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

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