includes all spaces anatomical land marks, diagrams

1. FACIAL SPACES OF PERIODONTAL
INTEREST
Presented By
Dr. M. Shiva Shanker
Ist Year Post Graduate Student ,
Dept of Periodontics, Mamata Dental College.

2. 
Introduction

Classification of spaces

Formation of spaces

Maxillofacial odontogenic infections

Individual spaces

Communications

Complications

Case report

conclusion
CONTENTS

3. 
Connective tissue - naturally forms a padding between and around the
various structures in the neck, and also elsewhere in the body.
- tends to be somewhat more dense where it is arranged immediately
about organs.

When the fascia and spaces of the head and neck of normal bodies are
investigated, the looser Connective tissue intervening between organs
is torn and pressed against these organs, there by exaggerating any
fascial layer already present.

The interrelationships of these spaces have been regarded as special
importance in the spread of infection.

Accurate knowledge of the anatomy of these spaces and prompt
drainage of them when they become infected is necessary.
INTRODUCTION

4.  Fascia
& spaces above the
hyoid bone :

Fascia & spaces below the hyoid
bone :

Superficial layer of fascia

Prevertebral

Superficial layer of fascia

Buccopharyngeal

Pretracheal

Space of the body of mandible

Prevertebral

Sub-maxillary gland space.

Carotid sheath

Masticator space.

Retrovisceral space.

Space of parotid gland.


Retropharyngeal space
Danger space or space of
Grodinsky and Holyoke.

Lateral pharyngeal space.
CLASSIFICATION

5. 
Depending upon its relationship with Hyoid bone.

Infrahyoid spaces
` (Below the hyoid bone)

Suprahyoid spaces (above the hyoid bone)

This is further divided into 2 categories.

Blind or intrafascial spaces.

Pretracheal space

Retrovisceral space

Space of the body of mandible.

Carotid space

Space of submaxillary gland.

Space 4 or danger space.

Masticatory spaces.

Space of parotid gland.

Peripharyngeal spaces.

Retropharyngeal space.

Lateral pharyngeal space.

Submandibular space.
CLASSIFICATION ….

6.  Depending
 Primary
upon the involvement
spaces
 Secondary
spaces
CLASSIFICATION ….

7. FASCIA
 The
fascia is divided into two major divisions
 Superficial layer
 Deep
cervical fascia
 Superficial fascia
 This
arises from the vertebral spinous processes and the ligamentum
nuchae and completely encircles the neck to attach again to these.
 It
invests the platysma in the neck, the muscles of facial expression, and
the epicranial muscles in the scalp.

8. Deep
cervical fascia
1. Anterior layer

Investing fascia (over the neck)

Parotideomassetric

Temporal
2. Middle layer

Sternohyoid-omohyoid division

Sternothyroid-thyrohyoid division

Visceral division

Buccopharyngeal

Pretracheal

retropharyngeal

9. Deep cervical fascia......

Posterior layer

Alar division

Prevertebral division
The DCF of the neck is contiguous with the mediastenal structures in the thorax through
the thoracic inlet. As it emerges from the neck superior to the hyoid bone.

10. FASCIAL
SPACES

11. Space of Burns
Fascia anterior to strap
muscles
between the two
sternocleidomastoid
muscles
splits into two layers just
above the sternum
Suprsternal space(
SOB)

12.  Pretracheal
fascia.

The pretracheal fascia passes behind the infrahyoid or strap muscles,
infront of the trachea and thyroid gland.

The pretracheal layer with the carotid sheath laterally and the
prevertebral layer posteriorly, forms the visceral compartment
containing the trachea, esophagus and associated structures.

13. FORMATION OF SPACES
 Vestibular space:

Medial: mandible or maxilla and overlying periosteum

Lateral: vestibular mucosa

Superior: buccinator muscle

Inferior: buccinator muscle

Anterior: intrinsic lip muscles

Posterior: lateral pharyngeal and massetric space

14. SUB MANDIBULAR SPACE

Medial: mylohyoid, hyoglossus, styloglossus
muscles

Lateral: skin and platysma muscle

Superior: mandible, mylohyoid and masseter
muscle
Mandible
Post digastric
Stylohyoid muscle  Inferior: hyoid bone

Anterior: anterior digastric muscle, submental
space

Posterior: posterior belly of digastric muscle
and stylohyoid muscle
Ant digastric
Mylohyoid

