1. Oral and maxillofacial infection
Mandibular spaces of infection
Done by:
‫الجواد‬ ‫عبد‬ ‫محمد‬ ‫آل ء‬

2. Mand. Space Infections involve:
1. Submental space
2. Submand. Space
3. Submasseteric space
4. Sublingual space
5. Ptrygo-mand. Space
6. Parapharyngeal space

3. For each fascial space:
Etiology
Boundaries
Contents
Clinical picture
treatment

4. Submental Space infection
 Etiology:
1. Lymphatic drainage of
infected lower anterior
teeth.
2. spread of infection from
other anatomic spaces.

5. Submental Space infection
Boundaries :
SUPERIORLY : MYLOHYOID MUSCLE
INFERIORLY: INVESTING LAYER OF DEEP CERVICA
FASCIA, PLETYSMA, SUPERFACIAL FACIA,SKIN
LATERALLY: ANTERIORLY BELLY OF DIAGESTRIC
MUSCLE
POSTERIORLY: HYOID BONE

6. Submental Space infection
 Contents:
1. sub mental limph node
2. anterior jugular veins
 Clinical picture:
1. painful submental edema
2. Generalized constitutional symptoms.

7. Submental Space infection
 Treatment:
1. Local anesthesia
2. incision on the skin is
made beneath the chin
3. Blunt dissection
4. Rubber drain
5. A/B administration

8. Sublingual space infection
 Etiology:
1. Infection of lower
incisors and
premolars
2. Spread of infection
from other spaces

9. Sublingual space infection
Boundaries:
INFERIORLY: MYLOHYOID MUSCLE
MEDIALLY: GENIOHYOID, GENIOGLOSSUS
LATERALLY: BODY OF MANDIBLE
SUPERIORLY: FLOOR OF THE MOUTH
POSTERIORLY: HYOID BONE

10. Sublingual space infection
 Contents:
1. Sub man gland duct(warttons duct)
2. Sub lingual gland
3. Hypoglssal n.
4. Lingual artery.

11. Sublingual space infection
 Clinical picture
1. Raised tongue
2. Sublingual swelling
3. Dysphagia
4. Enlarged painful
submental and subman.
Lymph nodes

12. Sublingual space infection
 Treatment
1. Incision ( intraorally lateral to the
sublingual duct )
2. Drainage
3. Rubber drain
4. A/B administration

13. Submandibular space infection
 Etiology:
1. Infection in lower molars
2. Pricoronitis ( lower
wisdoms )
3. Fracture angle
4. Indirect infection ( spread
from other spaces)

14. Submandibular space infection
Boundaries:
INFERIORLY: ANTERIOR & POSTERIOR BELLY OF
DIAGASTRIC
SUPERIORL: MEDIAL ASPECT OF MYLOHYIOD
ANTERIORLY: MYLOHYIOD SPACE
POSTERIORLY: HYIOD BONE

15. Submandibular space infection
 Contents:
1. Submandibular salivary gland, duct and
L.Ns
2. Facial artery
3. Lingual N
4. Hypoglossal N

16. Submandibular space infection
 Clinical picture:
1. Painful swelling
obliterating the angle of
the jaw
2. Tenderness
3. Generalized constitutional
symptoms.

17. Submandibular space infection
 Treatment:
1. Incision ( extraorally below lower border of the
mandible )
2. Blunt dissection
3. Rubber drain
4. A/B administration
5. Fluid replacement ( rehydration )
6. Bed rest

18. Submandibular space infection

19. Buccal space infection
Etiology
Infected upper or lower
molars
( depends on buccinator
muscle attachment )

20. Buccal space infection
 Boundaries:
Antero medialy: buccinator muscle
Postero medialy: masseter & anterior border of the ramus & internal
ptegoid muscle
Lateraly: platysma & deep fascia
Above: zygomatic process
Below: deep fascia of mandible

21. Buccal space infection
 Contents:
1. Buccal bad of fats
2. Facial lymph nodes

22. Buccal space infection
 Clinical picture:
1. Intra oral bulging
2. Extra oral swelling confined to cheek
3. Throbbing pain
4. General constitutional symptoms

23. Buccal space infection
 Treatment:
1. Incision and drainage:
 Intraorally
2. A/B administration
3. Rehydration
4. Bed rest

24. Submasseteric space infection
 Etiology:
1. Lower molar teeth
2. Pericoronitis
3. Buccal space infection
posterior spread

