1. CLASSIFICATION OF OROFACIAL INFECTION & FASCIAL SPACES INFECTION
AISHAH, RUHAIZAN, ANIS, SYAFIQAH

2. Based on the organism causing the infection
Based on the tissues affected
Based on the route of entry
Based on the deep fascial spaces of the head and neck infiltrated by the infection
CLASSIFICATION

3. Based on the organism causing the infection
Bacterial infections:
The odontogenic infections encountered in orofacial region are mostly bacterial infections
Nonodontogenic infections:
(i) Tonsillar
(ii) Nasal infections which are more common in children
(iii) Furuncle of overlying skin
Fungal infections:
These infections have slow rate of spread. These are difficult to diagnose in early stages.
Viral infections:
The literature does not show sufficient reports about these conditions of odontogenic origin.

4. Based on the tissues affected
Odontogenic infection
Caries in the dentin > spread to the pulp > pulpitis > spread to the bone > PA abscess
Traumatic root fracture/pathological exposure due to tooth wear
Traumatic pulpal exposure including dental treatment
Through PD membrane and accessory root canal
Rarely by anachoresis i.e seeding of the organism directly into pulp via pulpal blood supply during bacterimia
Trauma, cracks, decay under fillings
Periodontal disease > PA & periodontal abscess
Erupting teeth > operculitis & pericoronitis RR
Non-odontogenic

5. Based on the route of entry
Pulpal
Periodontal
Pericoronal
Fracture
Tumour
Iatrogenic
Opportunistic

6. Based on the clinical presentation
Acute
Abscess
It is a circumscribed collection of pus in a pathological tissue space.
Cellulitis
spreading infection of loose connective tissues. It is a diffuse, erythematous, mucosal or cutaneous infection. It is characteristically the result of streptococci infection; and does not normally result in large accumulation of pus
Fulminating infections
involves the secondary spaces involving vital structures, along the pathway of least resistance
Chronic
Chronic fistulous tract or sinus formation
Chronic osteomyelitis
Cervicofacial actinomycosis

7. Based on the deep fascial spaces of the head and neck infiltrated by the infection

8. Other spaces mandible Primary Maxillary Spaces Canine Space
Primary spaces
Submental Space
Submandibular space
Sublingual space
Buccal Space
Secondary spaces
submassenteric Space
Pterygomandibular Space
Temporal Space
Primary Maxillary Spaces
Canine Space
Buccal Space
Infratemporal space
Other spaces
Deep Neck Spaces
Lateral Pharyngeal Space
Retropharyngeal space
Prevertebral space

9. PRIMARY MANDIBULAR SPACES

10. Submental space Causes Mandibular anterior teeth Contents
Anterior jugular vein
Lymph nodes
Location
Laterally: between the anterior bellies of the digastric muscle
Deeply: by the mylohyoid muscle, and
Superiorly: by the deep cervical fascia, the platysma muscle, the superficial cervical fascia and the skin
Posteriorly: hyoid bone

12. Submandibular space Causes Mandibular molars Contents
Submandibular gland
Facial artery
Lymph nodes
Location
Superior- mylohyoid muscle and inferior border of the mandible
Anteriorly- anterior belly of the digastric muscle
Posteriorly- posterior belly of the digastric muscle
Inferiorly- hyoid bone
Superficially- platysma muscle and superficial layer of the deep cervical fascia

14. Sublingual space Causes Mandibular premolars Mandibular molars Trauma
Contents
Sublingual glands
Wharton’s duct
Sublingual artery & nerve
Lingual nerve
Location
Anterior – lingual surface of mandible
Posterior – body of hyoid bone
Medial – muscle of the tongue
Lateral – lingual surface of mandible
Superior- oral mucosa
Inferior- mylohyoid muscle

16. BUCCAL SPACE Boundaries • Anteromedially: Buccinator muscle
• Posteromedially: Masseter overlying the anterior border of ramus of mandible
• Laterally: By forward extension of deep fascia from the capsule of parotid gland and by platysma muscle.
• Inferiorly: Limited by the attachment of the deep fascia to the mandible and by depressor anguli oris.
• Superiorly: The zygomatic process of the maxilla and the zygomaticus major and minor muscles.
Contents
Buccal pad of fat, Stenson‘s (parotid ) duct, anterior and transverse facial artery and vein
Source of infection
Maxillary and mandibular bicuspid
Maxillary and mandibular molar

