Space Infections
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Transcript of Space Infections
![Page 1: Space Infections](https://reader033.fdocuments.net/reader033/viewer/2022061204/547edbb5b4795989508b4c9b/html5/thumbnails/1.jpg)
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SREE SANKARA DENTAL COLLEGE
ORAL MEDICINE SEMINAR
Presented By ;
AHANA A.
IV BDS PART I
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FACIAL SPACESFACIAL SPACES
• Potential spaces situated between the planes of fascia.
• Natural pathways along which infection can spread.
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HOW MANY SPACES ???
• PRIMARY SPACES
MAXILLARY SPACESMAXILLARY SPACES Canine Space Buccal Space Infratemporal space Parotid Space
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MANDIBULAR SPACESMANDIBULAR SPACES
Space for Body of mandible Submental space Sublingual Space Submandibular space Pterygomandibular space
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• SECONDARY SPACESMasseteric spacePterygomandibular spaceSuperficial & Deep temporal space
Lateral pterygoid spaceRetropharyngeal spacePrevertebral space
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CANINE SPACECANINE SPACE
ANATOMY LOCATIONLOCATION : B/w Anterior surface of maxilla & overlying levator labi superioris. BOUNDARIES Superiorly: Levator labi superioris Anteriorly : Orbicularis oris Posteriorly: Buccinator
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SOURCE OF INFECTION• Maxillary Canine• First Premolar
CLINICAL FEATURES
•INTRAORAL LOCATIONLabial sulcusRarely , Palatal swelling
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• LOCATION OF SWELLINGLOCATION OF SWELLINGLateral to noseObliterate nasolabial foldSometimes oedema of cheek &
upper lipSevere cases infection extend to
orbit
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BUCCAL SPACEBUCCAL SPACE
• ANATOMY
LOCATION LOCATION : B/W Buccinator & Masseter muscle & lies
superficial to Buccopharyngeal fascia.
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• BOUNDARIESBOUNDARIES Medially: Buccinator & Buccopharyngeal Laterally: Skin of cheek Anteriorly: Anterior border of
Zygomatic bone & Depressor anguli oris Superiorly: Zygomatic arch Inferiorly: Mandible Posteriorly: Masseter
&Pterygomandibular raphe
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CONTENTSCONTENTSBuccal pad of fatStenson’s ductAnterior facial artery & veinTransverse Artery & vein
SOURCES OF INFECTIONMaxillary bicuspidMaxillary molarsMandibular molarsMandibular Bicuspids
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CLINICAL FEATURES
• LOCATION OF SWELLINGLOCATION OF SWELLING lower border of mandible to
level of Zygomatic arch• SYMPTOMSYMPTOM Facial swelling with Trismus• SIGN SIGN Obvious, Dome Shaped
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PAROTID SPACEPAROTID SPACE
• Enclosed by superficial layer of deep cervical fascia along with Parotid gland
• Extension of odontogenic infection is difficult.
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CONTENTSCONTENTS
• Parotid gland• Extra glandular & intraglandular
parotid lymph nodes• External carotid artery• Internal carotid artery• Maxillary artery• Superficial temporal artery
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SOURCES OF INFECTION
• Blood born• Retrograde extension – from
lateral pharyngeal spacE
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CLINICAL FEATURES
LOCATION OF SWELLINGLOCATION OF SWELLINGZygomatic arch to lower border of mandible
Posteriorly extends upto retromandibular region
Anteriorly ends at the end of anterior border of ramus
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SIGNSSIGNS Evertion of ear lobule
SYMPTOMSSYMPTOMS Pain which is referred to ear & accentuated on chewing
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DIAGNOSISDIAGNOSIS : made byEvertion of ear lobuleNo trismusPossible escape of pus from parotid
duct on milkingAll signs of abscess
DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSISSubmasseteric Space
infection
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INFRATEMPORAL SPACEINFRATEMPORAL SPACE
ANATOMY
LOCATIONLOCATION: irregularly shaped space
behind posterior surface of mandible
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BOUNDARIESBOUNDARIES
Laterally: temporalis tendon, coronoid
process & ramus
Medially: Lateral plate of pterygoid process
Posteriorly: Lateral pterygoid muscle, condyle &
temporalis
Anteriorly: Maxillary tuberosity
Superiorly: Greater wing of sphenoid
Inferiorly: communicates with
Pterygomandibular space
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SOURCES OF INFECTION
CONTENTSCONTENTSPterygoid plexusMaxillary artery & veinMandibular division of trigeminal
nerve
Maxillary molarsLocal infiltration of maxillary nerve
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CLINICAL FEATURES
LOCATION OF SWELLINGLOCATION OF SWELLING
*Extraorally over the sigmoid notch
& TMJ area
*Intraorally in tuberosity
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SYMPTOMSSYMPTOMSTrismusSwelling of eyelids in case of involvement of post zygomatic fossa
SIGNSSIGNSEntire cheek swollen; if buccal space involved
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SPACE FOR BODY OF SPACE FOR BODY OF MANDIBLEMANDIBLE
ANATOMY LOCATIONLOCATION: formed as the external
cervical fascia splits medially & laterally, at the inferior border of mandible & becomes continuous with alveolar mucoperiosteum.
