SPACE INFECTIONSCLINICAL FEATURES & TREATMENT

Dr V.RAMKUMAR

CONSULTANT DENTAL&FACIOMAXILLARY SURGEON

REG N0:4118-TAMILNADU-INDIA(ASIA)

POTENTIAL SPACES FOR INFECTION

1. Vestibular abscess

2. Buccal space

3. Palatal abscess

4. Sublingual space

5. Submandibular space

6. Maxillary sinus

BUCCINATOR & ODONTOGENIC INFECTION

In maxilla Above the attachment

Root apex Extraoral

Below the

attachment

Intraoral swelling

(In Mandible it is vice versa)

MYLOHYOID & ODONTOGENIC INFECTIONS

Anteriors Posteriors

(Root apex below) (Root apex below)

Intraoral Extraoral

(Floor of the mouth) (submandibular)

SUBLINGUAL SPACE

SUBMANDIBULAR SPACE

SUBMASSETRIC SPACE(MASSETER & ODONTOGENIC INFECTION)

3- Layers (superficial, middle and deep)

Infection spreads between these three layers

Swelling less, pain is more

(Infection is usually caused by impacted mandibular, pulpally or periodontally involved third molars)

PTERYGOMANDIBULAR SPACE

Prime muscles of mastication

Infection

Trismus

(usually because of impacted tooth and contaminated injection in to the space)

TEMPORAL SPACE

(Superficial and Deep Temporal space

with Buccal space)

Dumb-bell shaped swelling

Trismus(usually through PSA nerve blocks, infection from maxillary

molars, spread of infection from other spaces)

HIGHWAY TO DANGER

• Pterygoid plexus

• Lincon’s highway

• Multispace infections

THE DANGER ZONES

• Cavernous sinus thrombosis

• Ludwig’s Angina (Multispace infection)

• Mediastinitis

ROOT CAUSE FOR DANGER

• Brain infection

• Respiratory obstruction

• Descending neck infection (mediastinitis, pericarditis)

LUDWIG’S ANGINA

(Sublingual, Submental and Sub mandibular space infection)

Swelling in the floor of the mouth

Lifting of the tongue

Obstruction of airway

Creating an emergency situation

Ludwig’s AnginaMaintain Airway

(Tracheostomy)

Control Infection

Medically Surgically

(Systemic Antibiotics) (Tube Drain)

CAVERNOUS SINUS THROMBOSIS

Pterygoid plexus

Infraorbital fissure

Terminal part of inferior ophthalmic vein

Superior orbital fissure

Cavernous sinus(Thrombosis)

MANAGEMENT

Antibiotic crossing blood brain barrier

(Chloramphenicol, Ciprofloxacin)

Anticoagulant therapy

(To prevent venous thrombosis)

RETROPHARYNGEAL SPACE

Retropharyngeal space

Danger space(space between the alar and prevertebral layer

of the deep cervical fascia)

Mediastinitis/ Carotid sheath infection(FATAL)

MANAGEMENT

Incision and Drainage (along the anterior border of he sternocleidomastoid muscle

at the level of the hyoid bone and the middle third respectively)

DESCENDING NECK INFECTION

Superficial Deep

Mediastinitis Acute necrotizing fascitis (malnourished & immuno-

compromised patients)

Pericarditis

(Stridor - fatal)

MANAGEMENT

DESCENDING NECK INFECTION

Acute necrotizing fascitis Deep

Control infection

(Appropriate systemic antibiotics)

Debridement, local antibiotic dressing, reconstruction of the necrosed skin with graft or flap

If retropharyngeal space is involved, posterosuperior mediastinum may also become infected secondarily. If prevertebral space is infected, the inferior boundary is diaphragm, so entire mediastinum is at risk.

TREATMENT OF SPACE INFECTION

• Empirical antibiotic therapy• Incision and Drainage• Culture and Sensitivity• Appropriate antibiotic therapy• Removal of the cause (teeth if odontogenic)• Supportive therapy• Physiotherapy (to improve mouth opening)

INCISION & DRAINAGE (Principle & Technique)

PRINCIPLE OF ANTIBIOTIC THERAPY

• Identification of causative organism• Determination of antibiotic sensitivity• Use of specific narrow spectrum antibiotic• Use of least toxic antibiotic• Patient drug history• Use of bactericidal rather than bacteriostatic drug

PRINCIPLE OF ANTIBIOTIC ADMINISTRATION

• Proper dosage• Proper time interval• Proper route of administration• Combination antibiotic therapy• Patient monitoring

– Response to treatment– Development of adverse reaction– Superinfection and recurrent infection

THERAPEUTIC USE OF ANTIBIOTICS IN MAXILLOFACIAL INFECTION

• Penicillin– Acute dentoalveolar abscess– Cellulitis– Acute pericoronitis

• Osteomyelitis– Culture sensitivity– Antibiotic therapy is for longer period

• Infected soft tissue wounds– Wound debridement with topical antibiotic– Amoxycillin with clavulanic acid– Metronidazole for anaerobic infection

THANK YOU