complex odontogenic infection (oral & maxillofacial surgery - dentistry)
Post on 21-Jan-2018
434 Views
Preview:
TRANSCRIPT
Dr. Sarang Suresh
Hotchandani
COMPLEX ODONTOGENIC
INFECTION
Infection erodes thorough the thinnest adjacent bone and causes
infection in the adjacent tissue.
Infection from Tooth apex perforates below the muscle
attachment – vestibular abscess will occur. (most common
infection)
Infection from Tooth apex above the muscle attachment –
facial space will be infected.
DEEP FASCIAL SPACE INFECTION
DR. SARANG SURESH HOTCHANDANI 2
They are fascia lined tissue
compartments filled with loose,
areolar connective tissue.The loose areolar tissue within these spaces serves to
cushion muscles, nerves, vessels, glands & other
structures.
FASCIAL SPACE (DEFINITION)
DR. SARANG SURESH HOTCHANDANI 3
PATHOPHYSIOLOGY OF
DEEP FASCIAL SPACE INFECTION
DR. SARANG SURESH HOTCHANDANI 4
SPACES WITH ANY TOOTH SPACES WITH MAXILLARY
TEETH
SPACES WITH
MANDIBULAR TEETH
SPACES OF NECK
Vestibular Infra orbital Body of mandible Lateral pharyngeal
Buccal Buccal Perimandibular space Retropharyngeal
Subcutaneous Infratemporal Submandibular Pre tracheal
Para nasal sinus Sublingual Danger space
Cavernous sinus thrombosis Submental Prevertebral
Masticator space
Pterygomandibular
Superficial temporal
Deep temporal
ANATOMIC SPACES INVOLVED IN
ODONTOGENIC INFECTION
DR. SARANG SURESH HOTCHANDANI 5
Severity Score Anatomic Space
Severity Score = 1
Little threat to airway or vital structures
Vestibular
Buccal
Sub periosteal
Space of body of mandible
Infra orbital
Severity Score = 2
Moderate severity – hindered access to airway by
causing trismus or elevation of tongue
Submandibular
Submental
Sublingual
Pterygomandibular
Sub masseteric
Superficial temporal
Deep temporal (or infratemporal)
Severity score = 3
High risk to airway & vital structures – directly
compress & deviate the airway
Lateral pharyngeal
Retropharyngeal
Pretracheal
Severity Score = 4
Extreme risk to airway & vital structures
Danger space (space 4)
Mediastinum
Intracranial infection
Cavernous sinus thrombosis
Necrotizing fasciitis – flesh eating bacterial infection
CLASSIFICATION OF DEEP FASCIAL SPACE
INFECTION BASED ON S E V E R I T Y
DR. SARANG SURESH HOTCHANDANI 6
ANATOMY OF DEEP FASCIAL SPACES OF
HEAD & NECK
DR. SARANG SURESH HOTCHANDANI 7
ANATOMY OF DEEP FASCIAL SPACES OF
HEAD & NECK
DR. SARANG SURESH HOTCHANDANI 8
RELATIONS OF DEEP FASCIAL SPACE
INFECTIONS OF HEAD & NECK
DR. SARANG SURESH HOTCHANDANI 9
RELATIONS OF DEEP FASCIAL SPACE
INFECTIONS OF HEAD & NECK
DR. SARANG SURESH HOTCHANDANI 10
MAXILLARY TEETH
INFECTION
DR. SARANG SURESH HOTCHANDANI 11
Palatal space (sub periosteal space) – maxillary
lateral, premolar & molar.
Infra – orbital space
Swelling of anterior face
Nasolabial fold obliterated
Spontaneous drainage of this space infection occurs near to
medial or lateral canthus of the eye.
INFECTIONS ARISING FROM MAXILLARY TEETH
DR. SARANG SURESH HOTCHANDANI 12
Buccal Space
Swelling below zygomatic arch &
above the inferior border of
mandible.
Buccal space infection follows the
extension of the buccal fat pad into
the infraorbital, periorbital &
superficial temporal space.
Dimpled appearance over the
zygomatic arch.
Zygomatic arch and inferior border of
mandible remain palpable in buccal
space infection.
INFECTIONS ARISING FROM MAXILLARY TEETH
A, Buccal space lies between buccinator muscle and overlying skin
and superficial fascia. This potential space may become involved via
maxillary or mandibular molars (arrows).
B, Typical buccal space infection, extending from the level of the
zygomatic arch to the inferior border of the
mandible and from the oral commissure to the anterior border of the
masseter muscle. DR. SARANG SURESH HOTCHANDANI 13
It is the bottom portion of deep temporal space & lies posterior to maxilla.