15. SUB MENTAL SPACE
Mandible
Ant digastric
Inferior border of the mandible
Mylohyoid muscle
Hyoid bone

16. SUBLINGUAL SPACE
Floor of mouth mucosa
Mandible
Geniohyoid
Mylohyoid
Hyoid bone

17. BUCCAL SPACE
Zygomatic arch
Skin
Buccinator muscle and attachment to maxillary and
mandibular alveolus
Mandibular and Sub Mandibular space

18. BUCCAL SPACE
Zygomatic major muscle
Depressor anguli oris

19. CANINE SPACE
Maxilla
Nasal bone
Levator labii superioris
Skin
Buccal space

20. LATERAL PHARYNGEAL SPACE
Sub lingual, sub mandibular spaces
Pterygomandibular raphae
Hyoid bone
Parotid capsule
Base of the skull

21. RETROPHARYNGEAL SPACE
Lateral pharyngeal space
Base of the skull
Vertebrae C6-T4

22. MASSETRIC SPACE
Superficial part of masseter
Deep part of masseter
Mucosa of retromolar triangle of mandible
Parotidomassetric fascia

23. PTERYGOMANDIBULAR SPACE
Parotid gland & its fascia
Superior constrictor of pharynx
Mandibular ramus
Lateral pterygoid muscle
Pterygomandibular raphae
Buccinator

24. SUPERFICIAL TEMPORAL SPACE
Temporal fascia
Temporalis

25. DEEP TEMPORAL SPACE
Temporalis
Fascia of deep surface of temporalis

26. PREVERTEBRAL SPACE
 Medial: postural
neck muscles
 Lateral: postural
neck muscles
 Superior: base
of skull
 Inferior: coccyx
 Anterior: alar
fascia and
retropharyngeal space
 Posterior: vertebral bodies

27. INFRA TEMPORAL SPACE
 Medial: lateral pterygoid muscle
 Lateral: temporalis
and lateral pterygoid plate
tendon and coronoid process
 Superior:  Inferior:  Anterior: maxillary
tuberosity
 Posterior: lateral muscle,
temporalis muscle, and condyle

28. MAXILLOFACIAL ODONTOGENIC INFECTIONS
Spread of infection

29. STAGES OF INFECTION
Characteristic
Duration
Pain
Inoculation
0-3 days
Mild-moderate
Cellulitis
3-7 days
Severe and generalized
Size
Location
Palpation
Small
Diffuse
Soft,doughy, mildly tender
Large
Diffuse
Hard, exquisitely tender
Abscess
>5 days
Moderate-severe
localized
Small
Circumscribed
Fluctuant, tender
Appearance
Normal color
Reddened
Peripherally reddened
Skin quality
Normal
Thickened
Centrally undermined and
shiny
Surface temperature
Slightly heated
Hot
Moderately heated
Loss of function
Tissue fluid
Minimal or none
Edema
Levels of malaise
Severity
Percutaneous bacteria
Mild
Mild
Aerobic
Severe
Moderately severe
Serosanguineous, flecks of Pus
pus
Severe
Moderately severe
Severe
Moderately severe
Mixed
Anaerobic
and

30. MANAGEMENT OF SPACE INFECTIONS
Management of infections, mild or severe, always has five general goals:

Medical support of the patient

Administration of proper antibiotics

Surgical removal of the source of infection as early as possible

Surgical drainage of the infection

Constant reevaluation of the resolution of the infection.

