25. Abscess and phlegmona of the infraorbital area and abscess of the canine fossa. Topographic and surgical anatomy

Question 1

Anatomical location of the canine space

Answer 1

• Superior to the upper lip and lateral to the apex of the maxillary canine=>
• Between levator labii superioris and zygomaticus minor muscles
• Boundaries=> orbicularis oris muscle anteriorly and the levator anguli oris muscle posteriorly

Question 2

Contents of the canine space

Answer 2

• Infraorbital nerve
• Angular artery and vein

Question 3

Etiology of infections in the canine space?

Answer 3

• Maxillary canine=>
• Sufficiently long roots to reach space
• Infection perforates lateral cortex of the maxillary bone=> superior to the attachment of the muscles of the upper lip

Question 4

Clinical features of a canine space infection

Answer 4

• Swelling of the anterior face, cheek and upper lip=> loss of the nasolabial fold
• Edema of the lower eyelids
• Drooping of the corner of the mouth
• Infection can communicate with the buccal space and cavernous sinus via venous connections

In advanced stages, the infection may spread to the orbit, potentially leading to spontaneous drainage from the medial canthus of the eye.

Question 5

Complications associated with a canine space infection

Answer 5

• Bacteremia=> sepsis.
• Arterial transport of the infection into the cranium
• Orbital involvement=> diplopia, blurred vision, or loss of visual field due to swelling

Question 6

How canine space infection treated

Answer 6

• Drainage through an intraoral approach
• Incision => in the maxillary labial vestibule=>
• Hemostat is advanced through the levator anguli oris muscle=>
• Rubber drain is placed and sutured into the lower margin of the vestibular incision