Post on 22-Oct-2014
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Spreading type of infection
• Into soft tissue –intra oral or extra oral swelling or abscess depending on muscle attachments.
• Spread into adjacent surgical spaces along facial planes – cellulitis.
• More dangerous distant spread
• Maxillary teeth– Molars
• PALATAL ABSCESS• BUCCAL VESTIBULAR/ SULCULAR ABSCESS • FACIAL SWELLING OR ABSESS – which may
lead to cellilitis.
– Anterior & Premolars.• Palatal abscess.• Labial abscess.
Cellulitis from maxillary teeth cause swelling of upper half of face direction towards eye may cause dangerous complication – CAVERNOUS SINUS THROMBOSIS.
• Mandibular premolars and molars.– Labial or buccal vestibular / sulcular abscess.– Lingual palate perforation – depending on
mylohyoid muscle – infection or pus or exudation may involve submandibular/ sublingual spaces – LUDWIG’S ANGINA.
• Mandibular anterior teeth.– Incisors or canines.
• If pus perforate above mentalis – labial abscess.• Below insertion of mentalis cause subcutaneous
abscess. Most often between two mentalis muscles.
• Usually odontogenic infection remained confined in the peri apical area or periodontal pockets.
• Peri apical infections may perforate cortex and form local abscess or spread intra medullary chronic infection or focal osteomyelitis.
• But depending on;– The number and virulence of micro
organisms, type and severity of mechanical or chemical irritant and defense of the host;
– Or initial PAI is not completely or adequately treated.
• It may lead to spreading type of infection– Cellulitis.
• Or may spread to adjacent facial and cervical or distant spaces
FACIAL SPACES
• Fascia–lined areas-- potential spaces that do not exist in healthy persons.
• They become filled by pus or exudation during infection.
• Some contain neurovascular structure– compartments.
• Others filled with loose areolar CT-- Clefts
Primary facial spaces
• Primary spaces are adjacent to tooth bearing area & are directly involved by infection.
• Primary maxillary spaces.» Canine
» Buccal
» Infratemporal.
• Primary mandibular spaces.» Submental.
» Buccal.
» Submandibular.
» Sublingual.
Secondary Facial Spaces
• Secondary spaces are away or lie more posteriorly tooth bearing area and are lined with a CT fascia which has poor blood supply.
• Involvement of these spaces produce more complicated infective conditions.
• They are;
• Masseteric.
• Pterygomandibular.
• Superficial & deep temporal.
This group is also known as the MASTICATOR SPACE because muscle & fascia of mastication bound them.
Cervical Facial Spaces
– Uncommon occurrence.– But spread to deep cervical spaces may have
life threatening sequelae. • Lateral pharyngeal.• Retropharyngeal.• Prevertebral.
PRIMARY MAXILLARY SPACES
Primary mandibular spaces 1
• When bilateral submandibular, sublingual & submental spaces become involved --- Ludwig's angina.
• It is a rapidly spreading cellulitis and commonly spread to secondary mandibular spaces.
• This usually produce life threatening condition.
Cervical Facial Spaces
Principles of management• Determine the severity of infection
• Evaluate the state of patient’s host defense mechanism
• Determine , whether treated by GDP or refer to specialist
• Appropriate antibiotic & their proper administration
• Treat infection surgically
• Diet & i-v fluids
• Evaluate pts frequently
MANAGEMENT
• Proper diagnosis.• Antibiotics.• Other Adjuncts.• I & D