Boundaries; Medial – lateral pterygoid plate of sphenoid bone
Superior – base of skull
Lateral & superiorly – continuous with deep temporal space
Contents; Branches of internal maxillary artery
Branches of pterygoid Venus plexus – emissary veins
Infra temporal space is the origin of the posterior route by which infection spread to cavernous sinus.
It is rarely infected, if infection occurs; it is mostly from maxillary 3 rd molar.
INFECTIONS ARISING FROM MAXILLARY TEETH
DR. SARANG SURESH HOTCHANDANI 14
The masticator space is bounded by the fascia overlying the masseter muscle, medial pterygoid muscle, temporalis muscle, and the skull.
The superficial and deep temporal spaces are separated from each other by the temporalis muscle.
The lateral pterygoid muscle divides the Pterygomandibular space from the infratemporal portion of the deep temporal space, and
the zygomatic arch divides the sub masseteric space from the superficial temporal space.
DR. SARANG SURESH HOTCHANDANI 15
• anteriorly via
the inferior or
superior
ophthalmic vein
or
• posteriorly via
emissary veins
from the
pterygoid
plexus.
HEMATOGENOUS
SPREAD OF
INFECTION FROM
THE JAW TO THE
CAVERNOUS
SINUS MAY
OCCUR
DR. SARANG SURESH HOTCHANDANI 16
Maxillary Sinus Infections 20% case of maxillary sinusitis are odontogenic
Odontogenic maxillary sinus infections may also spread superiorly through ethmoid sinus or the orbital floor and cause secondary periorbital or orbital infection.
Clinical Features of Periorbital or Orbital Infections; Redness & swelling of eyelids
Displacement of pupil
Cavernous Sinus Thrombosis Routes mentioned above.
Most vulnerable structure in cavernous sinus thrombosis – abducens 6th
cranial nerve.
INFECTIONS ARISING FROM MAXILLARY TEETH
DR. SARANG SURESH HOTCHANDANI 17
MANDIBULAR TEETH
INFECTION
DR. SARANG SURESH HOTCHANDANI 18
SUBMAXILLARY SPACES or PERIMANDIBULAR SPACE
It is one large space made of;
Submandibular
Sublingual
Submental space
Sublingual & submandibular spaces are infected by lingual perforation of mandibular molars & premolars
If the perforation occurs above the mylohyoid muscle – sublingual space infection will occur.
If the perforation occurs below the mylohyoid muscle – submandibular space infection will occur. Mostly infected by mandibular 3 rd molar
INFECTIONS FROM MANDIBULAR TEETH
DR. SARANG SURESH HOTCHANDANI 19
Sublingual Space;
Little or no extra oral swelling in floor of mouth
Mostly bilateral infection
Elevated tongue.
INFECTION FROM MANDIBULAR TEETH
A, The sublingual space lies between
the oral mucosa and the mylohyoid
muscle. The space is primarily involved
by infection from mandibular premolars
and first molar.
B, Severe sublingual space abscess that
has elevated the tongue into the palate
such that only the ventral
surface of the tongue and floor of the
mouth are visible.DR. SARANG SURESH HOTCHANDANI 20
Submandibular space (figure
17 – 15)
Swelling that look like an inverted
triangle
Base - inferior border of mandible
Sides – anterior & posterior bellies
of digastric muscle
Apex – hyoid bone
INFECTION FROM MANDIBULAR TEETH
The submandibular space lies between the mylohyoid muscle and
anterior layer of the deep cervical fascia, just deep to the platysma
muscle, and includes the lingual and inferior surfaces of the mandible
below the mylohyoid muscle attachment.DR. SARANG SURESH HOTCHANDANI 21
Typical
submandibular
space infection
demarcated by
both bel l ies of the
digastric muscle,
the inferior border
of the mandible,
and the hyoid
bone.
DR. SARANG SURESH HOTCHANDANI 22
Submental space
infection
appears as
discrete swell ing
in central area of
submandibular
region.
DR. SARANG SURESH HOTCHANDANI 23
Bilateral involvement of Perimandibular spaces.
Rapidly spreading cellulitis that can obstruct
airway and
Spread posteriorly to deep fascial spaces of
neck
LUDWIG ANGINA
DR. SARANG SURESH HOTCHANDANI 24
Sever swelling
Elevation & displacement of tongue
Tense, hard, bilateral induration of submandibular region superior to
hyoid bone.
