Complex Odontogenic Infections
Chapter | 17 |
Table 17-1 Borders of the Deep Fascial Spaces of the Head and Neck
Superficial or
Medial*
Deep or
Lateral
Mandible
Subcutaneous
tissue and skin
Buccinator muscle
Quadratus labii
superioris
muscle
Oral mucosa
Quadratus labii
superioris
muscle
Levator anguli oris
muscle
Maxilla
Posterior belly
digastric muscle
Stylohyoid muscle
Stylopharyngeus
muscle
Inferior and
medial surfaces
of mandible
Digastric
tendon
Platysma muscle
Investing fascia
Mylohyoid muscle
Hyoglossus muscle
Superior
constrictor
muscles
Inferior border of
mandible
Hyoid bone
Mylohyoid muscle
Investing fascia
Investing fascia
Anterior bellies of
digastric
muscles
Sublingual
Lingual surface of
mandible
Submandibular
space
Oral mucosa
Mylohyoid
muscle
Muscles of
tongue*
Lingual surface of
mandible
Pterygomandibular
Buccal space
Parotid gland
Lateral pterygoid
muscle
Inferior border
of mandible
Medial pterygoid
muscle*
Ascending ramus
of mandible
Submasseteric
Buccal space
Parotid gland
Zygomatic arch
Inferior border
of mandible
Ascending ramus
of mandible*
Masseter muscle
Lateral pharyngeal
Superior and middle
pharyngeal
constrictor
muscles
Carotid sheath and
scalene fascia
Skull base
Hyoid bone
Pharyngeal
constrictors and
retropharyngeal
space*
Medial pterygoid
muscle
Retropharyngeal
Superior and middle
pharyngeal
constrictor
muscles
Alar fascia
Skull base
Fusion of alar
and
prevertebral
fasciae at
C6-T4
Pretracheal
Sternothyroidthyrohyoid fascia
Retropharyngeal
space
Thyroid cartilage
Superior
mediastinum
Space
Anterior
Posterior
Superior
Inferior
Buccal
Corner of mouth
Masseter muscle
Pterygomandibular
space
Maxilla
Infraorbital space
Infraorbital
Nasal cartilages
Buccal space
Submandibular
Anterior belly
digastric muscle
Submental
Carotid sheath
and lateral
pharyngeal
space
Sternothyroidthyrohyoid
fascia
Visceral fascia over
trachea and
thyroid gland
*Medial border.
Lateral border.
From Flynn TR: Anatomy of oral and maxillofacial infections. In Topazian RG, Goldberg MH, Hupp JR, editors: Oral and maxillofacial infections, ed 4, Philadelphia, PA,
2002, WB Saunders.
Figure 17-5 A, Infraorbital space abscess that is about
to drain medial to the attachment of the levator labii
superioris muscle. B, Infraorbital space abscess with
chronic cutaneous drainage medial to the levator labii
superioris muscle. (A, From Topazian RG, Goldberg
MH, Hupp JR, editors: Oral and maxillofacial infections,
ed 4, Philadelphia, PA, 2002, Saunders. B, From
Topazian RG, Goldberg MH, Hupp JR, editors:
Oral and maxillofacial infections, ed 4, Philadelphia,
PA, 2002, Saunders.)
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Part | IV |
Infections
Table 17-2 Relations of the Deep Fascial Spaces of the Head and Neck
Space
Likely Causes
Contents
Neighboring
Spaces
Approach for Incision
and Drainage
Buccal
Upper premolars
Upper molars
Parotid duct
Anterior facial artery and vein
Infraorbital
Pterygomandibular
Intraoral (small)
Extraoral (large)
Lower premolars
Transverse facial artery and vein
Buccal fat pad
Infratemporal
Infraorbital
Upper canine
Angular artery and vein
Infraorbital nerve
Buccal
Intraoral
Submandibular
Lower molars
Submandibular gland
Facial artery and vein
Lymph nodes
Sublingual
Submental
Lateral pharyngeal
Buccal
Extraoral
Submental
Lower anterior teeth
Fracture of symphysis
Anterior jugular vein
Lymph nodes
Submandibular (on
either side)
Extraoral
Sublingual
Lower premolars
Lower molars
Direct trauma
Sublingual glands
Whartons ducts
Submandibular
Lateral
Pharyngeal
Intraoral
Intraoral-extraoral
Lingual nerve
Sublingual artery and vein
Visceral (trachea and
esophagus)
Mandibular division of
trigeminal nerve
Buccal
Intraoral
Inferior alveolar artery and vein
Lateral pharyngeal
Submasseteric
Deep temporal
Parotid
Peritonsillar
Intraoral-extraoral
Masseteric artery and vein
Buccal
Intraoral
Pterygomandibular
Superficial temporal
Parotid
Intraoral-extraoral
Pterygomandibular
Submasseteric
Lower third molars
Fracture of angle of mandible
Lower third molars
Fracture of angle of mandible
Infratemporal and
deep temporal
Upper molars
Pterygoid plexus
Interior maxillary artery and
vein
Mandibular division of
trigeminal nerve
Skull base foramina
Buccal
Superficial temporal
Inferior petrosal sinus
Intraoral
Extraoral
Intraoral-extraoral
Superficial
temporal
Upper molars
Lower molars
Temporal fat pad
Temporal branch of facial nerve
Buccal
Deep temporal
Intraoral
Extraoral
Intraoral-extraoral
Lateral pharyngeal
Lower third molars
Tonsils
Infection in neighboring
spaces
Carotid artery
Internal jugular vein
Vagus nerve
Cervical sympathetic chain
Pterygomandibular
Submandibular
Sublingual
Peritonsillar
Retropharyngeal
Intraoral
Intraoral-extraoral
From Flynn TR: Anatomy of oral and maxillofacial infections. In Topazian RG, Goldberg MH, Hupp JR, editors: Oral and maxillofacial infections, ed 4, Philadelphia, PA,
2002, WB Saunders. With permission.
the sinuses, they can follow the common ophthalmic vein through
the superior orbital fissure and extend directly into the cavernous
sinus. This is the anterior route to the cavernous sinus. Intravascular
inflammation caused by the invading bacteria stimulates the clotting pathways, resulting in a septic cavernous sinus thrombosis.
324
Cavernous sinus thrombosis is an unusual occurrence that is rarely
the result of an infected tooth. Like orbital cellulitis, cavernous sinus
thrombosis is a serious, life-threatening infection that requires aggressive medical and surgical care. Cavernous sinus thrombosis has a high
mortality even today. Figure 17-11 illustrates the rapid extension of
