primary space infection - chandrika

7/27/2019 Primary Space Infection - Chandrika

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PRIMARY SPACE INFECTION

Dr.Chandrika Dubey



Classification

1. Maxilla

– Canine Fossa Involvement

– Buccal Space Involvement

– Infratemporal Fossa Space

2. Mandible

– Submental Space

– Submandibular Space

– Sublingual Space



1- (a) - Canine Fossa Involvement

o Periapical abscess of cuspids

o Discharges bucally from upper canine or

First premolaro Leading to accumulation of pus in canine

fossa

INVOLVEMENT

• Maxillary canine and premolar

• Mesiobuccal root of first molar

BOUNDARIES

• Superioirly – levator labi superior

alaque nasi, levator labi superioris

• Inferiorlr – caninus muscle

• Anteriorly - orbicularis oris

• Posterioirly - buccinator muscle

• Medially- anterolateral surface of

maxilla



CLINICAL FEATURES

• Extraoral – swelling of cheek and upper lip

• Obliteration of naso labial fold

• Drooping of angle of mouth

• Oedema of lower eyelid

• Intraoral –tooth is mobile

• Tender on percussion

TREATMENT

Incision and drainage – approach through buccal vestibule in the region

of lateral incisor and canine. space is entered through mosquio

forceps, pus is evacuated and drain is inserted and is secured to one

of the margins with suture.



1-(b)-Buccal Space Involvemento Space between buccinator and

masseter muscle

INVOLVEMENT

• Maxillary and mandibularpremolars and molars

BOUNDARIES

• Anteromedially – buccinatormuscle

• Posteromedially - masseter

• Laterally – deep fascia fromthe capsule of parotid gland

• Inferiorly – depressor angulioris

•

Superiorly – zygomaticprocess of maxilla



CONTENT

• Buccal pad of fat

• Stenson duct

•Facial artery

CLINICAL FEATURES

• Gum boil (pus accumulation) is seen on the vestibule

• Prominent extraoral swelling – from lower border of mandible to

infraorbital margin

• Edema of lower eyelid



TREATMENT

Incision and drainage – horizontal incision through the oral mucosa of

cheek in premolar, molar region. Enter the space through curvedmosquito forceps. Drain is placed and sutured.

SPREAD

• To infratemporal space along the fascia accompanying stenson

duct

• To submasseteric space if infection penetrates the

paratidomasseteric fascia.



1-(c)-Infratemporal Fossa spaceo It is also called “retrozygomatic space” as it

is partky behind the zygomatic bone.

INVOLVEMENT

• Infection arises from infected buccalroots of maxillary second and thirdmolar

• LA injections with contaminatedneedles

• Spread from other space infection.BOUNDARIES

• Laterally – ramus of mandile, temporalismuscle

• Medially – medial pterygoid

• Superioirly – infratemporal surface of greater wing of spheniod

• Inferiorly – lateral pterygoid muscle

• Anteriorly – infratemporal surface of maxilla

• Posteriorly - parotid gland



CONTENTS

• Medial pterygoid

• Lateral pterygoid

• Pterygoid venous plexus

CLINICAL FEATURES

• Extraoral –

trismus• bulging of temporalis muscle

• Marked swelling of face on affected side

• Eye is often closed on affected side.

• Intraoral –

swelling on tuberosity area



TREATMENT

Incision and drainage –

INTRAORAL – if trismus is not marked, intraoral incision is given in

buccal vestibule opposite 2nd and 3rd molar. Exploration is carried outand space is entered. Drainage is done.

EXTRAORAL – carried out in severe conditions. Incision is made at upper

and posterior edge of temporalis muscle within hairline. Pus is

evacuated, rubber drain is inserted and secures with suture.

SPREAD

• pus can extend upwards to involve temporal space

• Or inferiorly it may involve the pterygomandibular space.



2-(a)-Submental spaceINVOLVEMENT

• most frequently by infections

originating from six anterior

mandibular teeth.

• Space can be secondarily involved

due to infections of submental

lymph nodes following lymphaticspread from lower incisors, lower

lip, skin overlying chin, tip of

tongue.

BOUNDARIES

• Lateral – lower border of mandible

• Superior – mylohyoid muscle

• Inferior – suprahyoid portion of

investing layer of deep cervical

fascia.



CONTENT

• Submental lymph node

• Anterior jugular vein

CLINICAL FEATURES

• Extraoral – distinct and firm swelling in midline, beneath the chin,

•

Fluctuation may be present• Intraoral – anterior teeth are either non-vital, fractured or carious.

• Tooth are mobile and tender on percussion.



TREATMENT

Incision and drainage – transverse incision in the skin below the

symphysis of the mandible. Blunt dissection is carried out by

inserting sinus forcep. Corrugated rubber drain is inserted andsutured.

SPREAD

• Posteriorly to submandibular space

• May discharge on face, in submandibular region.



2-(b)-Submandibular spaceo The space lies between anterior and

posterior belly of digastric.

INVOLVEMENT• Infections originating from

mandibular molars. Pus perforatesthe lingual cortical plates and passesdirectly to submandibular space.

BOUNDARIES

• Anteromedially – mylohyoid muscle

• Posteromedially – hyoglossusmuscle

• Superolaterally – mylohyoid ridge• Anterosuperiorly – ant. Belly of

digastric

• Posterosuperiorly – post. Belly of

digastric



CONTENT

• Submandibular salivary gland

• Submandibular lymph node

• Facial artery and vein

CLINICAL FEATURES

• Extraoral –

firm swelling in submandibular region.• Some degree of tenderness.

• Redness of overlying skin.

• Intraoral – teeth are sensitive to percussion.

• Dysphagia

• Moderate trismus.



TREATMENT

Incision and drainage – incision is made 2cms below the lower border of

mandible. A sinus forcep is inserted and corrugated drain is secured

with sutures.

SPREAD

• Infection can extend into submental space.

• Infection can spread across the midline and involve the

submandibular space on contra-lateral side.



2-(c)-Sublingual spaceo the space is a V-shaped trough lying

lateral to muscles of tongue.

INVOLVEMENT

• Mandibular incisors, canine,

premolars and sometime 1st

molars.

• It is a paired space, two sidescommunicate anteriorly.

BOUNDARIES

• Inferiorly – mylohyoid muscle

• Laterally – medial side of mandi

• Medially – hyoglossus

genioglossus geniohyoid muscle

• Posteriorly – hyoid bone



CONTENT

• Geniohyoid muscle

• Genioglossus muscle

• Sublingual salivary gland

CLINICAL FEATURES

• Extraoral –

little or no swellling• Lymph nodes may be tender

• Pain and discomfort on deglutition

• Speech may be affected

• Intraoral –

firm painful swelling seen on floor of mouth

• Floor of mouth is raised

• Tongue is raised which may lead to airway obstruction.

TREATMENT



TREATMENT

Incision and drainage – INTRAORALLY – an incision is made close to

lingual cortical plate (taking care of the submandibular nerve , lingual

nerve) sinus forcep is inserted and pus is evacuated.

EXTRAORALLY – when both submental and sublingual space contain

pus, they can be drained via skin incision.

SPREAD

• Infection always crosses the midline and can affect the space on

opposite side.

•

Infection can spread via lymphatics to submental andsubmandibular lymph nodes.



THANK YOU

primary space infection - chandrika

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