Trismus, drooling, difficulty swallowing & breathing.
Upper airway obstruction
LUDWIG ANGINA CLINICAL FEATURES
DR. SARANG SURESH HOTCHANDANI 25
Compartments of masticators space;
Sub masseteric space
Pterygo mandibular space
Superficial temporal space
Deep temporal space
MASTICATOR SPACE
DR. SARANG SURESH HOTCHANDANI 26
b/w the masseter muscle & lateral surface of ascending ramus
Infected by;
buccal space infection
pericoronitis
mandibular angle fracture
Clinically
moderate to severe trismus due to inflammation of masseter muscle.
Obscured ear lobe due to swelling b/w the masseter muscle & lateral surface of
ascending ramus
SUB MASSETERIC SPACE
DR. SARANG SURESH HOTCHANDANI 27
b/w medial pterygoid muscle & medial surface of ascending ramus.
It is the site into which LA is given in IAN block.
Clinically
Trismus without swelling is diagnostic of Pterygomandibular space infection
Swelling and erythema of anterior tonsillar pillar on the affected side.
Deviation of uvula on opposite side of infection.
On CT examination, fluid collection detected b/w medial pterygoid muscle and the
mandible.
Airway is compressed & deviated
PTERYGO MANDIBULAR SPACE
DR. SARANG SURESH HOTCHANDANI 28
Rarely infected
Clinical Features;
Swelling in temporal region, superior to
zygomatic arch and posterior to lateral orbital
rim
Hourglass shape in frontal view.
SUPERFICIAL & DEEP TEMPORAL INFECTION
DR. SARANG SURESH HOTCHANDANI 29
The lateral pharyngeal space is located between the medial
pterygoid muscle laterally and the superior pharyngeal constrictor
medially.
The retropharyngeal and danger spaces lie between the pharyngeal
constrictor muscles and the prevertebral fascia.
The retropharyngeal space lies between the superior constrictor muscle and the
alar fascia.
The danger space lies between the alar layer and the prevertebral fascia.
DEEP CERVICAL FASCIAL SPACE INFECTION
DR. SARANG SURESH HOTCHANDANI 30
Infection usually comes from
Pterygomandibular, submandibular, sublingual
space.
Is made of two compartments;
Anterior compartment – loose C.T
Posterior compartment – carotid sheath, cranial
nerves (9th, 10th, 12th)
LATERAL PHARYNGEAL SPACE INFECTION
DR. SARANG SURESH HOTCHANDANI 31
Trismus – inflammation of medial pterygoid muscle
Lateral swelling of neck – b/w angle of mandible & S.C.M
Bulge toward midline – swelling of lateral pharyngeal wall
Difficulty swallowing, high temperature.
swelling of the anterior tonsillar pil lar and blunting of the palate -vulvar fold.
Thrombosis of internal jugular vein
Erosion of carotid sheath
Airway is deviated to opposite side of infection.
LATERAL PHARYNGEAL SPACE INFECTION
(CLINICAL FEATURES)
DR. SARANG SURESH HOTCHANDANI 32
The retropharyngeal and the alar fasc ia fuse at a var iable levelbetween the C6 and T4 vertebrae, which forms a pouch at the infer iorextent of the retropharyngeal space.
I f infect ion passes through the alar fasc ia to the danger space, thePostero-superior mediast inum wi l l most l ike ly soon become involved.
The infer ior boundary of the danger space is the diaphragm, whichputs the ent i re mediast inum at r isk .
This space conta ins only loose C.T and lymph nodes, so i t providesl i t t le barr ier to spread of infect ion from one latera l pharyngeal space tothe other to encirc le the airway.
The infect ion can rupture the alar fasc ia poster ior ly to enter the dangerspace
Prevertebral infect ions are usual ly caused by osteomyel i t is ofver tebrae.
RETRO PHARYNGEAL SPACE
DR. SARANG SURESH HOTCHANDANI 33
This infection causes skin vesicle and then
a dusky purple discoloration of overlying
skin due to ischemia.
Later frank necrosis and undermining of
skin occur which require surgical
debridement of large areas of skin.
NECROTIZING FASCIITIS –
FLESH EATING BACTERIAL INFECTION
DR. SARANG SURESH HOTCHANDANI 34
Email: hotchandaniss@hotmail.com
THE END
References
JAMES R. HUPP, E. E. (n.d.). CONTEMPORARY ORAL AND MAXILLOFACIAL
SURGERY (6 ed.). ELSEVIER.
DR. SARANG SURESH HOTCHANDANI 35
top related