18. Mandibular Secondary spaces

19. Submasseteric space Causes Mandibular 3rd molars Contents
Masseteric artery & vein
Location
Anterior – buccal space, parotidomasseteric fascia
Posterior – parotid gland and its fascia
Medial – ramus of the mandible
Lateral – masseter muscle
Superior- zygomatic arch
Inferior- inferior border of mandible

21. Temporal space
Causes
Involvement is secondary to the initial involvement of pterygopalatine and infratemporal space.
Components
Superficial temporal space: located between temporal fascia and temporalis muscle
Deep temporal space: located between the temporalis muscle and the temporal bone
Continuous with the infratemporal space

23. Primary Maxillary Spaces

24. BUCCAL SPACE Boundaries • Anteromedially: Buccinator muscle
• Posteromedially: Masseter overlying the anterior border of ramus of mandible
• Laterally: By forward extension of deep fascia from the capsule of parotid gland and by platysma muscle.
• Inferiorly: Limited by the attachment of the deep fascia to the mandible and by depressor anguli oris.
• Superiorly: The zygomatic process of the maxilla and the zygomaticus major and minor muscles.
Contents
Buccal pad of fat, Stenson‘s (parotid ) duct, anterior and transverse facial artery and vein
Source of infection
Maxillary and mandibular bicuspid
Maxillary and mandibular molar

25. CANINE SPACE Boundaries Superiorly:
levator labii superioris alaque nasi, levator labii superioris, and zygomaticus minor muscles.
• Inferiorly, caninus muscle
• Anteriorly, orbicularis oris,
• Posteriorly, buccinator muscle
• Medially, anterolateral surface of maxilla.
Contents
Angular artery and vein
Infraorbital nerve
Source of infection
-Maxillary canine
-First upper premolar

27. INFRATEMPORAL SPACE Boundaries Anteriorly: Posterior pharyngeal wall
Posteriorly: prevertebral fascia
Superiorly: Base of skull
Inferiorly: Mediastinum
Medially: Common space, no wall
Laterally: Communicates with the lateral pharyngeal space
Content
No major structure
Source of infection
Suppurative adenitis
Dental infection diffusing through contiguous spaces
Nasal and pharyngeal infections through pharyngeal trauma or foreign bodies

29. Other spaces

31. LATERAL PHARYNGEAL SPACE
Boundaries
Anteriorly:
Superior and middle pharyngeal constrictor muscle
Posteriorly: Carotid sheath, stylohyoid, Styloglossus and Stylopharyngeus
Superiorly: base of skull
Inferiorly: Hyoid bone
Medially: superior pharyngeal constrictors
Laterally: medial pterygoid muscle and capsule of parotid gland
Content
Carotid artery
Internal jugular vein
Vagus nerve
Cervical sympathetic chain
Likely source of infection
Mandibular third molar
Tonsilar infection
Pharyngitis
Parotitis

32. DEEP NECK SPACES
Uncommon infection beyond the primary spaces of maxilla and mandible
Possible sequelae: compromise upper airway and descending mediastinitis
Pterygomandibular space infection spread posteriorly to the lateral pharyngeal space

33. PREVERTEBRAL SPACE Boundaries: Superiorly: skull base
Space between alar and prevertebral layers
Infection causes
Mediastinitis

34. RETROPHARYNGEAL SPACE
Boundaries
Anteriorly: Posterior pharyngeal wall
Posteriorly: prevertebral fascia
Superiorly: Base of skull
Inferiorly: Mediastinum
Medially: Common space, no wall
Laterally: Communicate with the lateral pharyngeal space
Content
No major structure
Likely source of infection
Suppurative adenitis
Dental infection diffusing through contiguous spaces
Nasal and pharyngeal infections through pharyngeal trauma of foreign bodies