Fascial Spaces 2

‫ﺑﺳم ﷲ اﻟرﺣﻣن اﻟرﺣﯾم‬
Fascial Spaces of
Infection
Dr. Yehia A. El-Mahallawy
Assistant professor of oral and maxillofacial surgery.
Faculty of Dentistry, Alexandria University.
Fascial
Spaces
Face Masticatory Neck
Suprahyoid Infrahyoid
Masticatory Spaces
Sub masseteric Pterygomandibular Temporal Infratemporal

Sepsis
Pain
Venous Clinical Cranial nerve

Engorgement Picture engorgement
Swelling
Structure
????
engorgement
Constitutional Fever (39–40 °C) Chills
Symptoms
Malaise Pain in muscles and joints
Anorexia Insomnia
Nausea & vomiting
leukocytosis Increased Erythrocyte

Sedimentation Rate
Raised C-Reactive Protein (CRP)
level
SUBMASSETERIC SPACE
Anatomy/Boundaries
Medially → lateral surface of the ramus of the mandible
Laterally → Middle part of the masseter muscle
Anterior → Oral mucosa
Posterior → Parotid gland,
Path of least resistance

SUBMASSETERIC SPACE
Pathologic development
1→ Spread of dento-alveolar infection involving the lower third molar
2→ Spread of Peri-coronal infection involving the mandibular third molar

SUBMASSETERIC SPACE

SUBMASSETERIC SPACE
Clinical Minimal Extraoral swelling
signs &
Rapid development of MARKED TRISMUS
symptoms
Evacuate the imprisoned pus
↓ ↓
Extraoral incision & Drainage Intraoral incision & Drainage
Intra-oral incision not less than 3 cm down the anterior border of the ascending ramus,
starting from the coronoid process, keeping the blade on the external oblique line finishing in
the buccal sulcus opposite the second molar
↓ ↓
(Blair incision) Below and behind the angle of the mandible

incision is made beneath the angle of the jaw and the ramus is exposed
PTERYGOMANDIBULAR SPACE
Anatomy/Boundaries

Anatomy/Boundaries

Content of the space
1→ Lingual nerve.
2→ Inferior Alveolar nerve &vessels
3→ Internal maxillary artery
4→ inferior head of the lateral pterygoid muscle
Pterygoid plexus of veins surrounding the inferior head of the lateral
5→
pterygoid muscle

1→ Spread of Peri-coronal infection involving the mandibular third molar
2→ Septic mandibular nerve block
3→ Inferior Spread of pus from the infratemporal space.

Clinical Swelling of the oral mucous membrane overlying the space with
medial displacement of the lateral pharyngeal wall/ uvela
signs & Dysphagia
symptoms
Severe trismus
Moderate extra-oral swelling.

↓ ↓
Incision is made just medial to the anterior border of the ramus.

↓ ↓
Below and behind the angle of the mandible

INFRATEMPORAL SPACE
Anatomy/Boundaries

INFRATEMPORAL SPACE
Anatomy/Boundaries
Anteriorly →1
Posteriorly → 1
1
Laterally →2
Medially →1
Superiorly →1
???
Inferiorly →

INFRATEMPORAL SPACE
1→ Maxillary artery
2→ Lateral pterygoid muscle
3→ Pterygoid plexus of veins
4→ Pharyngeal plexus.
5→ Mandibular nerve and its branches
6→ Lingual nerve.
7→ Chorda tympani nerve
8→ Long buccal nerve

INFRATEMPORAL SPACE
Spread of dental infection from infected maxillary molars teeth extending
1→
above the buccinator.
Ascending infection from pterygomandibular space that may be caused by
2→
pericoronitis around mandibular third molar teeth
3→ Septic local infiltration anesthesia of maxillary nerve

INFRATEMPORAL SPACE
Clinical Swelling of the eyelids may result often closing the eye completely
signs & Muscular trismus

symptoms severe pain aggravated by opening the jaw. ?????
Deviation of the jaw to the affected side when it is opened. ?????

