Primary Facial Primary Facial Spaces Spaces

Prepared By: Dr.Said Mir Shah HashemiPrepared By: Dr.Said Mir Shah HashemiSS

ContentsContents DefinitionDefinition ClassificationsClassifications Canine SpaceCanine Space Buccal SpaceBuccal Space Infratemporal SpaceInfratemporal Space Submandibular SpaceSubmandibular Space Submental SpaceSubmental Space Sublingual SpaceSublingual Space Medical ManagementMedical Management

Definition of Fascial SpacesDefinition of Fascial Spaces The fascial spaces are potential The fascial spaces are potential

spaces formed by the various fascial spaces formed by the various fascial layer’s division and different levels. layer’s division and different levels. They are separated by pus, blood, They are separated by pus, blood, drain or surgical instruments during drain or surgical instruments during surgery.surgery.

ClassificationClassification Topazian ClassificationTopazian Classification1. Face1. Facea)a) BuccalBuccalb)b) CanineCaninec)c) Masticatory ( Masseteric, Pterygoid, Masticatory ( Masseteric, Pterygoid,

Zygomaticotemporal)Zygomaticotemporal)d)d) ParotidParotid

2. Suprahyoid2. Suprahyoida)a) SublingualSublingualb)b) Submandibular-submaxillary-Submandibular-submaxillary-

submentalsubmentalc)c) Lateral pharyngeal Lateral pharyngeal

(pharyngomxillary)(pharyngomxillary)d)d) PeritonsillarPeritonsillar

3. Infrahyiod3. Infrahyioda)a) Anterovisceral(pretracheal)Anterovisceral(pretracheal)b)b) RetrovisceralRetrovisceral

4. Space of Total Neck4. Space of Total Neck

a)a) RetropharyngealRetropharyngealb)b) Danger spaceDanger spacec)c) Space of carotid sheathSpace of carotid sheath

According to involvement of According to involvement of spaces spaces

1. Primary Maxillary Spaces1. Primary Maxillary Spacesa)a) Canine (infraorbital)Canine (infraorbital)b)b) BuccalBuccalc)c) InfratemporalInfratemporal

2. Primary Mandibular Spaces2. Primary Mandibular Spaces

a)a) SubmentalSubmentalb)b) Sub mandibularSub mandibularc)c) SublingualSublinguald)d) BucallBucall

3. 3. Secondary Fascial SpacesSecondary Fascial Spacesa)a) MassetericMassetericb)b) Superficial and deep temporalSuperficial and deep temporalc)c) Lateral pharyngealLateral pharyngeald)d) RetropharyngealRetropharyngeale)e) PrevertebralPrevertebral

Canine space Canine space Boundaries of Canine SpaceBoundaries of Canine SpaceSuperficial and Superior: Superficial and Superior: Quadratus labii Quadratus labii

superiorissuperiorisInferior: Inferior: Orbicularis OrisOrbicularis OrisDeepDeep: Levator Anguli Oris, anteriior surface : Levator Anguli Oris, anteriior surface

of maxof maxMedial:Medial: Levator labii superioris alaeque nasiiLevator labii superioris alaeque nasiiLateral: Lateral: Zygomaticus MajorZygomaticus Major

Areas of spread in infraorbitalAreas of spread in infraorbitalspace infectionsspace infections

Angular artery & VeinInfraorbital Nerve

Clinical FeaturesClinical Features Swelling of the cheek & Upper lipSwelling of the cheek & Upper lip Obliteration of the nasolabial foldObliteration of the nasolabial fold Oedema of the lower eyelidOedema of the lower eyelid

Surgical ManagementSurgical Management Incision IntraorallyIncision Intraorally Application of drainApplication of drain

Buccal SpaceBuccal SpaceSuperior: Superior: Zygomatic archZygomatic archInferior: Inferior: Inferior border of mandibleInferior border of mandibleAnterior: Anterior: zygoma and dep anguli oriszygoma and dep anguli orisPosterior: Posterior: masseter musclemasseter muscleMedial: Medial: Buccinator Muscle & its fasciaBuccinator Muscle & its fasciaLateral: Lateral: Skin and subcutaneous tissueSkin and subcutaneous tissue

Pathway of spread for buccalPathway of spread for buccalspace infectionspace infection

ContentsContents Adipose TissueAdipose Tissue Parotid DuctParotid Duct Anterior & Transverse Facial Artery & Anterior & Transverse Facial Artery &

VeinVein

Clinical Features:Clinical Features: Dome shape swellingDome shape swelling

Surgical Management:Surgical Management: Extra OralExtra Oral Intra OralIntra Oral

Infratemporal SpaceInfratemporal Space Superior: Superior: Skull base sphenoid crestSkull base sphenoid crest Inferior: Inferior: Lateral Pterygoid muscleLateral Pterygoid muscle Medial: Medial: Lateral Pterygoid plateLateral Pterygoid plate Lateral: Lateral: Temporal Muscle & tendonTemporal Muscle & tendon Anterior: Anterior: Maxillary tuberosityMaxillary tuberosity Posterior: Posterior: Mandibular CondyleMandibular Condyle

