Dental infections in emergency medicine clinical presentation. Infections of the oral cavity, neck, and head infectious. Pdf cases of facial space infection of odontogenic origin are commonly reported in dentistry. The submental space is located below the chin and is bound above by the skin and the chin mentalis muscles, laterally by the anterior bellies of the digastric muscles, deeply by.
Submental space infections these originate from a mandibular incisor that perforates below the mentalis muscle. Jan 04, 2018 submental space infection is characterized by a firm midline swelling beneath the chin and is due to infection from the mandibular incisors. Lingualsurfaces of the mandiblearethis spaces lateral andanterior borders. Submental space infection is characterized by a firm midline swelling beneath the chin and is due to infection from the mandibular incisors. In this report, the infection had spread to the parapharyngeal space and the prevertebral space, but not to the mediastinum. Submandibular space infection is acute cellulitis of the soft tissues below the mouth.
Between the fibers of the matrix are interstices that are filled with tissue fluid or ground substance that can readily break down when invaded by infection. Buccal space parotid space submental space submandibular space submental, sublingual, andsubmandibular spaces with ludwigs angina parapharyngeal space most common teeth and associated periodontium involved in infection maxillary premolars, and maxillary and mandibular molars not generally of odontogenic origin mandibular anterior teeth. The infratemporal space is the inferior portion of the deep temporal space. Three characteristics of ludwig angina can be remembered as the 3 fs. The contraindications of submental intubation are patients refusal, bleeding diathesis, laryngotracheal disruption, infection at the proposed site, gunshot injuries in the maxillofacial region, longterm airway maintenance, tumor ablation in maxillofacial region, and history of keloid formation. Metgud r, professor and head, department of oral and maxillofacial pathology. Oct 04, 2014 abscesses of the second and third mandibular molars may perforate the mandible and spread into the submandibular and submental spaces. A potential fascial space exists in the chin and occasionally becomes infected, either directly from a mandibular incisor or indirectly from the submandibular space. Submental infection can spread easily to either or both submandibular spaces. Scribd is the worlds largest social reading and publishing site. Facial abscess and infection animal anatomy diseases.
Mar 11, 2015 the submental space lies between the anterior bellies of the digastric muscles and between the mylohyoid muscle and the skin. Surgical drainage of deep neck absesses and sepsis vula. Nov 16, 2012 spread of infection can be from the oral cavity, face, or superficial neck to the deep neck space via the lymphatic system. A rapidly spreading gangrenous cellulitis produces a brawny edema of the suprahyoid. Pdf odontogenic submandibular space infection complicated by. Masticator space buccal space canine space parotid space submandibular space submental space vestibular space ludwigs angina not including deep head and neck infection considered in extensive infections. Incidence rate of deep neck infection in department of otolaryngology, bhumibol adulyadej hospital is 9. Coding for incision and drainage in conjunction with. Modern understanding of the fascial spaces of the head and neck developed from the landmark research of grodinsky and holyoke in the 1930s. It consists largely of fat, neurovascular structures, and, in some definitions. A case report metgud r, jain s, chauhan d, gupta h, ranjitha rs, naik s and tak a department of oral and maxillofacial pathology, pacific dental college and hospital, udaipur, india corresponding author. Symptoms include pain, dysphagia, and potentially fatal airway obstruction.
Imaging the floor of the mouth and the sublingual space. Application of radiographic images in diagnosis and treatment. Lateral pharyngeal space was affected the site in a total of 8%. Although not a true abscess, it resembles one clinically and is treated similarly.
It is an infection of the bone that may occur due to the spread of dental abscess bacteria through the bloodstream into the bone. The submental space is a fascial space of the head and neck sometimes also termed fascial spaces or tissue spaces. Teeth involved in various types of space infections space. If infection extends below the insertion of the levator muscle, as is more commonly found, it presents as a swelling of the labial sulcus or, less commonly, as a palatal swelling. This space is bound medially by the masseter muscle and laterally by the outer surface of the ramus of the mandible. Diagnosis and management of odontogenic oral and facial. Microbiology and antibiotic sensitivities of head and neck space infections of odontogenic origin. Submandibular space infection is a rapidly spreading, bilateral, indurated cellulitis occurring in the suprahyoid soft tissues, the floor of the mouth, and both sublingual and submaxillary spaces without abscess formation. The parapharyngeal space, also known as the prestyloid parapharyngeal space, is a deep compartment of the head and neck around which most other suprahyoid fascial spaces are arranged. Spread of infections submental space infection spread of infections submental space infection. Conversely, infection can spread from the submandibular space into any contiguous space, including the pharyngeal spaces.
