● Deep fascial spaces of Maxilla:

○ Infraorbital / Canine space

◆ Max canine

◆ Obliterates nasolabial fold

◆ Drainage completed intraorally

○ Buccal space

◆ Max/mand molar/premolar

◆ Erodes above/below attachment of buccinator

◆ Drainage completed extraorally

○ Maxillary sinus

○ Infra temporal space

◆ Max 3rd molar

○ Palatal space

◆ Lateral incisors / canines / 1st premolars

○ Cavernous sinus thrombosis

◆ Vital structures—CN III, IV, V1, VI

○ Periorbital cellulitis

● Deep fascial spaces of Mandible:

○ Perimandibular spaces

◆ Submandibular

◆ 3rd molars

◆ Contents:

◆ Submand gland

◆ Facial a.

◆ Lingual & hyoglossal n.

◆ Whartons duct

◆ Signs:

◆ Dysphagia

◆ Dyspnea

◆ Trismus
 ◆ Sublingual
◆ Anterior to 2nd molar teeth

◆ Signs:

◆ Elevated tongue

◆ Swelling w/in FOM

◆ Redness of FOM

◆ Tender/firm palpation

◆ Submental

◆ Incisor

○ Masticator spaces
◆ Submasseteric

◆ Significant trismus

◆ Pterygomandibular

◆ Communicates w/ lateral pharyngeal space

◆ Superficial temporal

◆ Deep temporal

● Mandibular Infections:
○ **Most treated with EXTRA oral drainage incision

○ **Drainage better due to gravity

○ **Most important aspect with severe infections is—

AIRWAY CONTROL

● Ludwigʼs Angina:
○ Bilateral perimandibular space infection

○ Odontogenic origin = 90%

○ Mortality primarily due to airway security (4% rare)

● Deep fascial spaces of the Neck:

○ Lateral pharyngeal

◆ 2 compartments divided by styloid process

◆ Anterior

◆ Posterior—multiple vital structures**

 ◆ Signs:
◆ Trismus

◆ Bulging soft palate

◆ Deviated uvula

◆ Dysphagia

◆ Contents:

◆ CN IX, X, XI, XII

◆ IJV

◆ Internal carotid a.

○ Retropharyngeal
◆ Contains only Loose CT—little barrier to spread of

infection
◆ If punctured, can move into mediastinum

○ Danger space
◆ Infection can cause mediastinitis

◆ Compresses heart and lungs

◆ High mortality

○ Prevertebral
◆ Usually caused by osteomyelitis of vertebra

● Relative SEVERITY of deep fascial space infections:

○ LOW—little threat to airway or vitals

◆ Vestibular

◆ Buccal

◆ Subperiosteal

◆ Space of body of mandible

◆ Infraorbital

○ MODERATE—hindered access to airway

◆ Perimandibular spaces

◆ Submandibular

◆ Sublingual

◆ Submental

◆ Masticator spaces
 ◆ Submasseteric
◆ Pterygomandibular

◆ Superficial and deep temporal

○ HIGH—direct threat to airway or vitals

◆ Deep neck spaces

◆ Lateral pharyngeal

◆ Retropharyngeal

◆ Danger space

◆ Pretracheal

◆ Mediastinum

◆ Intracranial infections

◆ Cavernous sinus thrombosis

◆ Brain abscess

◆ Necrotizing fasciitis

● Osteomyelitis:
○ Inflammation of bone marrow

◆ Primarily oral flora

◆ Streptococcus

◆ Anaerobic cocci

◆ Gram (-) rods

◆ Begins in medullary cavity & spreads —> cortical

bone —> periosteum

◆ Rarely involves maxilla due to profound blood

supply
◆ Predisposing factors

◆ Odontogenic infection

◆ Mandible fractures

◆ MRONJ

◆ Immunocompromised patients

○ **Typically produces sequestra and involucrum

◆ Sequestra—necrotic Island of bone w/in areas of

purulence or necrosis
 ◆ Involucrum—increased bony production
surrounding area of necrosis (Rx finding)
○ **Typically Tx surgically w/ debridement until bleeding
bone identified & medically w/ long term IV antibiotics
◆ For at least 6 weeks

● Acute osteomyelitis Vs Chronic osteomyelitis:

○ ACUTE:

◆ Duration— <1 month

◆ Pain—deep intense

◆ Minimal soft tissue swelling

◆ Fever

◆ Pus

◆ Paresthesia

○ CHRONIC:

>- month
◆ Duration— <1

◆ Pain & swelling

◆ Pus—variable

◆ Loose teeth

◆ Moth eaten bone on radiograph

◆ Can develop fistula or sinus tracts

● Actinomycosis:
○ Uncommon infection of the hard & soft tissues of the

head & neck

○ Actinomyces Israelii is most common pathogen

○ Does NOT follow anatomic planes

◆ Burrows into tissue eventually extra oral sinus tract

formation
○ Difficult to culture but commonly I.D.ʼd due to SULFUR

GRANULES
○ Tx w/ debridement and long term IV PCNs w/ common

recurrence
◆ **Use LONG TERM to prevent recurrence