25. Submasseteric space infection
Boundaries:
Medial: lat. surface of the ramus
Lateral: Masseter ms.
Posterior: Parotid gland
Superiorly: zygomatic arch

26. Submasseteric space infection
 Clinical picture:
1. Deep seated, severe throbbing pain
2. Swelling over the angle and ramus
3. Marked trismus

27. Submasseteric space infection
 Treatment:
1. Incision and drainage
 Intraoral  only submasseteric space
 Extraoral  multiple spaces
2. A/B administration
3. Rehydration
4. Bed rest

28. Pterygomandibular space
infection
 Etiology:
 Odontogenic
 Lower third molar
 Infected needle
 Gun shot wounds or compound fracture
 Orthognathic surgery
 Downword spread of infratemporal space.

29. Pterygomandibular space
infection
 Boundaries:
Medial: medial pterygoid ms.
Lateral: meadial surface of ramus
Ant: pterygomandibular raphae
Posterior: parotid gland
Superior: lateral pterygoid ms.  infra-temporal space

30. Pterygomandibular space infection
 Contents:
1. Inferior alv. Bundle
2. Lingual n.
3. Internal maxillary artery
4. Pterygoid plexus of veins
5. Posterior temporal artery

31. Pterygomandibular space
infection
 Clinical picture:
1. Severe trismus ( med. & lat. pterygoid ms. )
2. Intraoral swelling  medial displacement of
lateral pharyngeal wall
3. Dysphagia
4. Uvula displacement to the opposite side
5. Air hunger
6. General constitutional symptoms

32. Pterygomandibular space
infection
Spread:
 Upward  infratemporal space
 Below  submandibular space
 Medial  lateral pharyngeal space

33. Pterygomandibular space
infection
 Treatment:
1. Incision and drainage:
Intraoral  only pterygomandibular space:
along the mesial temporal crest
Extraoral  multiple spaces
2. Rubber drian insertion
3. Rehydration
4. A/B administration
5. Bed rest

34. Parapharyngeal space infection
 Etiology:
1. Infection of lower wisdoms
2. Posterior spread of pterygoman. abscess

35. Parapharyngeal space infection
 Boundaries
BASE: skull base
APEX: hyoid bone
MEDIALLY: superior constrictor muscle
LATERALLY: medial pterygoid m.
POSTERIORLY: parotid glad and carotid sheath

36. Parapharyngeal space infection
 Contents:
1. deep cervical L.Ns
2. Accessory N
3. Glossopharyngeal N
4. Hypoglossal N
5. Carotid sheath
6. Facial artery

37. Parapharyngeal space infection
 Clinical picture:
1. dysphagia
2. Severe trismus
3. Ear and neck ache
4. Shifted tonsils and pharyngeal wall
5. Uvula is pushed medially

38. Parapharyngeal space infection
 Traetment:
1. Incision and drainage:
 Intraoral: vertical incision lateral and parallel to
pterygman. Fold
 Extraoral ( multiple spaces )
2. Rubber drain insertion
3. A/B administration
4. Rehydration
5. Bed rest

39. Retropharyngeal space abscess
 Retropharyngeal abscess (RPA) is an abscess located in the
tissues in the back of the throat behind the posterior pharyngeal
wall. It extends from the base of the skull to a variable level between
the T1 and T6 vertebral bodies.
 they are difficult to diagnose by physical examination alone.
 Early diagnosis is key, while a delay in diagnosis and treatment may
lead to death.
 Parapharyngeal space communicates with retropharyngeal space
and an infection of retropharyngeal space can pass down behind
the oesophagus into mediastinum
 Most commonly seen in infants and young children, RPAs can also
occur in adults of any age.
 RPA can lead to airway obstruction or sepsis - both life-threatening
emergencies.

40. Retropharyngeal space abscess

41. Retropharyngeal space abscess
 Boundaries:
 anterior margin: middle layer of the deep cervical
fascia 1
 posterior margin: alar fascia, which separates the
retropharyngeal space from the danger space
 lateral margins: deep layer of the deep cervical fascia 1
 superior margin: the clivus
 inferior margin: the point at which the alar fascia fuses
with the middle layer of the deep cervical fascia, typically
around the T4 vertebral body 3

42. Retropharyngeal space abscess
 The retropharyngeal space is:
1. anterior to the danger space
2. posterior to the
pharyngeal mucosal space
3. anteromedial to the carotid space
4. posteromedial to the parapharyngeal
space