Presentation and management of deep neck space abscess. The skin over the swelling is stretched and hardened, and the patient experiences. It consists largely of fat, neurovascular structures, and, in. The infection begins unilaterally but quickly spreads to include the entire neck. Jul 09, 2018 phlegmon is a medical term describing an inflammation of soft tissue that spreads under the skin or inside the body. The submaxillary space may be further divided into a central submental space, between the anterior bellies of the digastric muscles, and lateral submaxillary spaces. Space infection around the face local extension depends on the tooth involved. Spread of infection can be from the oral cavity, face, or superficial neck to the deep neck space via the lymphatic system. The submental space is commonly involved via medial extension of submandibular space infections. The classic signs are a brawny, tender nonfluctuant induration of the submandibular space, with an elevation of the tongue. In this article, the surgical definition of the anatomy is. Typical submental abscess presentation with obvious edema and erythema of the submental region.
Submandibular space infection msd manual professional edition. Submasseteric space the most common source of infection in this space is from lower third molar pericoronitis. Secondarily due to infection from submental lymph nodes which drain lower lip, skin overlying chin, anterior part of floor of the mouth. Because the mylohyoid muscle sling is an integral part and a boundary of the floor of the mouth, some radiologists consider it to be synonymous with the floor of the mouth, whereas the sublingual space is viewed as a separate compartment 2,3. Severe soft tissue infections of the head and neck. Management of dental infections by medical practitioners. Patients with dental infections frequently present to primary care medical practitioners, as costs are considerably less than those of dental consultations, afterhours access is available and many patients have no regular dentist. Submandibular space infection ear, nose, and throat disorders. Submental space infection sublingual space superiorto the mylohyoid muscleandinferior to the mucosaofthe floor ofthe mouth. The fascial spaces are filled with loose connective tissue readily breakdown in presence of even little amount of infection and a huge swelling can be seen. Submandibular space infections 30% were most frequently encountered followed by buccal 20%, submental 15%, and sublingual 10%. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
The following case report describes the dramatic course of a deep neck space infection in a pregnant patient, commencing with typical symptoms of localized odontogenic infection and ending in a critical, life. The submental space lies between the anterior bellies of the digastric muscles and between the mylohyoid muscle and the skin. Lymphadenopathy may lead to suppuration and finally focal abscess formation. Application of radiographic images in diagnosis and. It is quite likely that infection in a particular fascial space will spread to adjacent ones. Signs and symptoms of a severe submental abscess include a firm swelling below the chin. Ludwigs angina is a form of severe diffuse cellulitis that presents an acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a state of emergency. However infection of the canine space generally presents as swelling lateral to the nares and of the upper lip figure 20. When left untreated, this infection can spread inferiorly into the neck and mediastinum.
The submental space is located below the chin and is bound above by the skin and the chin mentalis muscles, laterally by the anterior bellies of the digastric muscles, deeply by the mylohyoid muscle, and superiorly by the deep cervical fascia, the platysma muscle, the superficial fascia, and the skin. Phlegmon is a medical term describing an inflammation of soft tissue that spreads under the skin or inside the body. Drainage of abscess, cyst, hematoma from dentoalveolar structures page 2 incision and drainage in conjunction with extractions it is critical that there be documentation of additional work required when these codes are submitted in conjunction with extraction codes. Fascial spaces of the head and neck the fascia of the head and neck is composed of loose fibrous connective tissue envelopes and may be divided into the superficial and deep fascia. Facial abscess and infection free download as powerpoint presentation. Space infections anatomical terms of location tongue. For evaluation of deep neck space infection, ultrasound, mri, and radiographic examinations such as soft tissue. Sep 06, 2011 the sublingual space is located on both sides of the tongue, superomedial to the mylohyoid muscle and lateral to the midline geniohyoidgenioglossus muscle complex 1,2.
