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3rd yr- CSB- Oral surgery > Facial space and the spread of infection > Flashcards

Facial space and the spread of infection Flashcards

1
Q

Define fascia

A

Sheets of fibrous connective tissue beneath the skin enclosing other structures

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2
Q

How are fascia classified

A

By layer

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3
Q

Name the layers used to classify fascias

A
  1. Superficial
  2. Deep
  3. Visceral
  4. Parietal
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4
Q

Describe the nature of fascia

A

It is sheet like

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5
Q

The fact that fascia is sheet like means what

A

That the body contains extensive planes of connective tissue

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6
Q

What can happen across fascial planes

A

infections can spread rapidly along the fascial planes

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7
Q

How are fascial planes beneficial for surgeons

A

Surgeons can separate adjacent tissue relatively easily across the planes

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8
Q

What is fascial space

A

A volume of tissue enclosed by fascia

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9
Q

Are fascial spaces empty

A

no

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10
Q

What is fascial space filled with

A

Connective tissue or a variety fo tissues eg muscles, bone

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11
Q

Name some of the fascial spaces that are significant in dentistry

A
  1. Vestibular space
  2. Buccal space
  3. Pharynx
  4. Lateral pharyngeal space
  5. Retropharyngeal space
  6. Pteryomandibular space
  7. Masticator space
  8. Submandibular and sublingual salivary glands
  9. Submandibular space
  10. Sublingual space
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12
Q

Where does the buccinator muscle attach to

A

Attaches to the maxilla and mandible

Posteriorly fibres attach to the pterygomandibular raphe

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13
Q

Name the fascia that overs the buccinator on its external surface

A

The buccopharyngeal fascia

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14
Q

Where does buccopharyngeal fascia extend

A

Extends posteriorly over the buccinator and down over the pharyngeal constrictor muscles

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15
Q

What is the function of the buccinator muscle

A

Helps keep food in the correct portion when chewing

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16
Q

Where is the vestibular space found

A

Between the buccinator and the oral mucosa (vestibule of the mouth)

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17
Q

Where is the vestibular space in relation to the buccinator

A

It is deep to the buccinator

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18
Q

Where is the buccal space found

A

Between the buccopharyngeal fascia and super ducal structures of the face

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19
Q

Where is the buccal space in relation to the buccinator

A

Superficial to the buccinator

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20
Q

What does the buccal space contain

A

Buccal fat pad
Parotid duct
Anterior facial artery and vein
Transverse facial artery and vein

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21
Q

How can the buccal space become infected

A

If an infection arises in the roots of the teeth it can enter the buccal space

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22
Q

Which space is the buccal space connected to

A

The pterygomandibular space

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23
Q

What does the buccal space communicate with

A

Communicates with the lateral pharyngeal space

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24
Q

Why is the communication between the buccal and lateral pharyngeal space clinically significant

A

As there is potential for infection to spread from the buccal space into the lateral pharyngeal space and the thorax

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25
Q

What is the pharynx

A

A muscular tube running posterior to the nasal and oral cavities as well as the larynx
It is continuous with the oesophagus at the inferior border of the larynx

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26
Q

What is the pharynx covered by

A

Buccopharyngeal fascia

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27
Q

Where is the retropharyngeal space found

A

Between the buccopharyngeal and the prevertebral fascia

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28
Q

Where are the lateral pharyngeal spaces found

A

On either side of the retropharyngeal space

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29
Q

What is the lateral pharyngeal space continuous with

A

Continuous with the buccal space anteriorly and the retromandibular space posteriorly
Also continuous with the pterygomandibular space

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30
Q

How far foes the lateral pharyngeal space extend

A

Extends laterally as far as the carotid sheath

31
Q

What can infection in the lateral pharyngeal space cause

A

Could cause Internal Jugular Vein thrombosis or carotid rupture

32
Q

What other spaces can the lateral pharyngeal space communicate with

A
  1. Buccal space (anteriorly)
  2. Retomandibular space (posteriorly)
  3. Pterygomandibular space
33
Q

Why is the connection between the lateral pharyngeal and the retropharyngeal spaces clinically significant

A

If you developed a retro pharyngeal abscess it could travel up to the lateral pharyngeal space causing extended infection

34
Q

Where does the retro pharyngeal space lie

A

Lies immediately posterior to the pharynx between the bucco pharyngeal and prevertebral fascia
It extends inferiorly to the thorax

35
Q

What can cause retro pharyngeal abscess

A
  1. Spread of bacterial infection from tonsils, throat, sinuses and nose
  2. HIV and TB
  3. Infection can be drained to the retro pharyngeal lymph nodes leading to abscess formation
36
Q

What can happen if a retro pharyngeal abscess spreads to the mediastinum

A

Can cause:

  1. Mediastinitis
  2. Pericarditis and tamponade
  3. Pyopneumothorax
  4. Bronchial erosion
37
Q

What can happen if a retro pharyngeal abscess gets really big

A

It can interfere with breathing by pushing the pharyngeal wall anteriorly
This can lead to:
1. Compression of the airway
2. Possible pneumonia or asphyxiation
3. Inflammation/destuction of adjacent tissue

