Facial space and the spread of infection Flashcards
Define fascia
Sheets of fibrous connective tissue beneath the skin enclosing other structures
How are fascia classified
By layer
Name the layers used to classify fascias
- Superficial
- Deep
- Visceral
- Parietal
Describe the nature of fascia
It is sheet like
The fact that fascia is sheet like means what
That the body contains extensive planes of connective tissue
What can happen across fascial planes
infections can spread rapidly along the fascial planes
How are fascial planes beneficial for surgeons
Surgeons can separate adjacent tissue relatively easily across the planes
What is fascial space
A volume of tissue enclosed by fascia
Are fascial spaces empty
no
What is fascial space filled with
Connective tissue or a variety fo tissues eg muscles, bone
Name some of the fascial spaces that are significant in dentistry
- Vestibular space
- Buccal space
- Pharynx
- Lateral pharyngeal space
- Retropharyngeal space
- Pteryomandibular space
- Masticator space
- Submandibular and sublingual salivary glands
- Submandibular space
- Sublingual space
Where does the buccinator muscle attach to
Attaches to the maxilla and mandible
Posteriorly fibres attach to the pterygomandibular raphe
Name the fascia that overs the buccinator on its external surface
The buccopharyngeal fascia
Where does buccopharyngeal fascia extend
Extends posteriorly over the buccinator and down over the pharyngeal constrictor muscles
What is the function of the buccinator muscle
Helps keep food in the correct portion when chewing
Where is the vestibular space found
Between the buccinator and the oral mucosa (vestibule of the mouth)
Where is the vestibular space in relation to the buccinator
It is deep to the buccinator
Where is the buccal space found
Between the buccopharyngeal fascia and super ducal structures of the face
Where is the buccal space in relation to the buccinator
Superficial to the buccinator
What does the buccal space contain
Buccal fat pad
Parotid duct
Anterior facial artery and vein
Transverse facial artery and vein
How can the buccal space become infected
If an infection arises in the roots of the teeth it can enter the buccal space
Which space is the buccal space connected to
The pterygomandibular space
What does the buccal space communicate with
Communicates with the lateral pharyngeal space
Why is the communication between the buccal and lateral pharyngeal space clinically significant
As there is potential for infection to spread from the buccal space into the lateral pharyngeal space and the thorax
What is the pharynx
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
What is the pharynx covered by
Buccopharyngeal fascia
Where is the retropharyngeal space found
Between the buccopharyngeal and the prevertebral fascia
Where are the lateral pharyngeal spaces found
On either side of the retropharyngeal space
What is the lateral pharyngeal space continuous with
Continuous with the buccal space anteriorly and the retromandibular space posteriorly
Also continuous with the pterygomandibular space
How far foes the lateral pharyngeal space extend
Extends laterally as far as the carotid sheath
What can infection in the lateral pharyngeal space cause
Could cause Internal Jugular Vein thrombosis or carotid rupture
What other spaces can the lateral pharyngeal space communicate with
- Buccal space (anteriorly)
- Retomandibular space (posteriorly)
- Pterygomandibular space
Why is the connection between the lateral pharyngeal and the retropharyngeal spaces clinically significant
If you developed a retro pharyngeal abscess it could travel up to the lateral pharyngeal space causing extended infection
Where does the retro pharyngeal space lie
Lies immediately posterior to the pharynx between the bucco pharyngeal and prevertebral fascia
It extends inferiorly to the thorax
What can cause retro pharyngeal abscess
- Spread of bacterial infection from tonsils, throat, sinuses and nose
- HIV and TB
- Infection can be drained to the retro pharyngeal lymph nodes leading to abscess formation
What can happen if a retro pharyngeal abscess spreads to the mediastinum
Can cause:
- Mediastinitis
- Pericarditis and tamponade
- Pyopneumothorax
- Bronchial erosion
What can happen if a retro pharyngeal abscess gets really big
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
What can happen if a retro pharyngeal abscess spreads laterally
It can reach the carotid sheath
What can happen if a retro pharyngeal abscess spreads posteriorly
Can cause erosion of the vertebral column with possible vertebral collapse and spinal cord damage
How do we treat retropharyngeal abscess
The size of the abscess can be controlled using antibiotics then surgery performed to drain the abscess
What is mediastinitis
Inflammation of tissues of the mid chest
What is pericarditis
Inflammation of the pericardium surrounding the heart
What is tamponade
Fluid build that causes compression on the heart which means the heart pumps less efficiently
What is Pyopneumothorax
Collection of pus and air between the lung and the pleura
What does the pterygomandibular space communicate with
The buccal and lateral pharyngeal space as well as the submandibular space
The temporal space deep to the zygomatic arch
Where is the pterygomandibular space found
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)
Why is the pterygomandibular space dentally significant
It is where you deliver anaesthetic for an inferior alveolar nerve Block
What is the pterygomandibular space part of
The masticator space and the infra temporal fossa
Where is the infra temporal fossa found
Posteror to tet maxilla
Medial to the ramus of the mandible
Lateral to the lateral pterygoid plate
Anterior to the styloid apparatus
What does the pterygomandibular space contain
Pterygoid musles
Maxillary artery
Pterygoid plexus of veins
What does the masticator space enclose
- All the muscles of mastication
2, Pterygomandibular space - Infra-temporal space
- Temporal space
Name the muscles of mastication
- Masseter
- Temporalis
- Lateral pterygoid
- Medial pterygoid
What does the masticator space communicate with
- Buccal sapce
- Lateral pharyngeal space
- Retropharengeal space
- Submandibular space
- Sublingual space
What can happen if the masticator space become infected
Due to its size and extensive communicates if the masticator space got infected a large area of the face will swell
Where is the submandibular gland found
Horseshoe shaped gland that runs around the mylohyoid muscle
Where are the sublingual glands found
Lies just underneath your tongue
Where ist eh submandibular space located
Inferior to the mylohyoid line
What does the mylohyoid Line do
Separates the submandibular space from the sublingual space
Also is where the mylohyoid muscle attaches
What can the submandibular space communicate with
Communicates posteriorly with the infra temporal space (therefore with the masticatory space) and can communicate with the sublingual space
How can infection spread to the submandibular space
As the submandibular space lies near the roots of the mandibular teeth infection can erode through the mandible to enter the space
How do infections in the submandibular space present
They typically appear as swellings in the upper neck adjacent to the inferior border of the mandible
Where is the sublingual space found
Lies inferior to the oral mucosa in the floor of the mouth and superior tot eh mylohyoid
What can the sublingual space communicate with
The submandibular space
The infra temporal fossa (therefore with the masticatory space)
Infection from where can spread into the sublingual space
Infection from a mandibular tooth
How are infections in the sublingual space presented
Present at swellings under the mucosa of the floor of the mouth
Most likely the swelling Is present in the lingual sulcus
What can happen easily between the sublingual and submandibular spaces
Infection can easily spread between the two spaces
How can infection spread easily between the sublingual land sub mandibular spaces
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
Name an infection that is associated with the sublingual and submandibular spaces
Ludgwigs angina
What is Ludgwigs angina
A life threatening gangrenous bacterial cellulitis in the submandibular and sub lingual spaces
How does Ludgwigs angina usually develop
Develops from a dental infection in a lower molar
can be other causes such as tongue piercings
What is the mortality rate for Ludgwigs angina
Mortality rate is 50% without antibiotics and with antibiotics it is 8-10%
Why is Ludgwigs angina life threatening
As it can lead to obstruction of the airway
What is Ludgwigs angina associated with
The sub lingual and submandibular spaces