ContentsContents Internal Maxillary ArteryInternal Maxillary Artery Pterygoid venous plexusPterygoid venous plexus Mandibular division of trigeminal Mandibular division of trigeminal

nervenerve

Neighboring SpaceNeighboring Space Buccal SpaceBuccal Space Superficial Temporal SpaceSuperficial Temporal Space Inferior Petrosal Sinus SpaceInferior Petrosal Sinus Space

Clinical FeaturesClinical Features SwellingSwelling TrismusTrismus Proptosed eyeProptosed eye

Surgical ManagementSurgical Management Extraoral ApproachExtraoral Approach Intraoral ApproachIntraoral Approach

Submandibular SpaceSubmandibular Space Lateral: Lateral: Skin, Fascia & PlatysmaSkin, Fascia & Platysma Medial: Medial: Mylohoid, Hyoglo, Stylo & Mylohoid, Hyoglo, Stylo &

Sup. CoSup. Co Superior: Superior: Mandible & MylohyoidMandible & Mylohyoid Inferior: Inferior: DigastricDigastric

Pathways of spread of Pathways of spread of submandibular space infection from submandibular space infection from

mandibular molarmandibular molar

ContentsContents Submandibular salivery gland Submandibular salivery gland

&lymph nodes&lymph nodes Facial ArteryFacial Artery Lingual ArteryLingual Artery

Neighboring SpacesNeighboring Spaces SublingualSublingual SubmentalSubmental Lateral PharyngealLateral Pharyngeal BuccalBuccal

Clinical FeaturesClinical Features SwellingSwelling Restriction of Mouth OpeningRestriction of Mouth Opening

Surgical ManagementSurgical Management IncisionIncision DrainageDrainage

Submental SapceSubmental Sapce Superior: Superior: Mylohoid MuscleMylohoid Muscle Inferior: Inferior: Skin & Subcutaneous tissue, Skin & Subcutaneous tissue,

platysma & deep cervical fasciaplatysma & deep cervical fascia Medial: Medial: Single Medline SpaceSingle Medline Space Lateral: Lateral: Ant. Belly of digastric (bilateral)Ant. Belly of digastric (bilateral) Anterior: Anterior: MandibleMandible Posterior: Posterior: Hyoid boneHyoid bone

Contents:Contents: No Vital StructuresNo Vital Structures Lymph Nodes & Ant. Jugular VeinsLymph Nodes & Ant. Jugular Veins

Neighboring SpaceNeighboring Space Submandibular SpaceSubmandibular Space

Clinical FeaturesClinical Features SwellingSwelling

Surgical ManagementSurgical Management Bilateral IncisionBilateral Incision DrainageDrainage

Sublingual SpaceSublingual Space

Superior: Superior: Mucosa of the floor of the mouthMucosa of the floor of the mouth Inferior: Inferior: Sup. surface of mylohyoid muscleSup. surface of mylohyoid muscle Medial: Medial: Medline RaphaeMedline Raphae Lateral: Lateral: Medial surface of mandibleMedial surface of mandible

Contents:Contents: Submandibular & Sublingual Glands & their draining Submandibular & Sublingual Glands & their draining

ductsducts Lingual NerveLingual Nerve

Neighboring Spaces:Neighboring Spaces: Submandibular spaceSubmandibular space Lateral Pharyngeal SpaceLateral Pharyngeal Space

Clinical Features:Clinical Features: SwellingSwelling

Surgical ManagementSurgical Management Intraoral IncisionIntraoral Incision Extraoral IncisionExtraoral Incision DrainageDrainage

Medical ManagementMedical Management PenicillinPenicillin ClindamycinClindamycin CephalosporinCephalosporin

Antibiotic therapy, con’tAntibiotic therapy, con’t.. ErythromycinErythromycin MetronidazoleMetronidazole AugmentinAugmentin

Supportive CareSupportive Care To ensure the patient’s maximum To ensure the patient’s maximum

immune response:immune response: Increase fluid intake (16 ounces/hour).Increase fluid intake (16 ounces/hour). Nutritional intake (soups, protein Nutritional intake (soups, protein

drinks, solids) with three meals/day.drinks, solids) with three meals/day. May need to see patient daily, until May need to see patient daily, until

resolution has begun.resolution has begun.

ReferenceReference S.M Balaji 2013. Text book of Oral & S.M Balaji 2013. Text book of Oral &

Maxillofacial Surgery. In: Head and Maxillofacial Surgery. In: Head and Neck Space infection. 2Neck Space infection. 2ndnd edi. A edi. A division of Reed Elsevier India. Pp. division of Reed Elsevier India. Pp. 477-495:24.477-495:24.