↓ ↓
Lateral to the ascending ramus

↓ ↓
Gillies Approach
(Hair line Incision)
3 cm incision in angle formed by the junction of the frontal and temporal processes of the malar bone (temporal Space
drainage)
↓ ↓
Through and through incision and drainage if the source of infection is the pterygomandibular space infection
TEMPORAL SPACE
Anatomy/Boundaries
Superficial temporal Space Deep temporal Space
Between temporalis fascia and temporalis muscle Between temporalis muscle and temporal bone

TEMPORAL SPACE
1→ Spread of infection from infratemporal space
2→ Spread of infection from pterygomandibular space.
3→ Spread of infection from submasseteric space.

TEMPORAL SPACE
Clinical Marked Trismus.
signs &
symptoms
Severe pain
↓
Extraoral incision & Drainage
Hair line temporal incision

What lies beyond the Masticatory spaces
Secondary fascial Spaces
PAROTID SPACE
Anatomy/Boundaries
The parotid space containing the encapsulated parotid gland that lies between two layers of Parotidomasseteric fascia fascia
Superiorly → Zygomatic arch

Anteriorly and medially → Masseter muscle
Posteriorly → Mastoid process , Sternocleidomastoid muscle, External acoustic meatus and the ramus of

PAROTID SPACE
Encapsulated exocrine gland

Superficial Layer
(Parotid Fascia)
Stylomandibular
Ligament
Deep Layer
(Pterygoid Fascia)
Investing layer of DCF

PAROTID SPACE
1→ Superficial and deep portion of the parotid gland
2→ Stenson's duct
3→ Portion of the facial nerve
4→ Posterior facial vein
5→ Auriculotemporal nerve
6→ External carotid artery
7→ Internal maxillary artery
8→ Parotid lymph nodes Path of least resistance
PAROTID SPACE
1→ Septic fractures of the ascending ramus of the jaw
2→ Secondarily from the parapharyngeal space
3→ Secondarily from the submandibular space
4→ Septic parotitis

PAROTID SPACE
Clinical Extraoral swelling raising earlobe
signs & Pain which is accentuated by eating and swallowing food referred to
symptoms the ear and temporal area.
The discharge from the duct of the affected side is clear
Mild Trismus ????

PAROTID SPACE
Differential diagnosis of sublingual abscess
1→ Parotid sialadenitis (Parotits)

PAROTID SPACE
1→ Parotid sialadenitis (Parotits)

Parotid Space Parotid sialadenitis (Parotitis)
A turbid and purulent discharge from
Clear Discharge
the duct)
Normal papilla Indurated papilla

↓
Blair's incision, this extends around the angle of the jaw from behind the posterior border of the ramus and forward 2 cm
below the bone
PARAPHARYNGEAL SPACE

The space is inverted cone; its base is the skull and its apex at the hyoid bone.

The space is inverted cone; its base is the skull and its apex at the hyoid bone.

Anatomy/Boundaries
Laterally → Medial pterygoid muscle / deep parotid
Medially → superior constrictor muscle
Anteriorly → superior constrictor muscle, Pterygopalatine raphe
and buccopharyngeal fascia
Superiorly → Base of the skull along the sphenoid bone
Inferiorly → Hyoid bone
Posteriorly → Prevertebral fascia and retropharyngeal space




Styloid P

1→ Extension from a pterygomandibular abscess (odontogenic)
The pharynx peri-tonsillar suppuration may erode the superior pharyngeal
2→
constrictor muscle to enter the lateral pharyngeal space.

Clinical Swelling of the lateral wall of the pharynx and medial displacement of
the tonsils, tonsillar pillar and the uvula
signs & Very Pain on swallowing (Dysphagia).
symptoms Firm, tender and indurated external swelling at the angle of the mandible
Severe pain in the affected side of his throat referred to the ear, face
or neck
Severe trismus ???

