertebral space .prevertebral space .

Boundaries-Boundaries- Anterior: Anterior: posterior pharyngeal wall. posterior pharyngeal wall. Posterior: Posterior: prevertebral fascia. prevertebral fascia. Superior: Superior: skull base.skull base. Inferior: Inferior: mediastinum.mediastinum. Laterally: Laterally: lateral pharyngeal space.lateral pharyngeal space.

Etiology-Etiology- Nasal & pharygeal infections.Nasal & pharygeal infections. Spread from odontogenic infections.Spread from odontogenic infections.

Prevertebral SpacePrevertebral Space

Potential space between two layers of prevertebral Potential space between two layers of prevertebral

fascia (fascia (alar and prevertebral layersalar and prevertebral layers). ).

Extends from skull base superiorly to the diaphragm Extends from skull base superiorly to the diaphragm

inferiorly. inferiorly.

MediastinitisMediastinitis is concern with prevertebral space is concern with prevertebral space

infections similarly to retropharyngeal space infections similarly to retropharyngeal space

infections.infections.

InvestigationsInvestigations for space infectionfor space infection Routine laboratory investigations.Routine laboratory investigations. Special laboratory investigations.Special laboratory investigations. Radiological examination- Radiological examination- helpful in locating offending teeth or helpful in locating offending teeth or

other underlying cause.other underlying cause. IOPAIOPA OPGOPG Lateral oblique view mandible.Lateral oblique view mandible. A-P & Lateral view of neck for soft tissues A-P & Lateral view of neck for soft tissues can be useful in can be useful in

detecting retropharyngeal space infection.detecting retropharyngeal space infection. Ultrasound of swelling. Ultrasound of swelling. CT scan, MRI help in diagnosing extension of infection beyond CT scan, MRI help in diagnosing extension of infection beyond

maxillofacial region.maxillofacial region.

Drainage of Fascial SpacesDrainage of Fascial Spaces

CanineCanine, , Sublingual Sublingual and and Vestibular Vestibular abscesses are drained abscesses are drained

intraorally.intraorally.

MassetericMasseteric, , PterygomandibularPterygomandibular, , BuccalBuccal and and Lateral Lateral

Pharyngeal space Pharyngeal space abscesses can be drained with combination abscesses can be drained with combination

of intraoral and extraoral drainage.of intraoral and extraoral drainage.

Temporal, Submandibular, Submental, Retropharyngeal and Temporal, Submandibular, Submental, Retropharyngeal and

Parotid space Parotid space abscesses may mandate extraoral incision and abscesses may mandate extraoral incision and

drainage. drainage.

ANTIBIOTICS ANTIBIOTICS INDICATIONSINDICATIONS -- acute onset of infectionacute onset of infection

- Diffuse infection- Diffuse infection

- involvement of fascial spaces- involvement of fascial spaces

- compromised host defense- compromised host defense

PENICILLIN is the drug of choice 600mg QIDPENICILLIN is the drug of choice 600mg QID

CLINDAMYCIN (300-450mg QID) used in case of penicillin CLINDAMYCIN (300-450mg QID) used in case of penicillin allergic patientallergic patient

-

COMPLICATIONS OF SPACE COMPLICATIONS OF SPACE INFECTIONINFECTION

OsteomyelitisOsteomyelitis MediastenitisMediastenitis Brain abscessBrain abscess Meningitis Meningitis Cavernous sinus thrombosisCavernous sinus thrombosis Scar formationScar formation Sinus tract formationSinus tract formation

LUDWIG’S ANGINA::

DEFINITION– It is a firm, acute,toxic cellulitis of the submandibular, sublingual and submental spaces bilaterally.

