16. Fascial Space Infection

Question 1

Submandibular

Answer 1

Superior Mylohoid m.

Inferior Platysma m.

Lateral Mandible medial surf

Medial Diagastric m. (ant belly)

Anterior Mandible medial surf

Posterior Hyoid bone

Question 2

Submental

Answer 2

Superior Mylohoid m.

Inferior Platysma m./deep cervical fascia

Lateral Diagastric m. (ant belly)

Medial –

Anterior Mandible inferior border

Posterior Hyoid bone

Question 3

Sublingual

Answer 3

Superior FOM

Inferior Mylohoid m.

Lateral Mandible medial surf

Medial genioglossus, intrinsic m. of tongue

Anterior Mandible medial surf

Posterior geniohyoid and genioglossus m.

Question 4

Mental

Answer 4

Superior Mentalis m.

Inferior Platysma m.

Lateral -

Medial -

Anterior -

Posterior -

Question 5

Buccal

Answer 5

Superior Zygomatic process/zygomaticus m.

Inferior depressor anguli oris m.

Lateral Platysma m.

Medial Buccinator m.

Anterior Angle of mouth

Posterior Masseter

Question 6

Canine/Infra-orbital

Answer 6

Superior levator labii superioris

Inferior oral mucosa of the maxillary labial sulcus

Lateral quadratus labii superioris m. (superficial)

Medial levator anguli oris m. (deep)

Anterior Nasal cartilages

Posterior Buccal space

Question 7

Submasseteric

Answer 7

Superior Zygomatic arch

Inferior Mandible inferior border

Lateral Masseter m.

Medial Ramus lateral surface

Anterior Masseter m.

Posterior Parotid gland

Question 8

Pterygomandibular

Answer 8

Superior Lateral pterygoid m.

Inferior Mandible inferior border (L)

Lateral Ascending ramus

Medial Medial pteryrgoid m.

Anterior Posterior border of buccal space

Posterior Parotid gland

Question 9

Deep temporal (infra-temporal)

Answer 9

Superior greater wing of the sphenoid bone

Inferior pterygomandibular space

Lateral -

Medial lateral pterygoid plate, part of the lateral pterygoid muscle and lateral pharyngeal wall

Anterior infra-temporal surface of the maxilla

Posterior -

Question 10

Sites of Localization of Acute Dental Infections

Answer 10

If muscle attch is apical to apex >>> vestibule

Otherwise:

Max canine >> Canine space

Max molars >> Buccal space

Md incisor >> Submental space

Md 1st molar >> Buccal space, Sublingual space

Md 2nd molar >> Buccal, Sublingual, Submand

Md 3rd molar >> Submand, Pterygomandibular

Also: palatal (max lat/PM/molars)

Question 11

Signs of Infection, Treatment

Answer 11

Signs of Infection:

Extraoral: Swelling, Dysphagia, Trismus, Lymphadenopathy

Lymphadenopathy: Submental (lower incisors), Submandibular (all other teeth)

Intraoral: Swelling, Sinus Tract

Treatment:

• Surgical (I&D, decompression)
• Antibiotics (Pen VK, Clindamycin)
• Supportive (Analgesics, Heat, Fluids)

Question 12

Fascial Space Complications

Answer 12

Ludwig’s Angina

Sublingual + Submental + Submandibular spaces bilaterally

>> pharyngeal/cervical spaces >> Airway closure (life threatening cellulitis)

Cavernous sinus thrombosis

Infection of midface (spread from canine or periorbital spaces) >> Inflammation/Pressure within the Infratemporal space

>> Reverse direction of venous blood flow & stasis within the Cavernous sinus

>>Thrombi formation within cavernous sinus

Symptoms: Unilateral periorbital edema, headache, bulging of eye, blindness, fever

Question 13

Incision and Drainage

Answer 13

Laskin 1964 Odontogenic infection and Anatomic Consideration (fascial spaces)

Dirlam txtbk 4 routes of spread of infection: lymphatic, hematogenous, venous, direct extension.

Matthews/Basrani 2003 meta-A Abx not helpful for localized AAA (should be drained via pulpectomy/I^D). Abx for systemic complications (fever, lymphadenopathy, cellulitis, immunocompromised pt).