Differential diagnosis
1→ Peritonsillar abscess (Quinsy) No trismus
Retro-pharyngeal abscess which is generally due to tuberculosis of the
2→
cervical spine

↓ ↓
Vertical incision is made in the retro-molar triangle, lateral and parallel to the
pterygomandibular fold
↓ ↓
Extra-oral incision is considered safer since there is no danger of aspiration of pus and pulmonary complication.
RETROPHARYNGEAL SPACE
Anatomy/Boundaries
Between posterior wall of the pharynx (buccopharyngeal/ visceral division of middle layer) and
loose areolar connective tissue of alar fascia of the pre-vertebral division of deep fascia.
Extend from skull base to T1 level

Synonyms
PREVERTEBRAL SPACE INFECTION
Infection to travel inferiorly to the posterior mediastinum as far as T1 and superiorly to the base of the skull.

Clinical Stiffness of neck..
signs & Dysphagia.

symptoms
Bulging of posterior pharyngeal wall
Dysponea

↓
X
↓
Gutter
X
Danger
spaces
Face Neck
• Airway obstruction.
• Aspiration pneumonia.
• Dehydration
Retrograde spread of infection
Spread of infection to fascial spaces that contains valveless vein
Septic Thrombosis of the vein will occur
No barrier to the back flow of blood inside the vein in the

opposite direction (CEPHALIC)
Detachment of Septic emboli and flow in the

opposite direction
Intracranial metastatic infection

Brain abscess/ CST/ meningitis
Route of retrograde infection
A-Superior Labial Venous Plexus (base of upper lip)
Junction between right and left superior labial vein
Angular branch of Anterior facial vein

Pass through
Superior ophthalmic vein Superior Orbital
Fissure
Cavernous sinus

DANGER TRIANGLE OF THE FACE
Between Base of the nose and upper lip

C- Pterygoid plexus of vein (in Infratemporal fossa)
Pass through
Communicating Branch to Inferior ophthalmic vein Inferior Orbital
Fissure
Cavernous sinus

D- Pterygoid plexus of vein (in Infratemporal fossa)
Emissary Vein Pass through Foramen ovale
Cavernous sinus

………………………
Danger
……………………… spaces of the ………………………
face
………………………
Base of upper lip
Danger
Pterygomandibular spaces of the Canine space
face
Infratemporal
Aim of the treatment is to:
Aim of the treatment is to:
• Control the number and the virulence of the invading microorganism.
• Remove the CAUSE of infection.
• EVACUATE the imprisoned pus at the periapical regions ????
• RAISING the body resistance and helping it to overcome the invading organisms.
1 • Diagnosis
2 • Support Medically
3 • Anesthesia
4 • Heat Application
5 • Empirical / Specific antibiotic
6 • I&D
7 • Removal of cause
8 • Postoperative care
Support medically
A- Rest and hospitalization.
B- Adequate fluid intake ???
• Oral or IV (1500-2000 ml) of Glucose soln/ ringer soln / 24h
C- Adequate nourishment (P/C/V)
D- Analgesics
Supportive Therapy
• Heat application
• Why
• Localization.
• Decrease pain.
• VD ???
Supportive Therapy
• Heat application
• Mouth wash
• Bag
• Infra-red lamp
• No pressure
• Depth
• Discover undue healing
Treat Surgical
↓
Removal of the cause Drainage of pus / pressure
I&D aim
• Allow removal of the pus (drain any drop of pus that may be present in deep tissue spaces)
• Decompression and allow increase blood flow
• To release the tissue tension and afford for later drainage of pus.
• To relief the local venous engorgement
• Decrease bacterial load.
↓ ↓
↓ ↓
Master Intraoral incision

Vertical incision is made in the retro-molar triangle,
lateral and parallel to the pterygomandibular fold
Intra-oral incision not less than 3 cm down the anterior

border of the ascending ramus, starting from the
coronoid process, keeping the blade on the external
oblique line finishing in the buccal sulcus opposite the
second molar
Drainage
Prevent closure and abscess reformation
Kept for 2-5 days.
Drainage
↓
Types
According to are of use:

A- Intra & extra oral
Gauze (Plain or iodoform)
Rubber dam (Fenestrated ????)
A- Extra oral
Rubber catheter tube Penrose
Corrugated Darin
Vacuum drains
Drainage
↓
Types
According to are of use:

