FASCIAL SPACES INFECTION

INTRODUCTION
Fascial space are potential spaces between the
layers of fascia.
Space is a misnomer ,there are no voids (SPACES)
in the tissues in actual reality.
These areas are potential spaces that do not exist in
healthy individual but become filled during
infections.
Spaces have boundaries formed by muscles, fascia,
periosteium, bone, mucous membranes.
 Classifications

BASED ON MODE OF INVOLVEMENT

DIRECT INVOLVEMENT
Primary space - Mandibular Spaces
Maxillary Spaces

INDIRECT INVOLVEMENT
Secondary space
 PRIMARY MANDIBULAR SPACES
Submental
Submandibular
Sublingual
Buccal

PRIMARY MAXILLARY SPACES

Canine
Buccal
Infratemporal
 SECONDARY FASCIAL SPACES

Masseteric
Pterygomandibular Masticator space
Superficial and deep temporal

Lateral pharyngeal
Retropharyngeal Cervical fascial spaces

Pre-vertebral
 Sublingual gland
Tongue

Sublingual space

Mylohyoid muscle
Submandibular gland
Submandibular space

Digastric muscle (Anterior Belly)

 LUDWIGS ANGINA
Definition
Ludwigs angina is a form of firm, acute, toxic and

severe diffuse cellulitis that spreads rapidly,

bilaterally, affecting the submandibular, sublingual

and submental spaces and resulting in a woody

swelling.
 Etiology
Dental infection most commonly the mandibular
3rd molar in 90% of cases.

Oral soft tissue lacerations.

Puncture wounds of the floor of the mouth.

Submandibular gland sialadenitis.

Secondary infections of oral malignancies.

 Clinical Features
Bilateral suprahyoid swelling with hard
consistency,non fluctuating & painful on
palpation
Swelling is characterized by rapid onset
Difficulty in breathing (dyspnea),
Difficulty in swallowing (odynophagia)
Restricted tongue movements, elevated tongue,
inability to open the mouth, salivation
Patients may exhibit muffled voice due to edema
of vocal apparatus (hot potato voice)
Firm, brawny swelling in bilateral submandibular
& submental and sublingual spaces, non
fluctuant,tender with ill defined borders

Open mouth due to edema of sublingual tissue

Airway obstruction due to edema of the glottis and

floor of the mouth

Infection can spread to involve the masticator

space and Para pharyngeal space in the latter
stages of the disease
 OSTEOMYELITIS
DEFINITION
In Greek osteon means bone
myelos means marrow
itis means inflammation
Osteomyelitis may be defined as an
inflammatory condition of bone, that begins
as an infection of medullary cavity and
haversian systems and extends to involve the
periosteum of the affected area
 CLASSIFICATION

Simplest and the most used is based on

presence or absence of suppuration

Based on clinical course

 Based on suppuration
SUPPURATIVE NON SUPPURATIVE
ACUTE SUPPURATIVE
CHRONIC SCLEROSING
- FOCAL
- DIFFUSE

GARRES SCLEROSING
CHRONIC SUPPURATIVE
- PRIMARY
- SECONDARY
INFANTILE ACTINOMYCOTIC

SPECIFIC INFECTIVE
- TUBERCULOSIS
- SYPHILIS

RADIATION
 CLASSIFICATION
BASED ON CLINICAL COURSE
 Acute oml
GEN. CONSTITUTIONAL SYMPTOMS
DEEP, BORING, INTENSE CONTINUOUS PAIN
PARAESTHESIA OR ANAESTHESIA OF LIP
FACIAL CELLULITIS OR INDURATED
SWELLING
FOETID ODOUR
TEETH TENDER
TRISMUS
 Chronic oml

PAIN IS MINIMAL

NONHEALING WOUNDS WITH INDURATION

INTRA ORAL OR EXTRA ORAL SINUS
THICKENED OR WOODEN CHARACTER OF BONE
ENLARGEMENT OF MANDIBLE
PATHOLOGICAL #S
LOOSE , TENDER TEETH
 GENERAL MANAGEMENT OF PATIENT WITH INFECTION

MEDICAL THERAPY: It consists of supportive care

Hydration
Soft and liquid diet
Rich protein diet
Analgesics
Antiseptic mouthwash
Maintenance of oral hygiene
Antibiotic therapy depends upon whether the
patient is non-compromised and compromised patient
 Antibiotic Therapy

Choice of antibiotics include

Penicillin+metronidazole
or
Clindamycin
 METRONIDAZOLE

Immediate infusion of Metronidazole - 500mg

Brings about rapid improvement

Repeated every 8 hours

 Surgical therapy

Incision and drainage of abscess

To get rid of toxic purulent material.

To decompress the oedematous tissue.

To allow better perfusion of blood containing

antibiotic and defensive cells present in blood.

To increase oxygenation of the infected area.

 APICOECTOMY
Apicoectomy or Apical surgery or Root resection
are the terms which are used for surgery involving
root apex to treat apical infection.

It is the cutting of apical portion of the root and

curettage of periapical necrotic, granulomatous,
inflammatory or cystic lesions.

In spite of good endodontic treatment, if periapical

lesions are not resolved, then apical surgery is
undertaken.
INDICATIONS
Roots with broken instruments/over fillings with infection.
Fracture of apical third of root.
Periapical granuloma or cyst.
Draining sinus tract.
CONTRAINDICATIONS
Presence of systemic diseases eg; Leukemia, uncontrolled
diabeties, anemia.
Teeth damaged beyond restoration.
Teeth with deep periodontal pockets.
Mobile teeth.
Short root length.
Acute infection non-responsive to treatment.