Space Inf Yuva Ppt

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<ul><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 1/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 2/95</p><p>Balance is lost infection occurs</p><p> Microbial factors Vs Host factors.</p><p>virulence local</p><p>quantity humoral</p><p>cellular</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 3/95</p><p>Pathophysiology of odentogenic</p><p>infections Dental apex apical osteomyelitis incresed interstitial</p><p>hydrostatic pressure (increase transudate &amp;exudate)-ischemia- tissue breakdown (recruit macrophages)-macrophages (osteoclast) bone resorption cortexbreached soft tissue areolar ( path of least resistance)deflected by</p><p> Muscle</p><p>Fascia Organs</p><p> Bone.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 4/95</p><p>Anatomical structures influencing</p><p>spread Mandible :</p><p> Mentalis.</p><p> Buccinator. Temporalis.</p><p> Mylohyoid.</p><p> Masseter.</p><p> Temporalis.</p><p> External oblique ridge</p><p> Mylohyoid ridge.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 5/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 6/95</p><p>Cervical fascia:</p><p>I.Superficail fascia</p><p>II. Deep cervical fascia</p><p>Anterior layer: Investing fascia</p><p> Parotideomasseteric</p><p> Temporal</p><p>Middle layer:</p><p>a. Sternohyoid-omohyoid division.</p><p>b. sternothyroid-throhyoid division.</p><p>c. Visceral division 1.buccopharyngeal.</p><p> 2. pretracheal. 3. retropharynmgeal.</p><p>Posterior layer: Alar division.</p><p> Prevertabreal division.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 7/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 8/95</p><p>Stages of infection Inoculation</p><p> Cellulitis</p><p>Abscess</p><p> Resolution</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 9/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 10/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 11/95</p><p>BUCCAL SPACE INFECTION (BUCCINATOR</p><p>SPACE INFECTION)</p><p>BOUNDARIES :Ant. modiolus</p><p>Post. buccinator joins sup. Const. muscle.Med. buccinatorLat. skin.Sup. infra orbital space.Inf. lower border of mand.</p><p>CONTENTS : buccal fat pad.</p><p>stensons duct.facial artery br. (transverse facial artery)</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 12/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 13/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 14/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 15/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 16/95</p><p> CLINICAL FEATURES :</p><p>this space can be expand to a surprising volume.</p><p>SWELLING.</p><p>COMMUNICATIONS :</p><p> On posteromedial side of mandible buccal space communicates withPTERYGOMANDIBULAR SPACE.</p><p> To infra temporal space above left pharyngeal muscle inferiorly.</p><p> breaches buccinator posteriorly sub masseteric space.</p><p> through temporal extension of BFP sup. Temp. space.</p><p> Erodes transverse facial artery reaches pterygoid venous plexus cavernous sinus spreads along subcutaneous space into periorbital spaceabove and even neck below.</p><p> Dd :</p><p> haemophilus influenza inf infants or children younger than 3 years - cancause non odontogenic buccal space infection.</p><p> recurrent buccal space inf as a complication of Cohns disease ( segmentaltransmural intestinal disease).</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 17/95</p><p>CANINESPACE (INFRA ORBITALSPACE)INFECTION</p><p> BOUNDARIES Ant. nasal cartilage.</p><p> Post. buccal space.</p><p> Sup. levator labii superioris</p><p> Inf. oral mucosa.</p><p> Med. levator labi superioris.</p><p> Lat. levator anguli oris.</p><p>.CONTENTS </p><p>infra orbital nerve and vessels.</p><p>CLINICAL FEATURES obliteration of nasolabial fold.</p><p> infra (circum) orbital oedema.</p><p> sinus near medial canthus of eye. ( inf open between levator labi</p><p>superoris and levator labii sup. Alaeque nasi.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 18/95</p><p> COMMUNICATIONS :</p><p> Can spread to cavernous sinus by an ascending thrombophebitis of</p><p>angular vein inferior ophthalamic vein cavernous sinus.*</p><p> facial veins are valve less*.</p><p> Dd Dacryocystitis </p><p> nasolacrimal duct.</p><p> maxillary sinusitis.</p><p> carbuncle.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 19/95</p><p>VESTIBULARSPACE (DENTO ALVEOLARABSCESS)</p><p> Space between oral mucosa and muscles of facial expression.