A- Intra & extra oral
Gauze (Plain or iodoform)
Rubber dam (Fenestrated ????)
A- Extra oral
Rubber catheter tube Penrose
Corrugated Darin
Vacuum drains
Choose & administer antibiotic therapy
↓ ↓
Empirical Specific
• Simple • C&S
• Narrow spectrum AB • Rapidly progressive
• Immunocontent patient • Previous multiple AB therapy
• No history • 48H non responsive
• No fascial space. • Recurrent
• Complex Infection • Compromised host state
• Broad spectrum AB
1 • Rest & Hospitalization
2 • Adequate fluid replacement
3 • Adequate nourishment.
4 • Adequate nourishment.
5 • Sedation and analgesic
6 • Empirical / Specific antibiotic
7 • Heat application
8 • I&D
9 • removal of cause
10 • Postoperative care
‫ﺑﺳم ﷲ اﻟرﺣﻣن اﻟرﺣﯾم‬
‫‪OSTEOMYELITIS‬‬
OSTEO-MYEL-ITIS
↓
Inflammation of the medullary bone.
OSTE-ITIS
↓
Inflammation of cortical bone.
Osteomyelitis 91
NATURAL PROGRESSION OF ODONTOGENIC INFECTIONS
Irritation Inflammation Infection

ODONTOGENIC
Break of natural barrier
INFECTION SEQUENCE
Caries → Pulpitis
Periapical Infection
Periapical/Periodontal Irritation Periodontal Infection
Pericronal Infection
Inflammation and cancellous
bone erosion
Cortical bone erosion
and periosteum
involvement
Soft tissue Involvement and

Fascial spaces
Osteomyelitis 94
• Deposition of bacteria in medullary bone cavity
1 • Direct spread, Hematogenous, or after trauma
• Compromising bone blood supply

2 • Infective embolus enters small vessel in medullary bone and block them
• Medullary Bone resorption & Decalcification

• Acute inflammation with ↑ capillary permeability, and PMN exudate → Proteolytic enzymes
3 destroy bacteria and medullary elements causes decalcification & fragments of necrotic bone
(sequestra)
Osteomyelitis 95
•Local cortical necrosis
• Debris and pus accumulate along with venous stasis → ↑ intramedullary
4 pressure. → pus Follows paths of least resistance (Haversian canal and
Volkmann canal) → reach cortical bone & cause OSTEITIS
•Soft tissue involvement and fistula Fistula formation

• Pus Enter sub-periosteal space → periosteum stripping & perforation → Enters
5 soft tissue and drain out
• To wall-off the infection.

6 • Body may attempt to further isolate the area of infection by forming a layer of
new bone (involucrum) around the sequestrum
Osteomyelitis 96
Staphylococcus Streptococcus
•Grow in Colonies • Grow in Chains

• Less chemotactic
•More chemotactic
• Fibrinolysis &
•Coagulase Hyaluronidase
Help in the spread of

infection
Help in localization of
infection
Aetiology
↓
• According To mode of spread (Inoculation)
↓
• Contiguous spread ?????
• Hematogenous spread of infection.
Osteomyelitis 98
Aetiology
↓
• According To Origin
↓
• Odontogenic osteomyelitis. (non-Specific ??)
• Trauma to maxilla or mandible. (Breakage of Intagium ??)
• Non odontogenic osteomyelitis. (Specific/ nosocomial ??)
Osteomyelitis 99
More Prevalent Incidence of osteomyelitis
MANDIBULAR OSTEOMYELITIS MAXILLARY OSTEOMYELITIS
- Abundant amounts of medullary - Thin cortical plates of bone with
tissue with Thick cortical bone. minimal amounts of medullary tissue.
- The mandibular blood supply is - The maxillary blood supply is more
Less prevalent
less extensive than that of the extensive than that of the mandible.
mandible.
- Infection less likely to be confined in
- Infection more likely to be medullary spaces and extends to the
confined in medullary spaces. maxillary sinus
Mandibular : maxillary osteomyelitis ranging from 3 : 1
Osteomyelitis 100
Predisposing Factors for osteomyelitis
a) Systemic predisposing factor
Impaired host defense and altered host immunity.
Increase
↓
• Endocrine Diseases (Uncontrolled DM)
• Blood Discases. (Agranulocytosis, sickle cell anemia, neutropenia)
• Autoimmune Diseases.
• Malignancy.
• Malnourished
• Extremes of age.
• COVID-19 ???.
Osteomyelitis 101
b) Local predisposing factor
↓bone vascularity.
Increase
↓
• Trauma.
• Sinusitis
• Osteoporosis.
• Fibrous Dysplasia.
• Osteo-Sclerotic Bone Diseases
• Osteopetrosis, Paget’s disease, Pycnodysostosis ???.
• Bone Malignancy.
• Major vessel disease (atherosclerosis).
Osteomyelitis 102
c) Medication
• Corticosteroids.
Increase
• Immunosuppressive drugs.
• Radiation injury
• Bisphosphonates.
• Anti-resorptive Chemotherapy
• Antiangiogenic Chemotherapy
Osteomyelitis 103
• Classification based on clinical picture, radiology, and etiology:
I. Suppurative osteomyelitis II. Non suppurative osteomyelitis
1. Acute suppurative osteomyelitis 1. Chronic sclerosing osteomyelitis
a. Focal sclerosing osteomyelitis

