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Oral Surgery

Lecture Outline
Dr.A.Sabagh

Orofacial Infection Lec#4
• Submental space infection:

higher posteriorly than anteriorly In the lower posterior aspect. indurated browny edema (Cellulitis). Submandibular salivary glands.Level of the apices of the lower arch (Direct penetration of the lingual plate). • Submandibular space infection: Anatomic continuation of the submental space creating a bilateral right & left submandibular spaces. the apices of teeth related to the area below the myelohyoid ridge will spread infection into the submandibular space.The position of the myelohyoid ridge The myelohyoid ridge runs obliquely.  Surgical anatomy: . 2. enlarged . Lies below the myelohyoid muscle which separate it from the oral cavity & located below & medially to the posterior part of the inner aspect of the mandible. "It has a tongue-like projection that extend into the sublingual space". . . Submandibular lymph nodes. Diffuse. . Bordered posteriorly by: Hypglossous muscle Posterior belly of digastric muscle Medial pterygoid muscle  Contents: . . No elevation of lobe of ear (elevated in case of parotid swelling)  Spread of infection: (according to) (I) 1.  Clinical picture: .

Sublingual space. the myoid bone limits spread inferiorly. Usual systemic signs & symptoms.  Treatment: Extra-oral Incision & Drainage The incision should be done at the deepest area of infection to help the drainage rapidly & completely with the aid of gravity.  The difficulty with swallowing arise from the large surface area of myelohyoid muscle that is involved. causing a "bull neck" appearance. The submandibular space is inferior to the mylohyoid muscle Spread of process superiorly and posteriorly elevates floor of mouth and tongue. In anterior spread. inflammatory red & hot. .. Moderate mandibular limitation. (II) Secondary to involvement of submandibular lymph nodes. . tender.  Signs & symptoms . Incision in the stage of pitted on edema or localized swelling. Massive browny swelling along the lower border of the mandible extending posteriorly to the angle. superior to mylohyoid muscle. indurated.. The swelling is board-like.  The moderate limitation of the mandible arise from the involvement of the medial pterygoid muscle which extend posteriorly in the space not within the infection. This incision should be: . .

painful swelling on the affected side sublingually causing tongue deflection medially & superiorly. Finally. The incision should pass through the (skin. 2. the space should be filled with gauze by a mosquito forceps & left there for 24 hours. dressing is placed externally to allow healing. This drain will allow pus evacuation from un-reached areas & the newly formed pus. The ideal blunt instrument is an index finger. At minimally scanning or disfiguring area "Cosmotic consideration" e.  Signs & symptoms: . . Firm. This drainage should be left in place to keep the incision line patent until the entire induration is relieved. the incision should be done along the medical surface of the dentist finger. a blunt instrument should be inserted within the infected space to completely damage any septi & partition to ensure complete drainage of pus. .5- 2cm) below the inferior border of the mandible @ the skin rest position. superficial fascia. Anatomically should be away from any important anatomical structures (mandibular branch of facial nerve). I finger breadth (1. & the mandibular bone resist the spread. . canine & premolars.  Treatment: . Finally. No extra-oral manifestation because myelohyoid muscle. • Sublingual space infection:  Surgical anatomy: It's a V-shaped space located lateral to the tongue bilaterally. 1.  Bounded by: The mucosa of the floor of the mouth  roof The origin of the myelohyoid muscle  floor The lingual aspect of the mandible  laterally The hyoglossous. Further more.g along s skin crisis So. Shiny sublingual mucosa & of a gelatinous appearance. platysma. Pain & discomfort during swallowing. deep fascia) layer by layer with blunt dissection. genioglossous& geniohyoid muscles  medially  Spread of infection: Apical or periodontal infection related to the incisors.

the buccal space infection can occur as a result of upper & lower posterior teeth infection. Above  Zygomatic process Below Attachment of deep fascia to the mandible Laterally  Platysma muscle & skin  Contents: Buccal pad of fat.  Theoretically. Lower teeth infection is more likely to cause sublingual or submandibular infection due to the thick buccal plate of bone compared to the upper.  Etiology: Dento-alveolar abscess of posterior teeth: .  Signs & symptoms/treatment: Localized extra-oral swelling in the cheek area: Causing buffness when compared to the outer side + Difficulty in mouth opening. However. Vestibular infection: S&S: Intra-oral localized swelling Tx: Intra-oral horizontal incision (in the same location of linea alba) . Posteromedially  masseter & lateral surface of anterior part of the ramus. • Buccal space infection:  Anatomy: Anteromedially  buccinator muscle. The direction should be posterior-anterior to prevent damage of salivary gland ducts. If abscess outside the buccinator muscle  buccal space infection. lateral to the tongue & sublingual plica. Intraoral horizontal incision low down inside the cheek most likely related to the mucobuccal fold. Intra-oral manifestation is seen in case of vestibular space infection. . Intra-oral incision & drainage The incision should run postero-anteriorly. If abscess inside the buccinator muscle  vestibular abscess Extra-oral manifestation is seen in case of buccinator muscle infection. The incision should be followed by blunt dissection of the buccinator muscle sheet.

Palatal abscess (subperiosteal abscess): Occasionally involvement of the palatal roots of upper teeth may lead to palatal abscess beneath the mucosa & periosteum. .  Signs & symptoms: . even under G. Allah Bless You Muchas Gracias . Patient has severe pain upon complete closure into occlusion due to the contraction & approximation of the masseter muscle to the lateral border of the mandibular ramus. the inflammatory edema spreading into the masseter muscle can cause moderate extra-oral swelling & slight disfiguring.  Treatment: . • Submasseteric space infection:  Anatomy: Bounded by masseter muscle laterally The lateral aspect of the mandible ramus medially The parotid gland is found posteriorly  Spread of infection: Lower 3rd molar area Pericoronitis or periapical infection. .. Intraoral incision along the anterior border of the ramus staring from the condylar process & ending lateral to the ramus. Tx: Posterior-anterior incision through the mucosa & the periosteum. In case of severe mandibular lock. Tender in palpitation.A. We should take care of the greater palatine bundle. Complete limitation to mouth opening due to the contractive spasm of the masseter muscle. . . In both cases. . Usual systemic signs & symptoms. No extra-oral swelling is seen however. . elimination of the main cause is essential. extra-oral incision along the mandibular angle inferiorly can be done.

Strawberry .