31. INDIVIDUAL SPACES
Vestibular space
Etiology
Signs
and symptoms
Treatment and
applied aspects

32. CLINICAL PICTURE SHOWING VESTIBULAR
SPACE INFECTION

33. SUBMANDIBULAR SPACE
Facial vessels
Hypoglossal nerve
Submandibular gland
Marginal mandibular branch of VII
CONTENTS

34. Etiology
Signs
and symptoms
Treatment and
aspects
applied

35. CLINICAL PICTURE OF SUBMANDIBULAR
SPACE

36. SUBMENTAL SPACE
Etiology

Signs
and symptoms
Treatment and
aspects
Spread of infection
applied

37. CLINICAL PICTURE OF A SUBMENTAL SPACE

38. SUBLINGUAL SPACE
Lingual nerves and vessels
Submandibular ganglion
Submandibular gland
CONTENTS

39. Etiology

Signs
and symptoms
Treatment and
aspects
Spread of infection
applied

40. CLINICAL PICTURE OF A SUBLINGUAL SPACE

41. BUCCAL SPACE
Parotid duct
Buccal branch of VII
Facial vessels
Buccal fat pad
CONTENTS

42. Etiology

Signs
and symptoms
Treatment and
aspects
Spread of infection
applied

43. CLINICAL PICTURE OF BUCCAL SPACE

44. CANINE SPACE
Infraorbital nerves and vessels
Levator anguli oris
CONTENTS

45. Etiology
Signs
and
symptoms
Treatment and
applied aspects

46. CLINICAL PICTURE OF A CANINE SPACE

47. LATERAL PHARYNGEAL SPACE
Etiology
Signs
and symptoms
Treatment and
aspects
B. Lateral
Pharyngeal
Space
applied

48. RETROPHARYNGEAL SPACE
Etiology
Signs
and symptoms
Treatment and
aspects
applied

49. PREVERTEBRAL SPACE

Etiology
Signs
and symptoms
Treatment and
aspects
applied

50. MASTICATOR SPACE
Etiology
Signs
and symptoms

51. MASSETRIC SPACE
Treatment and
applied aspects:
Spread of infection

52. CLINICAL PICTURE SHOWING
MASSETRIC SPACE

53. PTERYGOMANDIBULAR SPACE
Treatment and
aspects:
A. Pterygomandibular Space
applied

54. TEMPORAL SPACE
Treatment and
applied aspects:

55. INFRATEMPORAL SPACE
Etiology
Signs
and symptoms
Treatment and
aspects
applied

56. PRETRACHEAL SPACE
 The
pretracheal space is encased by the
middle layer of the DCF and contains the
thyroid gland, trachea, and esophagus.
 Infections in
this space usually result from
thyroiditis or perforation of the anterior
cervical esophagus.
 This
space is rarely involved as a result of
odontogenic infection

57. COMMUNICATIONS

58. COMPLICATIONS OF HEAD AND NECK INFECTIONS









Extension of infection from local to regional
spaces
Orbital complications (blindness,
ophthalmoplegia)
Jugular vein thrombosis
Septicemia
Metastatic abscesses
Airway compromise
Aspiration
Carotid artery rupture
Mediastinitis







Osteomyelitis
Cutaneous fistula
Cranial nerve deficits
Cavernous sinus thrombosis
Necrotizing fasciitis
Maxillary sinusitis, oroantral fistula
Septic shock

59. Aminoglycosides
Gentamicin
IM/IV
Cephalosporins
Cefaclor
Cefadoxil
cephalexin
3mg/kg/day in equal doses 8 hourly
250-500 mg 8 hourly
500mg-1g 12-24 hrs
250-500mg 6hrs
Penicillins
Amoxicillin
Cloxacyclin
1g initially than 250-500mg 6hrs
250-500mg 6hrly
Macrolides
Erythromycin
Azithromycin
250-500mg 6hrly
10mg/kg upto 500mg initially followed by 5mg/kg upto
250 mg qd- 5 days
Tetracyclins
Doxcycline
100mg q 24hrs or 50mg q 12 hrs
250mg q 24 hrs
ANTIBIOTIC ADMINISTRATION REGIMEN
oxytetracycline
Clindamycin
150mg q 6hrs
FOR ORAL INFECTIONS
Metronidazole
Vancomycin
500mg q 6hrs
IV
1g infused over 1hr before procedure

60. 
For practical purposes, it makes little difference to the surgeon in an uninfected neck
whether a facial sheath is present or not. Of some practical importance however are the
relationships of the loose connective tissue areas, the fascial spaces, of the head and neck,
both because of the structures that transverse or abut against them, and because they may
become infected. The interrelationships of these spaces have been regarded as special
importance in the spread of infections and many surgeons have urged accurate knowledge
of the anatomy of these spaces and a prompt drainage of them when they become infected
CONCLUSION

61. REFERENCES
1. Grays anatomy-Muscles and fascia of the head, 38th edition, (789-807)
2. Oral and Maxillofacial surgery, Fonseca, vol-5 (77-118)
3. Oral and Maxillofacial surgery, Laskin, Vol-2 (219-252)
4. Oral and Maxillofacial infections, Topazian, 4th edition (158-214)
5. Atlas of minor oral surgery, Hary dym (154)
6. Text book of Clinical periodontology, Newman, Takei, Carranza, 10th
edition
7. Anatomical considerations in periodontal
periodontology 1971, vol 42, number 10.
surgery,
journal
of
8. Two cases of masticator space abscess initially diagnosed as TMJD,
Clarke, Kobe J. Med. Sci., Vol. 54, No. 3, pp. E163-E168, 2008

62. THANK YOU………….