b. Diffuse sclerosing osteomyelitis
2. Chronic suppurative osteomyelitis 2. Garre's sclerosing osteomyelitis
} Primary chronic suppurative osteomyelitis

} Secondary chronic suppurative osteomyelitis
Suppurative
Osteomyelitis
Acute Suppurative Osteomyelitis
Infection is confined in medullary cavity
Clinical Picture:
• Deep intermittent pain related to
• Affected tooth (Mobile, Tender to percussion )
• Gingival crevice pus exudate.
• Tender Regional Lymphadenitis.
• General connotational symptoms of acute infection
• low-grade fever, malaise and fatigue.
• Mild leukocytosis (8,000–15,000 cells/mm3)
• ↑ ESR
• ↑CRP
Osteomyelitis 106
Acute Suppurative Osteomyelitis
Infection is confined in medullary cavity
Radiographic Picture ???

• Normal ????
• Do not appear until after at least 10-14 days.
• Mild rarefaction and loss of trabeculation of the medullary space (ill defined
appearance)
Osteomyelitis 107
Inadequate treatment
Osteomyelitis 108
Chronic Suppurative Osteomyelitis
• Sequele of acute >2-4 weeks
• Primary with no acute phase
Clinical Picture:
• Mild pain.
• Mobile tender tooth.
• Fistula formation.
• Sequestration
• Pathologic fracture
• Trismus
• Vincent syndrome ??.
• Normal WBC count.
Osteomyelitis 109
Chronic Suppurative Osteomyelitis
Radiographic Picture:
• Ill-defined moth-eaten appearance (mixed RL/RO).
• Root resorption.
• Pathological fracture.
• periosteal reaction
• Sequestrum radiographic appearance. ??
Osteomyelitis 110
Osteomyelitis
Management
The management of osteomyelitis of the maxillofacial region requires both :

• Conservative Medical treatment .
• Surgical Interventions.
Treatment of Suppurative osteomyelitis
I. General supportive measures

(acute and chronic)
Sedative and Systemic

Bed rest or Adequate fluid Adequate analgesics diseases
hospitalization. intake nourishment. diagnosed &
?? management.
II. Heat therapy
III. Effective Specific antibiotic therapy
IV. Drainage of the Suppurative areas.
V. Management of the Cause.
VI. Surgical Management.
A. Sequestrectomy
• Removing the infected and necrotic pieces of bone
B. Saucerization
• Sequestrectomy using a large round bur to produce a “saucer like defect”
• It exposes the medullary cavity for proper debridement
• Eliminates the dead space to prevent reinfection of the blood clot
D. Resection
• Reserved as a last option.