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 20/95 </p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 21/95</p><p>DEEPSPACESASSOCIATED WITH MAND.ODONTOGENIC INFECTION</p><p> SPACE OF BODY OF MANDIBLE : ( MANDIBULAR SPACE):</p><p> BOUNDARIES : periosteal envelope and cortical surface of mandible.</p><p> CONTENTS : no contents, but sometimes mental nerve may cross</p><p>this space if distended near foramen. CLINICAL FEATURES : Infections which cross bony cortex, but not</p><p>periosteum cause this infecton.</p><p> mand itself appears enlarged.</p><p> quite painful since periosteum ( richly innervated) is dissected from</p><p>bone by abscess.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 22/95</p><p>SUBLINGUALSPACE</p><p> BOUNDARIES Sup. : mucosa of oral cavity.</p><p> Inf. : mylohyoid.</p><p> Ant and lat.: lingual surface of mandible.</p><p> Med.: genioglossus and intrinsiic muscles of tongue. Post.: sup, post, and medial portion of sub mand space.</p><p> CONTENTS : sublingual gland, sub mandibular duct, hilum of sub</p><p>mandibular gland, lingual nerve, sub lingual artery and vein.</p><p> CLINICAL FEATURES :</p><p> elevation of tongue and restriction in movement.</p><p> can cause epiglotitis in severe case ( infection dissects intrinsic (m)</p><p>tongue and reach epiglotis).</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 23/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 24/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 25/95 </p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 26/95</p><p>Communications:</p><p> Pass around mylohyoid sub mandibular. Buccopharyngeal gap (sup and middle const) to lateral pharyngeal</p><p>space along styloglossus.</p><p> Anteriorly breach mylohyoid enter sub mental.</p><p> Dd sialolith in whartons duct.</p><p> sub lingual gland infection.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 27/95</p><p>SUB MANDIBULARSPACE (SUBMAXILLARY,SUB MYLOHYOID)</p><p>INFECTIONBOUNDARIES:</p><p> Ant.: anterior belly of digastric.</p><p> Post.: post belly of digastric, stylohyoid.</p><p> Sup.: inf and lingual border of mand. Below the mylohyoid lines.</p><p> Med.: mylohyoid (m).</p><p> Inf.: digastric tendon.</p><p> Sup.: platysma (m) and inv lar of deep fascia.</p><p>CONTENTS:</p><p> sub mandibular salivary gland, lymph nodes, facial artery and vein, poximal portion of whartons duct, lingualand hypoglossal nerve.</p><p>CLINICAL FEATURES : swelling in the typical region.</p><p>COMMUNICATIONS :</p><p> posteriorly -infection crosses post belly of digastric (or) along lateral surface of pharyngeal const (m) to lt</p><p>pharyngeal space. Anteriorly crosses ant belly to sub mental cross mylohyoid sub lingual space.</p><p> Dd acute sialadenitis, sub lingual trauma , sub lingual lymph adenitis.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 28/95 </p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 29/95</p><p>SUB MENTALSPACE</p><p>BOUNDARIES: Lat. : ant belly of digastric.</p><p> Sup. : deep cervical fascia, platysma and skin.</p><p> Deep: mylohyoid (m).</p><p> Ant.: inferior br of mandible. Post.: hyoid bone.</p><p>CONTENTS: areolar CT, sub mental lymph nodes, ant jugular vein.</p><p>CLINICAL FEATURES: swelling in chin and sub mental region.</p><p>COMMUNICATIONS :</p><p>post submandibular.sup.- sub lingual ( unlikely).</p><p>Dd </p><p> plunging ranula, sub mental lymph adenitis.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 30/95</p><p>MASTICATORSPACE</p><p> Anatomical compartment enclosed by splitting of anterior layer of deep</p><p>cervical fascia around , muscles of mastication.</p><p> Sub masseteric</p><p> Pterygomandibular</p><p>Sup and deep temporal space infection.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 31/95</p><p>SUB MASSETERICSPACE</p><p>BOUNDARIES: Med: lat surface of ramus.</p><p> Lat: parotidomassetric fascia.</p><p> Inf: pterygomassetric sling.</p><p>Sup: par.mas.fascia fusing with lateral surface of zygo arch. Ant. Buccal space.</p><p> Post: parotid gland.</p><p>CONTENTS:</p><p> Masseter, submasseteric artery and vein.</p><p>CLINICAL FEATURES: TRISMUS</p><p> no obvious extra oral swelling.</p><p> osteomyelitic changes ( sometimes young patients sub periosteal osteosclerosis PA</p><p>view).</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 32/95 </p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 33/95</p><p>COMMUNICATIONS:</p><p> Through sigmoid notch to pterygomandibular space.</p><p> Sup. Continuous with sup and deep temporal space.</p><p> To buccal space anteriorly.</p><p> Lt. pharyngeal and parotid space post.