W12 Fascia and spaces

Question 1

Define fascia

Answer 1

It is connective tissue layer that surrounds muscles, bones, organs, nerves, blood vessels and other structures.

Fascia has superficial, middle and deep layers which divide, unite, blend and fuse to form various compartments

Question 2

Define space

Answer 2

Spaces between the fascia.

Potential spaces created between the layers of fascia, due to the sheet like nature of fascia. Contain loose CT, some spaces in the head are created by boundries of other structures, not necessarily fascia. Spaces that communicate with one another.

Question 3

Define superficial fasciae of the head and neck

Answer 3

Superficial is found just deep to and attached to the skin. It separates skin from deeper structures, permitting the skin to move independently from those deeper structures.

Fascia varies in thickness. Vessels and nerves of the skin travel in the superficial fascia.

Encloses the muscles of facial expression, superficial cervical fascia of the need contains the platysma muscle.

Question 4

Define deep fasciae of the head and neck

Answer 4

Forms sheath around deeper structures such as bones, muscles, vessels and nerve

Question 5

What are the (3) names of deep fascia of the head?

Answer 5

1. Temporal fascia
2. Masseteric-parotid fascia
3. Pterygoid fascia

Question 6

What are the (6) names of deep fascia of the neck (cervical fascia)?

Answer 6

1. Investing layer
2. Pretracheal fascia (muscular and visceral portions)
3. Carotid sheath - surrounds carotid arteries, internal jugular vein and the vagus nerve.
4. Prevertebral fascia
5. Buccopharyngeal fascia
6. Alar fascia

Question 7

Name the (6) layers of the head and neck and there fuctions.

Answer 7

Investing layer: Outter most layer, surround the neck like a collar.

Prevertebral fascia: lies in front of the prevertebral muscles, provides fixed basis for phayrnx and larynx, esophagus, carotid sheath, can glide your neck movements and swallow.

Pretracheal fascia: lies deep to the infrahyoid muscles, encloses the thyroid, esophagus, trachea, providing a lubricated surface for the up and down gliding of the trachea during swallowing and neck movements. Blends laterally with carotid sheath.

Carotid sheath: Felt work of the aerolar tissue that surrounds the carotid arteries, both common and internal, surrounding the internal jugular vein and vagus nerve. Thin over the internal jugular veins, because it allows the vein to dilate during ↑ blood flow.

Question 8

Define the Temporal space

Answer 8

Located between temporal fascia and temporalis muscle

Question 9

Define the Infratemporal space

Answer 9

Occupies the infratemporal fossa. Bound by ramus, lateral pterygoid plate and maxillary tuberosity. No boundary inferiory and posteriorly, where the infratemporal space is continuous with the cervical fascial space, the parapharyngeal space

Question 10

EXAM Define the Sublingual and Submandibular tissue space

Answer 10

Sublingual is medial to the mandible and superior to mylohyoid muscle.

Submandibular is inferior to mylohyoid muscle, reaching inferiorly to the hyoid bone

Question 11

Define the Submental tissue space

Answer 11

Located in the midline between the mandibular symphysis and hyoid bone.

Floor of this space: superficial cervical fascia

Question 12

Define the Submassetric space

Answer 12

Located between the masseter muscle and external surface of ramus.

This space communicates with the temporal and infratemporal spaces.

Question 13

Define the Pterygomandibular space

*

IAV: Inferior Alveolar Vein

IAA: Inferior Alveolar artery

IAN: Inferior Alveolar Nerve Trigeminal, V3

SML: Sphenoid Mandibular Ligament

MP:

R: Ramus

L: Lingual

TT: Tendon of Temporalis

SCM: Superior constrictor muscle

PMR: PterygoMandibular Raphe

B: Buccinator muscle

Answer 13

Located between the medial pterygoid muscle and medial surface of the ramus.

INSERTIONS FOR IAN BLOCK

Question 14

EXAM What are the Pterygomandibular space-borders

Answer 14

Superior border: lower head of lateral pterygoid muscle.

Inferior border: medial pterygoid m. attachment to the medial surface of ramus of mandible.

Lateral: medial surface of ramus

Medial border: medial pterygoid m.

Posterior border: parotid gland

Anterior border: oral mucosa and posterior part of buccinator m./pterygomandibular raphe

Question 15

What is the danger space?

Answer 15

Retropharyngeal space located between the Alar space and Prevertebral space.

Question 16

Define the retropharyngeal space

Answer 16

Immediately posterior to the pharynx. Infection in this space may pass behind the carotid sheath, or inferiorly into the upper part pf the thorax.

Question 17

Define the Parapharyngeal/lateral pharyngeal space

Answer 17

Lateral to the pharynx, medial to medial pterygoid muscles.

Continuous with buccal and infratemportal spaces anteriorly and retropharyngeal space posteriorly.

Question 18

How do dental infections spread?

Answer 18

Infections can spread:

• Via facial spaces - cellulitis, risk of deep infections spreading into the neck and mediastium,
• Into bone osteomyelitis
• Via the cardiovascular system to the heart, infective endocarditis
• Via venous system into the veins of cranial cavity, specifically the cavernous sinuses cavernous sinuses thrombosis (blood clotting).
• Into the paranasal sinuses secondary sinusitis
• Via Lymphatic system Lymphadenopathy (lymphadenitis)

Question 19

What does the spread of dental infection cause?

Answer 19

Periodontal space infections may cause gingival or soft tissue or mucosal swelling, whereas infections at the apices cause swelling in either buccal or palatal direction.

Abcess in vestibual spaces: an infection may break through bone around the involved teeth and spread/travel into tissue spaces/fascial spaces.

Infection will follow the path of least resistance.

Muscle attachment serve as barrier to the spread of infection via fascial spaces

Question 20

What is Cellulitis?

Answer 20

When an infection has entered the fascial space, the loose CT of this space undergoes diffuse inflammation, with severe inflamation of dermal and subcutaneous layers of the skin.

E:O swelling

Clinically: pain, tenderness, redness, diffuse oedema, psyphagia, restricted eye opening, dyspnoea.

Question 21

What is Ludwig’s Angina?

Answer 21

Bilateral infection of the submandibular and sublingual spaces in addition to the submental space. It is a life threatening condition