• Extraoral route
• Reconstruction can be either immediate or delayed
E. Immobilization
of the jaws
F. Remodeling of jaw
• Reconstruction can be either

immediate or delayed based
on the surgeon’s preference
• Curettage
• Sequestrectomy and Saucerization
Small OM • Decortication
• Sequestrectomy and Saucerization Specific

• Decortication antibiotic for
4 weeks to 6
• Immobilization months
Extensive OM • Primary or Delayed Reconstruction According to….
• (En-block grafting).
• Segmental Resection
Refractory • Immobilization
OM
• Primary or Delayed Reconstruction .
Non-
Suppurative
Osteomyelitis
Proliferative bone reaction to low grade non-pyogenic dental infection

Young
Low age
grade <20Y
infection
Non-
pyogenic
MO
.
Non-
Suppurative
Osteomyelitis
Focal Chronic Sclerosing Osteomyelitis
Condensed Osteitis
Clinical Picture:
• Infected tooth (Lower first Molar)
• Asymptomatic / mild pain.
• Non-vital tooth.
• Circumscribed RO mass of sclerotic
bone associated with non-vital lower
6 roots.
• Can distinguish LD.
Osteomyelitis 123
Focal Chronic Sclerosing Osteomyelitis
Differential Diagnosis ??
Osteomyelitis 124
Localized Alveolar Osteitis
Dry Socket .
Non-suppurative sterile Osteitis due to lack of wound blood clot.
Sterile wound.
Osteomyelitis 125
Diffuse Chronic Sclerosing Osteomyelitis
Condensed Osteitis
Clinical Picture:
• Old edentulous patient.
• Unilateral.
• Infected tooth (Non-vital tooth).
• Unremitting Pain/ Swelling.
• 3♀ : 1♂.
• Blacks > whites.
• Diffuse RO with ill-defined margins
limited to half the mandible
• Salt-and-pepper Sclerosing with
Differential Diagnosis ?? Osteomyelitis 126
Garre’s Sclerosing Osteomyelitis
(PROLIFERATIVE PERIOSTITIS)
• Periosteum reaction to low-grade infection/ irritation
• Stimulates periosteum to lay down new bone
Clinical Picture:
• Adolescents (mean age of 12)
• 1.4 ♀ : 1♂.
• localized, non-tender bony hard enlargement
• Normal mucosa and skin;.
• Gingivobuccal sulcus obliterated.
Osteomyelitis 127
• “Onion skin” pattern of successive layers of new bone deposition
• Radiolucent rim is often present between original cortex and new bone
Osteomyelitis 128
Differential Diagnosis ??
Osteomyelitis 129
Antibiotics
• Antibiotics are antimicrobial drugs used to treat
bacterial infections
• A limited number of antibiotics also possess
antiprotozoal activity (Metronidazole is effective
against a number of parasitic diseases).
• Antibiotics have no effect on viral
infections.
MOA Classification
1. Inhibitor of cell wall synthesis
• Examples: Beta-lactams.
2. Inhibitor of Nucleic acid synthesis
• Examples: Quinolones.
3. Inhibitor of protein synthesis
• Examples: Macrolides.
4. Inhibitor of folic acid synthesis
• Examples: Sulfonamides.
Action Classification
Bactericidal
• Kills Bacteria
Bacteriostatic
• Stop Growth.
Spectrum Classification
• Narrow-spectrum
antibacterial antibiotics target
specific types of bacteria, such as
Gram- negative or Gram-positive
bacteria.
• Broad-spectrum antibiotics
affect a wide range of bacteria
usually both gram positive and
gram negative cells.
Spectrum Classification
• Narrow-spectrum
antibacterial antibiotics target
specific types of bacteria, such as
Gram- negative or Gram-positive
bacteria.
• Broad-spectrum antibiotics
affect a wide range of bacteria
usually both gram positive and
gram negative cells.
Classification Narrow spectrum antibiotics
• Penicillins.
Broad spectrum antibiotics
• Tetracyclines.
based on • Aminoglycosides. • Quinolones.
their Glycopeptides. • Third-generation” and
• Macrolides. “fourth-generation”
spectrum of • Metronidazoles.
Cephalosporins.
activity • Sulfonamides. • Chloremphenicols .
Systemic Topical
• Oral (Tablets & Syrup) • A more safe route for
Classification • Injection (IV or IM)
antibiotics to avoid
their undesirable side
according to Advantages: effects.
the route of • Rapid action. • Controlled release

