8/13/2019 Spread of Odontogenic Infection

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8/13/2019 Spread of Odontogenic Infection

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Handout of Part II lecture - Prof J Weerasingh

Sub Mandibular space

mylohyoid muscle separates the submandibular space from sublingual

mylohyoid muscle also determines the direction of spread of dental infections

apices of the second and third molars below the mylohyoid line and the apex of the first molar above

When penetrates lingual plate

1st molar infection to sublingual2nd,3rd molar infection to submandibular space

Infection further spread to Lateral pharyngeal space

Ludwigs Angina

Ludwig angina is characterized by hard boardlike swelling

from a rapidly spreading cellulitis of the

Bilateral sublingual and submandibular spaces

with elevation and edema of the tongue, saliva drooling,

and airway obstruction.

Submassteric space

contains the pterygoid and masseter muscles insertion of the temporalis muscle

It communicates freely with the temporal space superiorly

and trismus is the most pronounced clinical feature

Lateral (para) pharyngeal space

occupies a critical area in the neck,

communicates with all other fascial spaces

as an inverted cone with its base at the base of skull and apex at the hyoid bone.

divided into anterior and posterior compartments by the styloid process.

Retro pharyngeal & Prevertebral Spaces

bordered anteriorly by the constrictor muscles and posteriorly by the alar layer of the deep cervical fasciInfections of this space can extend down to the superior mediastinum

If the infection perforates the alar layer posteriorly, it enters the danger space, which extends down th

entire mediastinum to the level of the diaphragm. Further extension posteriorly enters the prevertebral spacwhich extends down to the coccyx.

Principles of Management

Removal of the focus if infection

Incision and drainage

Antibiotic therapy

Submasseteric space- through-&-through drainage

Ludwigs Angina

emergency admission

IV antibioticsAirway management

Multiple incisions to relive pressure build-up in the neck