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SOURCES OF INFECTION
CONTENTSCONTENTSMandible anterior to ramusVarious Mandibular attachments.
•Fracture or direct extension•Dental caries•Blood born
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CLINICAL FEATURES
LOCATION OF SWELLINGLOCATION OF SWELLING Incisors, Canines & bicuspids
•Outer cortical plate involvement
•Inner cortical plate involvement Molars
•Perforation of infection above external oblique ridge: oblique swelling in the oral vestibules.
•Perforation below mylohyoid line: infection point in the skin
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SUBMENTAL SPACE
ANATOMY LOCATIONLOCATION: Midline b/w
symphysis menti & hyoid bone BOUNDARIESBOUNDARIES:
Floor: Mylohyoid muscle Roof: Suprahyoid portion of
investing layer of deep cervical fascia Lateral: Anterior belly of
Digastric
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SOURCE OF INFECTION
• Mandibular anterior teeth
CLINICAL FEATURES LOCATION OF SWELLINGLOCATION OF SWELLING: Chin
SYMPTOMSSYMPTOMS: Dyspnoea, Dysphagia SIGNSSIGNS: -Grossly swollen cheek -Firm -Erythematous
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SUBMANDIBULAR SPACEANATOMY LOCATIONLOCATION: Lateral to submental
space
BOUNDARIES:BOUNDARIES: Laterally
»Submandibular skin»Superficial fascia»Platysma»Superficial layer of deep cervical
fascia»Lower border of mandible
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Medially–Mylohyoid–Hyoglossus–styloglossus
Inferiorly–Anterior & Posterior belly of digastric
Posteriorly–Hyoid bone
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CONTENTSCONTENTS
• Superficial part of Submandibular salivary gland & lymph nodes
• Facial artery• Wharton’s duct• Lingual & hypoglossal nerve• Facial vein
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SOURCES OF INFECTION
• Second & Third Molars
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CLINICAL FEATURES
LOCATIONLOCATION: Near angle of jaw
SIGNSSIGNS–Brawny–Edematous–After some days swelling becomes soft & cystic
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SUBLINGUAL SPACE
ANATOMY LOCATIONLOCATION: Above mylohyoid BOUNDARIES: Superiorly – mucous membrane
of floor of mouth Anteriorly & laterally – inner
surface of body of mandible Medially – geniohyoid,
genioglossus, median raphe of tongue
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SOURCES OF INFECTION
Posteriorly – Hyoid bone Inferiorly – mylohyoid muscle
• Directly from perforation of lingual cortical plate
• From submandibular space
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CLINICAL FEATURESLOCATION: Floor of mouth, close to
mandible &spreads towards midline or beyond
SYMPTOMSSYMPTOMS–Elevation of tongue–Dysphasia–Dyspnoea
SIGNSSIGNS–Brawny–Erythematous–Tender
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SUBMASSETERIC SPACE
ANATOMY BOUNDARIESBOUNDARIES Anteriorly: body of mandible Posteriorly: Parotid space Medially: Lateral pharyngeal
space Superiorly: continuous with
superficial & deep temporal pouches
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SOURCES OF INFECTIONSOURCES OF INFECTION
CONTENTSCONTENTS - Masseteric artery & vein - Muscles of mastication
- Mandibular 3rd molars
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CLINICAL FEATURESLOCATIONLOCATION - External: brawny induration over
ramus & angle of mandible - Internal: Sublingual region &
pharyngeal wallSYMPTOMS SYMPTOMS -Excruciating pain -Radiates to ear -Dysphagia -Trismus
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TEMPORAL SPACE
ANATOMY LOCATIONLOCATION: Superficial & deep
temporal BOUNDARIESBOUNDARIES Anteriorly- Maxillary tuberosity Posteriorly- Lateral pterygoid,
condyle, temporalis Laterally- Lateral pterygoid plate,
inferior belly of lateral pterygoid
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CLINICAL FEATURES
LOCATIONLOCATION • Infection with superficial temporal space
–Swelling is limited below by zygomatic arch
–Laterally by outline of superficial temporal line