This is characterized by rapid progression and is associated with typical signs and symptoms. Early diagnosis and immediate treatment planning could be a lifesaving procedure. The full text of this article is available as a pdf 1. Treatment includes airway management, surgical drainage, and iv antibiotics. For example, ludwigs angina constitutes an infection that has spread to involve the submental and bilateral submandibular and sublingual spaces which could cause impingement and embarrassment of the airway figs. Submandibular space infection ear, nose, and throat. The cyst was particularly persistent and recurred within a month of its excision and had to be reexcised along with the overlying epithelium. Infection can be related to sepsis in an adjoining space, such as the sublingual, the submental, or the masticator space. Ludwigs angina is manifested by swelling of the floor of the mouth and elevation and posterior displacement of the tongue. Odontogenic infections chapter 3 onur gonul, sertac aktop. Sublingual space infection is indicated by swelling of the mouths floor with possible tongue elevation, pain, and dysphagia due to. About 80% of cases of ludwigs angina, or cellulitis of the submandibular space, are caused by dental infections. Occurs in the closed space of the fatty tissues of the finger tip and pulp. Lateral pharyngeal space was affected the site in a total of 8%, canine space in 5%, mesenteric in 4%, palatal 3%, and pterygoid in 2% sites.
Its usually caused by an infection and produces pus. It is a potential space located between the mylohyoid muscle superiorly, the platysma muscle inferiorly, under the chin in the midline. This infection most commonly arises from an infected second or third mandibular molar tooth. In some cases the nerve blocks which are giving lead to space infection as seen in pterygomandibular space and retrozygomatic space when the needle pierces the surrounding muscle and enters the space leading to infection. Infection of this space usually arises from mandibular anterior teeth, where the infection perforates the lingual cortex. Because of its primarily fatty content, the sublingual space has low attenuation similar to that of fat at ct. Space infection is infection spreading to the facial spaces in the head and neck region from one or many teeth infected. Ludwig angina is a rapidly spreading and potentially fatal infection of the sublingual, submandibular, and submental spaces bilaterally.
It is in direct communication with the lateral pharyngeal space posteriorly. Epidermal inclusion cyst of the maxillofacial region. The teeth involved in various types of space infections or space infections caused due to teeth. If it does not regress completely, it may become subacute or chronic. The most common presenting symptoms are oral, neck, and dental pain. Infections spread from the origin into these spaces, which are. Fascial spaces of the head and neck pocket dentistry. Microbiology and antibiotic sensitivity of odontogenic space infection. Space infections free download as powerpoint presentation. Ludwigs angina is a bilateral infection of the submandibular space that consists of two compartments in the floor of the mouth, the sublingual. However infection of the canine space generally presents as swelling lateral. Submandibular space infections ludwigs angina uptodate.
Prior to surgical drainage, a sterile aspirate is obtained for culture and sensitivity. Original article aerobic microbiology and culture sensitivity. Start studying fascia, spaces and anatomy of spread of infection. The submental space is a fascial space of the head and neck it is a potential space located. Microbiology and antibiotic sensitivities of head and neck. Other deep neck space infections are discussed separately. The infection requires careful monitoring and rapid intervention for prevention of asphyxia and aspiration pneumonia. Teeth involved in various types of space infections. A comparison of different techniques of airway access in complex maxillofacial injury is. Pus sample was obtained either by aspiration or by swab stick from the involved spaces, and culture. It represents an aggressive form of cellulitis diffuse spread of infection through fascial planes of soft tissue and typically results from infection of the mandibular molars. The infectious process commonly spreads across the midline into the contralateral submandibular space. Abscesses of the second and third mandibular molars may perforate the mandible and spread into the submandibular and submental spaces.
Deep neck infection occurred at any ages which peak incidence during 30 21year of age. Infection can spread among the deep neck spaces by the paths of communication between spaces. Jun 04, 2016 fascial spaces of the head and neck the fascia of the head and neck is composed of loose fibrous connective tissue envelopes and may be divided into the superficial and deep fascia. A rapidly spreading gangrenous cellulitis produces a brawny edema of the suprahyoid region of the neck. Hyoglossus, geniohyoid and genioglossus muscles can dividethis space into two sections sublingual space. Sublingual space infection is indicated by swelling of the mouths floor with possible tongue elevation, pain, and dysphagia due to anterior mandibular tooth infection. Airway obstruction and spread of the infection to the mediastinum are the most troublesome complications of submandibular space infections. Ludwigs angina is a bilateral infection of the submandibular space that consists of two compartments in the floor of the mouth, the sublingual space and the submylohyoid also known as submaxillary space.
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