43. Retropharyngeal space abscess
 contents:
1. areolar fat
2. lymph nodes (lateral and medial
retropharyngeal)
3. small vessels

44. Retropharyngeal space abscess
 etiology:
1. bacterial infection originating from the
nasopharynx, tonsils, sinuses, adenoids
or middle ear. Any Upper Respiratory
Infection (URI) can be a cause. RPA can
also result from a direct infection due to
penetrating injury or a foreign body.
2. Odontogenic cause

45. Retropharyngeal space abscess
 Clinical picture:
1. stiff neck (limited neck mobility or torticollis)
2. some form of palpable neck pain (may be in "front of
the neck" or around the Adam's Apple)
3. Malaise
4. difficulty swallowing
5. fever, stridor
6. drooling
7. croupy cough
8. enlarged cervical lymph nodes.

46. Retropharyngeal space abscess
 Management:Management:
1. A tonsillectomy approach is typically
used to access/drain the abscess.
2. Antibiotic administration
3. Rehydration
4. Bed rest

47. Carotid sheath abscess
 The carotid space is a roughly cylindrical
space that extends from the skull base
through to the aortic arch. It is
circumscribed by all three layers of the
deep cervical fascia, forming the carotid
sheath :
1. Pretracheal
2. Prevertebral
3. investing

48. Carotid sheath abscess
 Boundaries:
1. superior margin: lower border of jugular
foramen
2. inferior margin: aortic arch
3. Anterolateral : sternocleidomastoid
muscle

49. Carotid sheath abscess
 Relations:
1. Suprahyoid carotid space:
2. anteriorly: masticator
space; parapharyngeal space
3. laterally: parotid space
4. posteriorly: perivertebral space

50. Carotid sheath abscess
 Contents:
1. common carotid artery inferiorly and internal carotid
artery superiorly
2. internal jugular vein
3. glossopharyngeal nerve (CN IX)
4. vagus nerve (CN X)
5. accessory nerve (CN XI)
6. hypoglossal nerve (CN XII)
7. sympathetic nerves
8. deep cervical lymph node chain

51. Carotid sheath abscess
 Etiology:
1. Infection usually arises from thrombosis of the internal
jugular vein or from infection of those deep cervical
lymph nodes that lie within the sheath ·
2. Thrombosis of the jugular vein from a deep infection of
the neck is probably not due to direct infection of the
carotid sheath, but rather to the fact that infectious
material follows tributaries of the internal jugular vein to
reach the sheath. ·
3. Drug use (Heroin) usually use carotid route to obtain a
fast high.

52. Carotid sheath abscess
 Clinical picture:
1. Swelling extend to the neck
2. Localized pain along the course of the
vessels

53. Carotid sheath abscess
Management:
Incision and drainage along the anterior
border of sternomasoid muscle.
If the external jugular vien is indurated and
thrombosed it must be ligated to prevent
farther spread.

54. Abscess of the parotid space
It is a rare condition to occur due to dental sepsis, but it
may occur due to:
• Septic parotitis
• Septic fracture of the ascending ramus
• Indirect spread from the parapharyngeal and
submandibular space

55. Abscess of the parotid space
Anatomy :
The parotid space lies between the two
layers of the superficial layer of fascia,
these tow layers are situated medially and
anteriorly . It is bounded laterally by
superficial layer of deep cervical fascia, it
is in direct continuation with the
submasseteric space, submandibular
space, parapharyngeal space

56. Abscess of the parotid space
 Contents:
1.Parotid gland and its duct
2.Facial nerve and its branches
3.Auricalotemporal nerve
4.Superficial temporal artery and
vein
5.Parotid lymph node
6.Posterior facial vein

57. Abscess of the parotid space
 Clinical picture:
1. Swelling at the parotid region
2. elevating the ear lobules
3. Severe pain in the parotid area, may be
referred to
4. ear and temporal region
5. Pain during mastication
6. Some Trismus may be observed
7. Pus from parotid duct when milked
8. General constitutional symptoms

58. Abscess of the parotid space

59. Abscess of the parotid space
 D.D:
1. Mumps (young age, bilateral)
2. Parotitis (discharge is turbid and
purulent)
3. Parotid sialolithiasis
4. Cyst of the parotid salivary gland
5. Tumor

60. Abscess of the parotid space
Management:
Incision and drainage (Blair’s incision)
Drain is inserted
A/B administration
Supportive measures

61. Thank you