</p><p>Dd parotid infection ( elevate ear lobe, submandibular abscure it).</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 34/95</p><p>PTERYGOMANDIBULARSPACE</p><p> Lat: lingual surface of ascending branch of ramus.</p><p> Med: medial pterygoid.</p><p> Inf.: pterygo mass sling.</p><p> Sup: lt. pterygoid.</p><p> Ant: buccinator fusing with superior const (m).</p><p> Post: parotid gland.</p><p>CONTENTS: IAN vessels, motor supply to med pteryg and masseter and</p><p>sensory nerve like lingual, auriculotemporal, mylohyoid, IAN.</p><p>CLINICAL FEATURE:</p><p> trismus ( edema and inflammation of med pteryg (m).</p><p> No obvious extra oral swelling.</p><p> Deviation of uvula to opposite side.</p><p> Swollen ant tonsillar pillar.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 35/95 </p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 36/95</p><p>COMMUNICATION :</p><p> Spreads to Lt pharyngeal space by passing around ant border of med</p><p>pteryg muscle.</p><p> Infra temporal of deep temporal space by passing around Lt pteryg</p><p>muscle superiorly.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 37/95</p><p>SUPERFICAIL TEMPORALSPACE</p><p>BOUNDARIES: Med: temporalis.</p><p> Lat : temporalis fascia.</p><p> Ant: post surface of Lt orbital rim.</p><p>Post : fusion of temp. fascia with pericranium. Inf : zyg arch and areolar CT medial arch where it communicates with sub masset space.</p><p>CONTENTS :</p><p> Above 2 cm from zyg arch fascia splits to enclose buccal fat pad,</p><p>small veins.</p><p>CLINICAL FEATURES: trismus, swelling above zyg arch.</p><p>COMMUNICATION :</p><p> buccal space temporal extension of BFP</p><p> pteryg and submassetric as they are continuous.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 38/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 39/95</p><p>DEEP TEMPORALSPACE (TEMPORALPOUCHES)</p><p> Lat : temporalis.</p><p> Med : squamous temporal bone.</p><p> Inf : superior surface of lateral pteryg muscle.</p><p> Sup. And post : temporalis muscle to cranium.</p><p> Ant : post wall of maxillary sinus, pterygomaxillary fissure, post surface of orbit.</p><p> Infra temporal space is portion of temporal space that lies inferior to</p><p>infra temporal crest of sphenoid bone.</p><p> CLINICAL FEATURES: TRISMUS, swelling ( may not be obvious)</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 40/95</p><p> CONTENTS:</p><p> Pterygo venous plexus, maxillary artery and branches andsphenopalatine ganglion.</p><p> COMMUNICATION :- 1). Cavernous sinus through pterygoid venous plexus which connects</p><p>cavernous sinus by emisary through 3 foramens - ovale, Lacerum ,versalis. 2) Infection from buccal space erode transverse FACIAL Ptg. venous plexus 3). Directly from Ptg &amp; sub massetric.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 41/95</p><p>Pharyngeal space infection</p><p> Lateral pharyngeal space:- [ Pharyngomaxillary space , Para pharyngeal space ]</p><p>Pyramidal space withBase (sup):- Base of skull.</p><p>Apex (Inf) :- Hyoid bone</p><p>Med:- Pharyngeal constr. (m) [ overling visceral div. of middle layer of deepcervical fascia called buccopharyngeal fascia].</p><p>Lat :- laterosup med ptg. (m)</p><p>L. infer ant. Layex of deep ceroical fascia.</p><p>Ant:- Ant. sup:- Palatine (m)</p><p>middle :- buccinator + sup. Const.</p><p>Inferior :- stytoid (m)</p><p>post belly of digastric.</p><p>Post :- Post medially retropharyngeal.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 42/95</p><p>Post lateral carotid sheath.</p><p>facial condensation from</p><p>to</p><p>ant layer of styloid process Buccopharyngeal fascia</p><p>Deep cervical styloid (m)</p><p>Fascia</p><p>divides Lateral . ph. Space into</p><p> Anterior &amp;</p><p> posterior compartment</p><p>Aponeurosis of this facial cond ZUCKERKANDL &amp; TESTUT</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 43/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 44/95</p><p>CONTENTS :-</p><p>Anterior compt :- Loose areolar C.T. (pre-styloid)</p><p>Posterior compt (Post- Styloid) :- cranial nerves IX,X,XI,XII ,carotid sheath and its contents.</p><p>Cervical symp. Chain attached to posterior sutface of carotid sheath.</p><p>CLINICAL FEATURE :-</p><p>Ant. Compt:- pain, fever, chills, palatoglossal arch may be blunted on affected side with uvula tounaffected side.</p><p>In the frontal view only visible swelling will be between post belly of digastric and ant br of SCM justsup to hyoid bone below angle of mandible.</p><p>Trismus.</p><p>Post compt: - absence of trismus.</p><p>visible swelling.