38
Q

What can happen if a retro pharyngeal abscess spreads laterally

A

It can reach the carotid sheath

39
Q

What can happen if a retro pharyngeal abscess spreads posteriorly

A

Can cause erosion of the vertebral column with possible vertebral collapse and spinal cord damage

40
Q

How do we treat retropharyngeal abscess

A

The size of the abscess can be controlled using antibiotics then surgery performed to drain the abscess

41
Q

What is mediastinitis

A

Inflammation of tissues of the mid chest

42
Q

What is pericarditis

A

Inflammation of the pericardium surrounding the heart

43
Q

What is tamponade

A

Fluid build that causes compression on the heart which means the heart pumps less efficiently

44
Q

What is Pyopneumothorax

A

Collection of pus and air between the lung and the pleura

45
Q

What does the pterygomandibular space communicate with

A

The buccal and lateral pharyngeal space as well as the submandibular space
The temporal space deep to the zygomatic arch

46
Q

Where is the pterygomandibular space found

A

Lies between the epimysium of the medial pterygoid muscle and the medial surface of the mandibular ramus
(ie between the mandible and the medial pterygoid muscle)

47
Q

Why is the pterygomandibular space dentally significant

A

It is where you deliver anaesthetic for an inferior alveolar nerve Block

48
Q

What is the pterygomandibular space part of

A

The masticator space and the infra temporal fossa

49
Q

Where is the infra temporal fossa found

A

Posteror to tet maxilla
Medial to the ramus of the mandible
Lateral to the lateral pterygoid plate
Anterior to the styloid apparatus

50
Q

What does the pterygomandibular space contain

A

Pterygoid musles
Maxillary artery
Pterygoid plexus of veins

51
Q

What does the masticator space enclose

A
  1. All the muscles of mastication
    2, Pterygomandibular space
  2. Infra-temporal space
  3. Temporal space
52
Q

Name the muscles of mastication

A
  1. Masseter
  2. Temporalis
  3. Lateral pterygoid
  4. Medial pterygoid
53
Q

What does the masticator space communicate with

A
  1. Buccal sapce
  2. Lateral pharyngeal space
  3. Retropharengeal space
  4. Submandibular space
  5. Sublingual space
54
Q

What can happen if the masticator space become infected

A

Due to its size and extensive communicates if the masticator space got infected a large area of the face will swell

55
Q

Where is the submandibular gland found

A

Horseshoe shaped gland that runs around the mylohyoid muscle

56
Q

Where are the sublingual glands found

A

Lies just underneath your tongue

57
Q

Where ist eh submandibular space located

A

Inferior to the mylohyoid line

58
Q

What does the mylohyoid Line do

A

Separates the submandibular space from the sublingual space

Also is where the mylohyoid muscle attaches

59
Q

What can the submandibular space communicate with

A

Communicates posteriorly with the infra temporal space (therefore with the masticatory space) and can communicate with the sublingual space

60
Q

How can infection spread to the submandibular space

A

As the submandibular space lies near the roots of the mandibular teeth infection can erode through the mandible to enter the space

61
Q

How do infections in the submandibular space present

A

They typically appear as swellings in the upper neck adjacent to the inferior border of the mandible

62
Q

Where is the sublingual space found

A

Lies inferior to the oral mucosa in the floor of the mouth and superior tot eh mylohyoid

63
Q

What can the sublingual space communicate with

A

The submandibular space

The infra temporal fossa (therefore with the masticatory space)

64
Q

Infection from where can spread into the sublingual space

A

Infection from a mandibular tooth

65
Q

How are infections in the sublingual space presented

A

Present at swellings under the mucosa of the floor of the mouth
Most likely the swelling Is present in the lingual sulcus

66
Q

What can happen easily between the sublingual and submandibular spaces

A

Infection can easily spread between the two spaces

67
Q

How can infection spread easily between the sublingual land sub mandibular spaces

A

As the submandibular gland hooks around the posterior border of the mylohyoid muscle which means that there is ready communication between the submandibular and sublingual spaces posteriorly

68
Q

Name an infection that is associated with the sublingual and submandibular spaces

A

Ludgwigs angina

69
Q

What is Ludgwigs angina

A

A life threatening gangrenous bacterial cellulitis in the submandibular and sub lingual spaces

70
Q

How does Ludgwigs angina usually develop

A

Develops from a dental infection in a lower molar

can be other causes such as tongue piercings

71
Q

What is the mortality rate for Ludgwigs angina

A

Mortality rate is 50% without antibiotics and with antibiotics it is 8-10%

72
Q

Why is Ludgwigs angina life threatening

A

As it can lead to obstruction of the airway

73
Q

What is Ludgwigs angina associated with

A

The sub lingual and submandibular spaces

3rd yr- CSB- Oral surgery (4 decks)

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