• Deep temporal abscess–Produce less swelling–Lies deep to temporalis muscle–Less fluctuant
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DUMBELL SHAPED APPEARANCEDUMBELL SHAPED APPEARANCE : with buccal space involvement
SYMPTOMSSYMPTOMSPain severeTrismus
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PTERYGOMANDIBULAR SPACE
ANATOMY LOCATIONLOCATION - Well defined - b/w ramus & pterygoid
muscle CONTENTSCONTENTS - Fat - Inferior alveolar nerve - Maxillary artery
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BOUNDARIESBOUNDARIES
Lateral wall: Inner surface of ramusMedial wall: Medial pterygoid muscleRoof : Lateral pterygoid Posterior : Retromandibular spaceAnterior : Deep tendon of
temporalis
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CLINICAL FEATURES
LOCATIONLOCATION : No external evidence Intraorally anterior
bulging of soft palate
SIGNSSIGNS : Deviation of tongue to affected side
SYMPTOMSSYMPTOMS : Severe trismus & Dysphagia
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LUDWIG’S ANGINA
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•FIRST DESCRIPTION IN 1836 BY DR.VON LUDWIG
DEFINITION
ARCHER: IT’S A BILATERAL, ACUTE, RAPIDLY SPREADING, SEPTIC, INFLAMMATORY, INDURATED, WOODEN HARD CELLULITIS OF FLOOR OF MOUTH
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SIGNS AND SYMPTOMS
•MASSIVE,FIRM,HARD BOARD LIKE,BRAWNY NON PITTING SWELLING OF NECK EXTENDING DOWN TO CLAVICLE•OPEN MOUTH•DRIBBLING OF SALIVA•RAISED FLOOR OF MAOTH•SHINY MUCOSA•WHITE COLLAR APPEARANCE•STIFF TONGUE TOUCHING PALATE•DYSPHAGIA, DYSPNOEA•EDEMA OF GLOTTIS
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• MOST IMPORTANT COMPLICATION OF SPACE INFECTIONS
• INCLUDES SUBMANDIBULAR, SUBMENTAL & SUBLINGUAL SPACES BILATERALLY.
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•AIR WAY OBSTRUCTIONAIR WAY OBSTRUCTION
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MANAGEMENT OF MANAGEMENT OF FACIAL SPACE FACIAL SPACE INFECTIONSINFECTIONS
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PROPER HISTORY TAKING , EXAMINATION & INVESTIGATION
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MEDICAL TREATMENT
• ANTIBIOTICS & ANALGESICS»Penicillin»Amoxicillin»Ornidazole»cephalosporin
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SUPPORTIVE THERAPY
• Adequate hydration• Rich nutritional supplements• Rx of pre existing disease
EXTRACTION
•Extraction of offending tooth
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INCISION & DRAINAGE
• Surgical evacuation of pus is necessary for 2 reasons; To prevent further burrowing of purulent mass in an attempt to spontaneous evacuation & to avoid dreaded complications like erosion of major vessels
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TECHNIQUETECHNIQUE• Preparation of skinPreparation of skin – Aseptic manner
prepared area is draped with sterile towels• Local anesthesiaLocal anesthesia• Site of incisionSite of incision – Most dependent part of
abscess than the centre. - This provides dependent
drainage & avoids puckering of skin & excessive scar contracture
- Incision should be in cosmetically & functionally acceptable place
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• Blunt dissectionBlunt dissection – After initial sharp
incision through mucosa
- Sinus forceps : gentle poking & opening beaks of instrument till abscess cavity s reached
- Beaks of forceps should be spread parallel to vital structures.
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• DissectionDissection - Extended to alveolar
process overlying the roots of involved tooth i.e.; the source of infection.
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• AN INFECTED TOOTH SHOULD ALWAS BE GIVEN DUE IMPORTANCE TO PREVENT THE ABOVE FURTHER COMPLICATIONS !!!!!!
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REFERENCES
• Text book of Oral medicine- ANIL GHOM
• Textbook of Oral Pathology – Shaffers
• Textbook of oral surgery –BALAJI• Textbook of Anatomy –
CUNNIGHAM• Google images
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