-- FRIST DISCRIBED BY WILHELM FREDREICH VON LUDWIG IN 1836

TERMINOLOGIES - MARBUS STRANGULATORIUS - ANGINA MALIGNA - GARROTILLO

ETIOLOGYETIOLOGY

MODE OF SPREADMODE OF SPREAD

CLINICAL FEATURES

SYSTEMIC FEATURES- Pyrexia Dyspnoea Dehydration Hoarseness of voice and STRIDOR

EXTRA ORAL FEATURES Hard to firm brawny indurated swelling Skin over the swelling appears erythematous and stretched Swelling is tender, severe muscle spasm Difficulty in closing the mouth and drooling of saliva Respiratory distress

INTRA ORAL FEATURES – Trismus Floor of the mouth is raised Tongue raised upwards against palate Increased salivation Stiffness Backward spread of infection leads to edema of glottis

SPREAD OF SPREAD OF INFECTIONINFECTION

FATE OF LUDWIG’S FATE OF LUDWIG’S ANGINAANGINA

If untreated can be fatal within 12- If untreated can be fatal within 12- 24 hours ; death arising from 24 hours ; death arising from asphyxia.asphyxia.

Other causes of death include Other causes of death include septicemia/septic shock,mediastinitis septicemia/septic shock,mediastinitis and aspiration pneumonia.and aspiration pneumonia.

With the introduction of newer With the introduction of newer antibiotics mortality rate has antibiotics mortality rate has decreaseddecreased

MANAGEMENT -

1.Airway maintainence - Tracheostomy and Cricothyroidectomy is advisable.

2. Parentral antibiotics-Penicillin antibiotic of choice - Amoxycillin + Cloxacillin - Metronidazole in anaerobic infection - I.V. Dexamethasone sodium phosphate given for 48 hours- beneficial in reducing edema which helps maintain airway integrityand enhances antibiotic penetration.

3.Surgical decompression – performed under L.A . - Bilateral submandibular incision with a midline submental incision pus should be drained

4.Hydration of the patient – It is necessary to put the patient on i.v. fluids 5. Removal of cause - The offending tooth is removed

CONCLUSIONCONCLUSION We must understand anatomy of fascial We must understand anatomy of fascial

spaces, spread of infection as many spaces spaces, spread of infection as many spaces are adjacent to each other and proper are adjacent to each other and proper management ( by determining severity, management ( by determining severity, evaluating host defense, decision on setting evaluating host defense, decision on setting of care, treating surgically, supporting of care, treating surgically, supporting medically, choosing and prescribing medically, choosing and prescribing antibiotic properly, evaluating pathway antibiotic properly, evaluating pathway frequently) for the prevention of further frequently) for the prevention of further complications and also the treatment of complications and also the treatment of space infection as soon as possible for space infection as soon as possible for betterment of health of the patientbetterment of health of the patient..

References References Textbook of oral & maxillofacial surgery : Textbook of oral & maxillofacial surgery :

Neelima Anil Mallik- 3Neelima Anil Mallik- 3rdrd edition edition Textbook of oral medicine oral diagnosis Textbook of oral medicine oral diagnosis

and oral radiology : Ravikiran Ongole and and oral radiology : Ravikiran Ongole and Praveen BN 2Praveen BN 2NDND edition edition

Textbook of oral & maxillofacial surgery Textbook of oral & maxillofacial surgery volume two : Daniel M. Laskinvolume two : Daniel M. Laskin

http://www.upd8.org.uk www.jcda.ca/article/a37 - Dr. curtis - Dr. curtis

gregoiregregoire

Peritonsillar abscess or quincyPeritonsillar abscess or quincy:: It is a localized infection in the connective tissue bed between It is a localized infection in the connective tissue bed between

tonsil and superior constrictor muscle between anterior and tonsil and superior constrictor muscle between anterior and posterior pillars of fauces.posterior pillars of fauces.

22……LINCOLN’S HIGHWAYLINCOLN’S HIGHWAY A viscerovascular space as coined by moscher is the A viscerovascular space as coined by moscher is the

carotidsheath from jugulaar foramen and carotid canal at the carotidsheath from jugulaar foramen and carotid canal at the base of skull to the pericardium or middle mediastinum.base of skull to the pericardium or middle mediastinum.

Infection in this space are usually associatedwith internal Infection in this space are usually associatedwith internal jugularvein thrombophelibitis or carotid artery erosionjugularvein thrombophelibitis or carotid artery erosion

3.NAME SOME PENICILLIN 3.NAME SOME PENICILLIN Axoicillin,ampicillin, penicillinV, carbenicillin.Axoicillin,ampicillin, penicillinV, carbenicillin.