device.
administration • Wide spectrum.
• Availability.
• Affordable cost.
Disadvantages: The
undesirable side effects are
the main obstacle.
Origin Classification
• 1. Natural origin: Penicillin.
• 2. Semi-synthetic antibiotics:
Amoxycillin.
• 3. Synthetic antibiotics:
Quinolones,
Sulfonamides.
PRINCIPLES FOR CHOOSING
APPROPRIATE ANTIBIOTIC Empirically based upon the knowledge of the pathogens
and clinical presentation of specific infection
OR
Scientifically determined either in the laboratory, where

the organism can be isolated from pus
EMPIRIC ANTIBIOTIC TREATMENT
Early infection
PRINCIPLES FOR CHOOSING
APPROPRIATE ANTIBIOTIC (first 3 days of symptoms and mildly immunocompromised)
•Penicillin
•Clindamycin
•Cephalexin
Late infection
(After 3 days of symptoms or moderately to severely immunocompomised)
•Clindamycin
•Revicillin and metranidazole.
•Ampicillin and sulbactam.
•Cephalosporin (first or second generation)
CULTURES SHOULD BE PERFORMED:-
PRINCIPLES FOR CHOOSING 1.Pt. with an infection has compromised host defenses
APPROPRIATE ANTIBIOTIC
2.Received appropriate treatment for 3 days without

improvement
3.Postoperative wound infection
4.Recurrent infection
5.Actinomycosis is suspected.
6.Osteomyelitis is present.
Class of antibiotic Generic Brand Name
Penicillins Amoxicillin Ibiamox
Amoxicillin and clavulanate Augmentin
Ampicillin Unasyn
Tetracyclines Doxycycline Vibramycin
Tetracycline Tetracid
Cephalosporins Cephradine Velosef
Quinolones Ciprofloxacin Ciprobay
Macrolides Azithromycin Zithromax
Sulfonamides Sulfamethoxazole and trimethoprim Septazol
Lincomycins Clindamycin Dalacin C
Aminoglycosides Gentamicin Garamycin
Carbapenems Meropenem Merrem
Metronidazole Metronidazole Flagyl
Chloramphenicol Chloramphenicol Miphenicol
Glycopeptides Vancomycin Vancoled

Fascial Spaces 2

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Fascial Spaces 2

Uploaded by

Copyright:

Available Formats

‫ﺑﺳم ﷲ اﻟرﺣﻣن اﻟرﺣﯾم‬

Face Masticatory Neck

Sub masseteric Pterygomandibular Temporal Infratemporal

Venous Clinical Cranial nerve

Nausea & vomiting

leukocytosis Increased Erythrocyte

Laterally → Middle part of the masseter muscle

Anterior → Oral mucosa

Posterior → Parotid gland,

Path of least resistance

Path of least resistance

Path of least resistance

(Blair incision) Below and behind the angle of the mandible

Path of least resistance

Path of least resistance

Path of least resistance

Path of least resistance

Moderate extra-oral swelling.

Incision is made just medial to the anterior border of the ramus.

Below and behind the angle of the mandible

Path of least resistance

Path of least resistance

Path of least resistance

Path of least resistance

signs & Muscular trismus

Deviation of the jaw to the affected side when it is opened. ?????

Lateral to the ascending ramus

Path of least resistance

Path of least resistance

Hair line temporal incision

Superiorly → Zygomatic arch

Path of least resistance

Encapsulated exocrine gland

Path of least resistance

Path of least resistance

Mild Trismus ????

Path of least resistance

Differential diagnosis of sublingual abscess

Path of least resistance

Path of least resistance

Path of least resistance

Path of least resistance

Posteriorly → Prevertebral fascia and retropharyngeal space

Path of least resistance

Path of least resistance

Path of least resistance

Path of least resistance

Path of least resistance

Path of least resistance

Path of least resistance

Path of least resistance

Path of least resistance

Path of least resistance

signs & Dysphagia.

Path of least resistance

Extraoral incision & Drainage

Extraoral incision & Drainage

Septic Thrombosis of the vein will occur

No barrier to the back flow of blood inside the vein in the

Detachment of Septic emboli and flow in the

Intracranial metastatic infection

Junction between right and left superior labial vein

Angular branch of Anterior facial vein

Path of least resistance