Handout of Part II lecture - Prof J Weerasinghe

Course Unit 4.6.4,

Diagnosis, Treatment of Spread of Infections of Odontogenic Origin

Spread of Odontogenic infections
Dento-alveolar abscess Cervical Lymphadenopathy Osteomyelitis Cellulitis Deep Fascial Spaces

Spread of infections to fascial spaces

Possible

fascial spaces that can involve Upper anterior teeth From upper posterior teeth From lower anterior teeth From lower posterior teeth
From

Canine Fossa Buccal Space Sub Lingual space Sub Mandibular space Ludwigs Angina Submassteric space Lateral (para) pharyngeal Other deep spaces
Retro

space

pharyngeal mediastinal

Antaomical considerations of fascial spaces Fascial compartments (spaces) of the neck are potential spaces between layers of fascia. cervical fascia superficial cervical fascia -envelopes the platysma and muscles of facial expression, and completely surrounds the neck superficial (investing) layer of the deep cervical fascia invests the sternocleidomastoid, trapezius, strap muscles, parotid and submandibular glands. middle (visceral) layer surrounds the thyroid gland, esophagus and trachea Antaomical considerations of fascial spaces deep layer of the deep cervical fascia splits into prevertebral and alar layers prevertebral layer lies immediately adjacent to the vertebral bodies and extends from the skull base to the coccyx alar layer is located just anterior to the prevertebral layer but extends only to the level of the second thoracic vertebra All three layers of the deep cervical fascia contribute to the carotid sheath From lower anterior teeth From Upper anterior teeth Labial, Labial, Sublingual, Palatal, Submental Canine Fossa From lower posterior teeth Buccal, From upper posterior teeth Sublingual, Buccal, Submandibular, Palatal, Submasseteric Maxillary sinus Deep spaces

Handout of Part II lecture - Prof J Weerasinghe

Sub Mandibular space mylohyoid muscle separates the submandibular space from sublingual mylohyoid muscle also determines the direction of spread of dental infections apices of the second and third molars below the mylohyoid line and the apex of the first molar above When penetrates lingual plate 1st molar infection to sublingual 2nd,3rd molar infection to submandibular space Infection further spread to Lateral pharyngeal space Ludwigs Angina Ludwig angina is characterized by hard boardlike swelling from a rapidly spreading cellulitis of the Bilateral sublingual and submandibular spaces with elevation and edema of the tongue, saliva drooling, and airway obstruction. Submassteric space contains the pterygoid and masseter muscles insertion of the temporalis muscle It communicates freely with the temporal space superiorly and trismus is the most pronounced clinical feature Lateral (para) pharyngeal space occupies a critical area in the neck,

communicates with all other fascial spaces as an inverted cone with its base at the base of skull and apex at the hyoid bone. divided into anterior and posterior compartments by the styloid process.
Retro pharyngeal & Prevertebral Spaces bordered anteriorly by the constrictor muscles and posteriorly by the alar layer of the deep cervical fascia. Infections of this space can extend down to the superior mediastinum If the infection perforates the alar layer posteriorly, it enters the danger space, which extends down the entire mediastinum to the level of the diaphragm. Further extension posteriorly enters the prevertebral space, which extends down to the coccyx. Principles of Management Removal of the focus if infection Incision and drainage Antibiotic therapy Submasseteric space- through-&-through drainage Ludwigs Angina emergency admission IV antibiotics Airway management Multiple incisions to relive pressure build-up in the neck 2