FASCIAL SPACES INFECTION
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INTRODUCTION
Fascial space are potential spaces between the
layers of fascia.
Space is a misnomer ,there are no voids (SPACES)
in the tissues in actual reality.
These areas are potential spaces that do not exist in
healthy individual but become filled during
infections.
Spaces have boundaries formed by muscles, fascia,
periosteium, bone, mucous membranes.
Classifications
BASED ON MODE OF INVOLVEMENT
DIRECT INVOLVEMENT
• Primary space - Mandibular Spaces
Maxillary Spaces
INDIRECT INVOLVEMENT
• Secondary space
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PRIMARY MANDIBULAR SPACES
Submental
Submandibular
Sublingual
Buccal
PRIMARY MAXILLARY SPACES
• Canine
• Buccal
• Infratemporal
SECONDARY FASCIAL SPACES
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Masseteric
Pterygomandibular
Superficial and deep temporal
Lateral pharyngeal
Retropharyngeal
Pre-vertebral
Masticator space
Cervical fascial spaces
Sublingual gland
Tongue
Sublingual space
Mylohyoid muscle
Submandibular gland
Submandibular space
Digastric muscle (Anterior Belly)
LUDWIG’S ANGINA
Definition
• Ludwig’s angina is a form of firm, acute, toxic and
severe diffuse cellulitis that spreads rapidly,
bilaterally, affecting the submandibular, sublingual
and submental spaces and resulting in a woody
swelling.
Etiology
Dental infection most commonly the mandibular
3rd molar in 90% of cases.
Oral soft tissue lacerations.
Puncture wounds of the floor of the mouth.
Submandibular gland sialadenitis.
Secondary infections of oral malignancies.
Clinical Features
 Bilateral suprahyoid swelling with hard
consistency,non fluctuating & painful on
palpation
 Swelling is characterized by rapid onset
 Difficulty in breathing (dyspnea),
 Difficulty in swallowing (odynophagia)
 Restricted tongue movements, elevated tongue,
inability to open the mouth, salivation
 Patients may exhibit muffled voice due to edema
of vocal apparatus (hot potato voice)
Firm, brawny swelling in bilateral submandibular
& submental and sublingual spaces, non
fluctuant,tender with ill defined borders
Open mouth due to edema of sublingual tissue
Airway obstruction due to edema of the glottis and
floor of the mouth
Infection can spread to involve the masticator
space and Para pharyngeal space in the latter
stages of the disease
OSTEOMYELITIS
DEFINITION
In Greek osteon means bone
myelos means marrow
itis
means inflammation
“ Osteomyelitis may be defined as an
inflammatory condition of bone, that begins
as an infection of medullary cavity and
haversian systems and extends to involve the
periosteum of the affected area ”
CLASSIFICATION
• Simplest and the most used is based on
presence or absence of suppuration
• Based on clinical course
Based on suppuration
SUPPURATIVE
ACUTE SUPPURATIVE
CHRONIC SUPPURATIVE
- PRIMARY
- SECONDARY
INFANTILE
NON SUPPURATIVE
CHRONIC SCLEROSING
- FOCAL
- DIFFUSE
GARRE’S SCLEROSING
ACTINOMYCOTIC
SPECIFIC INFECTIVE
- TUBERCULOSIS
- SYPHILIS
RADIATION
CLASSIFICATION
• BASED ON CLINICAL COURSE
Acute oml
 GEN. CONSTITUTIONAL SYMPTOMS
 DEEP, BORING, INTENSE CONTINUOUS PAIN
 PARAESTHESIA OR ANAESTHESIA OF LIP
 FACIAL CELLULITIS OR INDURATED
SWELLING
 FOETID ODOUR
 TEETH – TENDER
 TRISMUS
Chronic oml
 PAIN IS MINIMAL
 NONHEALING WOUNDS WITH INDURATION
 INTRA ORAL OR EXTRA ORAL SINUS
 THICKENED OR WOODEN CHARACTER OF BONE
 ENLARGEMENT OF MANDIBLE
 PATHOLOGICAL #S
 LOOSE , TENDER TEETH
GENERAL MANAGEMENT OF PATIENT WITH INFECTION
MEDICAL THERAPY: It consists of supportive care
Hydration
Soft and liquid diet
Rich protein diet
Analgesics
Antiseptic mouthwash
Maintenance of oral hygiene
Antibiotic therapy — depends upon whether the
patient is non-compromised and compromised patient
Antibiotic Therapy
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Choice of antibiotics include
Penicillin+metronidazole
or
Clindamycin
METRONIDAZOLE
• Immediate infusion of Metronidazole - 500mg
• Brings about rapid improvement
• Repeated every 8 hours
Surgical therapy
Incision and drainage of abscess
• To get rid of toxic purulent material.
• To decompress the oedematous tissue.
• To allow better perfusion of blood containing
antibiotic and defensive cells present in blood.
• To increase oxygenation of the infected area.
APICOECTOMY
• Apicoectomy or Apical surgery or Root resection
are the terms which are used for surgery involving
root apex to treat apical infection.
• It is the cutting of apical portion of the root and
curettage of periapical necrotic, granulomatous,
inflammatory or cystic lesions.
• In spite of good endodontic treatment, if periapical
lesions are not resolved, then apical surgery is
undertaken.
INDICATIONS
Roots with broken instruments/over fillings with infection.
Fracture of apical third of root.
Periapical granuloma or cyst.
Draining sinus tract.
CONTRAINDICATIONS
Presence of systemic diseases eg; Leukemia, uncontrolled
diabeties, anemia.
Teeth damaged beyond restoration.
Teeth with deep periodontal pockets.
Mobile teeth.
Short root length.
Acute infection non-responsive to treatment.