1. FASCIAL SPACES INFECTION
INTRODUCTION
Fascial space are potential spaces between the layers of fascia.
Space is a misnomer ,there are no voids (SPACES) in the tissues in actual reality.
These areas are potential spaces that do not exist in healthy individual but become filled during infections.
Spaces have boundaries formed by muscles, fascia, periosteium, bone, mucous membranes.

2. BASED ON MODE OF INVOLVEMENT
Classifications
BASED ON MODE OF INVOLVEMENT
DIRECT INVOLVEMENT
Primary space - Mandibular Spaces
Maxillary Spaces
INDIRECT INVOLVEMENT
Secondary space

3. PRIMARY MANDIBULAR SPACES PRIMARY MAXILLARY SPACES
Submental
Submandibular
Sublingual
Buccal
PRIMARY MAXILLARY SPACES
Canine
Infratemporal

4. SECONDARY FASCIAL SPACES
Masseteric
Pterygomandibular
Superficial and deep temporal
Lateral pharyngeal
Retropharyngeal
Pre-vertebral
Masticator space
Cervical fascial spaces

6. Digastric muscle (Anterior Belly)
Sublingual gland
Tongue
Sublingual space
The sublingual and submandibular spaces communicate at the posterior edge of the mylohyoid. The sublingual space contains the sublingual salivary glands and the deep parts of the submandibular salivary glands with their ducts, the submandibular gland being a structure partly occupying both the sublingual and submandibular spaces.
Mylohyoid muscle
Submandibular gland
Submandibular space
Digastric muscle (Anterior Belly)

11. LUDWIG’S ANGINA Definition
Ludwig’s angina is a form of firm, acute, toxic and
severe diffuse cellulitis that spreads rapidly,
bilaterally, affecting the submandibular, sublingual
and submental spaces and resulting in a woody
swelling.

12. Etiology
Dental infection most commonly the mandibular 3rd molar in 90% of cases.
Oral soft tissue lacerations.
Puncture wounds of the floor of the mouth.
Submandibular gland sialadenitis.
Secondary infections of oral malignancies.

13. Clinical Features
Bilateral suprahyoid swelling with hard consistency,non fluctuating & painful on palpation
Swelling is characterized by rapid onset
Difficulty in breathing (dyspnea),
Difficulty in swallowing (odynophagia)
Restricted tongue movements, elevated tongue, inability to open the mouth, salivation
Patients may exhibit muffled voice due to edema of vocal apparatus (hot potato voice)

14. Firm, brawny swelling in bilateral submandibular & submental and sublingual spaces, non fluctuant,tender with ill defined borders
Open mouth due to edema of sublingual tissue
Airway obstruction due to edema of the glottis and floor of the mouth
Infection can spread to involve the masticator space and Para pharyngeal space in the latter stages of the disease

15. OSTEOMYELITIS DEFINITION
In Greek osteon means bone myelos means marrow itis means inflammation “ Osteomyelitis may be defined as an inflammatory condition of bone, that begins as an infection of medullary cavity and haversian systems and extends to involve the periosteum of the affected area ”

16. CLASSIFICATION
Simplest and the most used is based on presence or absence of suppuration
Based on clinical course

17. Based on suppuration SUPPURATIVE NON SUPPURATIVE ACUTE SUPPURATIVE
CHRONIC SCLEROSING
- FOCAL
- DIFFUSE
CHRONIC SUPPURATIVE
- PRIMARY
- SECONDARY
GARRE’S SCLEROSING
INFANTILE
ACTINOMYCOTIC
SPECIFIC INFECTIVE
- TUBERCULOSIS
- SYPHILIS
RADIATION

18. CLASSIFICATION
BASED ON CLINICAL COURSE
Acute
Sub-acute
Chronic

19. Acute oml GEN. CONSTITUTIONAL SYMPTOMS
DEEP, BORING, INTENSE CONTINUOUS PAIN
PARAESTHESIA OR ANAESTHESIA OF LIP
FACIAL CELLULITIS OR INDURATED SWELLING
FOETID ODOUR
TEETH – TENDER
TRISMUS

20. Chronic oml PAIN IS MINIMAL NONHEALING WOUNDS WITH INDURATION
INTRA ORAL OR EXTRA ORAL SINUS
THICKENED OR WOODEN CHARACTER OF BONE
ENLARGEMENT OF MANDIBLE
PATHOLOGICAL #S
LOOSE , TENDER TEETH

21. GENERAL MANAGEMENT OF PATIENT WITH INFECTION
MEDICAL THERAPY: It consists of supportive care Hydration Soft and liquid diet Rich protein diet Analgesics Antiseptic mouthwash Maintenance of oral hygiene Antibiotic therapy — depends upon whether the patient is non-compromised and compromised patient

22. Antibiotic Therapy Choice of antibiotics include
Penicillin+metronidazole or
Clindamycin

23. METRONIDAZOLE Immediate infusion of Metronidazole - 500mg
Brings about rapid improvement
Repeated every 8 hours

24. Incision and drainage of abscess
Surgical therapy
Incision and drainage of abscess
To get rid of toxic purulent material.
To decompress the oedematous tissue.
To allow better perfusion of blood containing antibiotic and defensive cells present in blood.
To increase oxygenation of the infected area.

25. APICOECTOMY
Apicoectomy or Apical surgery or Root resection are the terms which are used for surgery involving root apex to treat apical infection.
It is the cutting of apical portion of the root and curettage of periapical necrotic, granulomatous, inflammatory or cystic lesions.
In spite of good endodontic treatment, if periapical lesions are not resolved, then apical surgery is undertaken.

26. INDICATIONS
Roots with broken instruments/over fillings with infection.
Fracture of apical third of root.
Periapical granuloma or cyst.
Draining sinus tract.
CONTRAINDICATIONS
Presence of systemic diseases eg; Leukemia, uncontrolled diabeties, anemia.
Teeth damaged beyond restoration.
Teeth with deep periodontal pockets.
Mobile teeth.
Short root length.
Acute infection non-responsive to treatment.