</p><p>but may have respiratory obstruction, septic thrombosis ofIJV, carotid artery</p><p>haemorrhage.CT is much helpful in diagnosis of post compt infection.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 45/95</p><p>COMMUNICATIONS:</p><p> To sub lingual space buccopharyngeal gap.</p><p> Peri tonsillar inf that penetrates pharyngeal constrictor (m) enters Lt</p><p>Ph space.</p><p> From sub mandibular crossing post belly of digastric reach Lt</p><p>pharyngeal space.</p><p> From retropharyngeal directly to Lt pharyn space.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 46/95</p><p>Space Ptg Lt Ph peritonsillar</p><p> Anatomy bet mand &amp; med pteryg bet med pty &amp; sup cons bet sup cons &amp; mucous</p><p>memb</p><p> Limitation of extreme mod. Some</p><p>opening.</p><p> External little none(except none</p><p>swelling in angle of mand.</p><p> Swelling in some over good deal of pillar of little in faucial pillar most</p><p>in</p><p>oral cavity med aspect of ant fauces but little soft soft tissue.</p><p>br of ramus tissue.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 47/95</p><p>RETROPHARYNGEALSPACE(RETROESOPHAGEAL,</p><p>RETROVISCERALSPACE)BOUNDARIES:</p><p> Lat : carotid sheath and lt pharyngeal space.</p><p> Sup : skull base.</p><p> Inf : alar fascia with visceral division of middle layer of deep cervicalfascia ( retropharyngeal fascia) C6 T4.</p><p> Post : alar fascia.</p><p> Ant : sup and middle pharyngeal const(m)</p><p>midline septum divides right from left.</p><p>CONTENTS:</p><p>areolar CT, rich supply of lymph nodes that drains waldeyers ring.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 48/95</p><p>CLINICAL FEATURES:</p><p> can be caused from oesophageal trauma, nasal pharyngeal infection,</p><p>through dental infection of contiguous space or necrosis lymph nodes</p><p>involved.</p><p> Dysphagia, dyspnea, nuchal rigidity, oesophagus regurgitation, with</p><p>fever.</p><p> Bulging in posterior wall either to one side can be visualized.</p><p> Lateral soft tissue radiograph of neck.</p><p> Widening of retropharyngeal space</p><p>C2 - &lt; 6mm</p><p>C6 - &lt; 20mm.</p><p>COMMUNICATIONS : it has to breach only alar fascia to reach danger</p><p>space.</p><p>continuous to Lt pharyngeal space.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 49/95</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 50/95</p><p>MANAGEMENT OFFACIALSPACEINFECTION</p><p>HOST, NOT ANTIBIOTICS CURES INFECTION</p><p> Presence of infection :- local and systemic sign.</p><p> State of host defense :- depressed defense may be a)</p><p>physiological, b) disease, c) congenital, d) drug induced.</p><p>Principles for choosing antibiotics:1. Identify causative organism aerobes and anaerobes, GPC-Str GPC-Strp, GNB-E.coli GNB-fuso</p><p>bactereobes</p><p>2. Determine sensitivity: Majority is sensitive to penicillin</p><p>3. Use a specific , narrow spectrim antibiotics:- Broad spectrum resitance , super injections.</p><p>4. Least toxic.</p><p>1. Bactericidal rather than bacterostatic</p><p>1. Less resistance to hostt.</p><p>2. Faster results.</p><p>3. Flexibility with dose.</p><p>Cost and patient complaince- od 80%, bid 69%, qid 35%</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 51/95</p><p>2.Principles of antibiotic administration</p><p>1. Dose- 3-4 times MIC</p><p>2. Time interval- 4 times t1/2.</p><p>3. Proper route4. consistency in route</p><p>5. combinations</p><p>3 . Patient monitoring</p><p>4. Causes of failure:</p><p> Inadequate surgical drainage Depressed host defence</p><p> Presence of foreign body</p><p> Antibiotic problems- not reaching, adequate wrong choice, diagnosis.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 52/95</p><p>5. Complications:- adverse reaction, toxicity, ACC, superinfection.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 53/95</p><p>Incision and drainage</p><p> Hiltons method:</p><p> Objectives:</p><p> To drain pus and maintain drainage.</p><p> Relive pressure - vascularity( o2</p><p>supply)</p><p> By increasing vascularity- access to bodies defence mech. And</p><p>antibiotics to reach the site.</p><p> Converts spectrum of organism present- Anaerobic Aerobic</p><p>environment.</p><p> Reduces the load and narrows spectrum of antibiotics required.</p></li><li><p>8/6/2019 Space Inf Yuva Ppt</p><p> 54/95</p><p>Principles in placing incision:-</p><p> Healthy skin</p><p> Esthetics</p><p> Dependent drainage</p><p> Explore and break compartments</p><p> Place drain and suture</p><p> Dont leave the drain for long period</p><p> Regular re-exploratio...</p></li></ul>