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

space

Retro

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
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