Fascial infections derived from maxillary odontogenic. Anatomic considerations in diagnosis and treatment of odontogenic infections. Infections of the oral cavity, neck, and head infectious. The study consisted of 25 patients with unilateral buccal space inflammatory swellings of. Less frequently, benign lesions eg, hemangioma and dilated parotid ducts and softtissue malignancies eg, sarcoma manifested as buccal space masses. Diagnosis and management of odontogenic oral and facial. The author has used the protocol designed by ansari mk. Sources of infections were of odontogenic origin in 92. Buccal space associated with temporal space dumb bell shaped appearance due to lack of swelling over zygomatic arch. In a series of 26 patients with unsuspected buccal space masses, salivary gland tumors were the most common masses. Gross anatomy the buccal spaces are paired fatcontaining spaces on each side of the face forming cheeks. The main objective of the study was a to differentiate cellulitis and abscess in buccal space region, b to study the ultrasonographic anatomy of cheek region and c to investigate the use of ultrasound in the diagnosis of inflammatory swellings of cheek region.
Buccal pad of fat stensons parotid duct anterior and transverse facial artery and vein. Extraoral incision and drainage of submandibular abscess. A case of buccal abscess from an impacted wisdom tooth in an. Other terms for these conditions include periapical abscess, apical abscess, chronic periapical dental infection. The relative risk of fascial space infection is related to the location of the space in relation to the anatomy of the head and neck. Management of fascial space infections in a nigerian teaching. Abstract submasseteric abscess is unusual in the head and neck region. Ct and mr imaging of the buccal space and buccal space. Factors that influence the spread of odontogenic infections. The ideal treatment for pa is wide local excision with good safety margins and regular follow up for 34 years 17. If an infection moves deep into gum pockets, drainage of pus is blocked and a periodontal abscess results. A periodontal abscess is the third most common dental emergency. Deep temporal space by extending superiodeep temporal space by extending superioposteriorly.
Usually this will be under general anaesthesia on an inpatient basis. Penrose drain place in the loculation of infection. Space infections in dentistry pdf edema of the involved soft tissue space. Dental abscess which penetrate the lingual cortical. Coding for incision and drainage in conjunction with. Role of ultrasound as a diagnostic tool in superficial. It is an odontogenic infection buccal space infection can spread to or from the teeth. Case report third molar tooth and buccal space infection. A case of buccal abscess from an impacted wisdom tooth in. Space between buccinator and superficial fasciaskin. The fascial spaces can also be opened during the dissection of a cadaver. A silastic drainage tube for communication between the temporal and intraoral incision is placed for postoperative irrigation.
To provide a concept of the threedimensional anatomy of the buccal space. The buccal space occupies the portion of subcutaneous space between the fascial skin and buccinator muscle. Surgical drainage is crucial for resolving dental abscesses 10, 11. Mar 31, 2005 the buccal space is located lateral to the buccinator muscle and deep to the zygomaticus major muscle.
Management of odontogenic space infection with microbiology study. Feb 10, 2018 it is an odontogenic infection buccal space infection can spread to or from the teeth. Coding for incision and drainage in conjunction with extractions. Although rare in the postantibiotic era, deep space. Other terms for these conditions include periapical abscess, apical abscess, chronic periapical dental infection, dental pyogenic infection, periapical periodontitis. 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. Infections spread from the origin into these spaces, which are. It is quite likely that infection in a particular fascial space will. Pdf on jan 1, 2018, kalim ansari and others published management of odontogenic buccal space infection in patient with severe. Sunderland, england department of oral and maxillofacial surgery, sunderland district general hospital a patient is described with generalized gastrointestinal. 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. To discuss the advantages, disadvantages, and rationale for various surgical approaches to the tumors of the buccal space. Ct assessment of pathways of space involvement koichi yonetsu, masahiro izumi, and takashi nakamura.
Buccal space involvement was always associated with masseter muscle involvement table 2. Solitary fibrous tumors are submesothelial mesenchymal fibroblastic tumors that typically occur in relation to parietal or visceral pleura. We report a case of buccal abscess caused by an impacted wisdom tooth in an extremely elderly person with malnutrition. Out of 30 cases, pathogens were isolated in 28 cases and 2 cases yielded negative culture.
Teeth involved in various types of space infections space. Rodgers gk, myers en 1988 surgical management of the mass in the buccal space. Ultrasonographic evaluation of inflammatory swellings of. However, deep temporal space infection could be easily misdiagnosed and. Pedlar, in oral and maxillofacial surgery second edition, 2007. An abscess of this space is causedmainly by infection of mandibular third molars or the result of an inferior. It is a potentially hazardous and expensive procedure, but in selected cases can be carried out under local anaesthetic, avoiding some of. In the present case, a patient with rare phlegmon in the buccal, temporal and deep temporal space, associated with mandibular wisdom tooth, in the background of drug abuse and malnutrition is reported. The buccal space may serve as a conduit as there is a lack of fascial compartmentalization in the superior, inferior, and posterior directions, which permits the spread of pathology both to and from the buccal space. Buccal space abscess the buccal space is confined laterally by the superficial cervical fascia just deep to the skin, medially by the investing layer of cervical fascia that overlies the buccinator muscle, anteriorly by the labial musculature, posteriorly by the pterygomandibular raphe, superiorly by. Most frequent causes of this space infection are the dental abscesses, pericornitis of mandibular molars and post surgical infections.
Buccal space abscess the buccal space is confined laterally by the superficial cervical fascia just deep to the skin, medially by the investing layer of cervical fascia that overlies the buccinator muscle, anteriorly by the labial musculature, posteriorly by the pterygomandibular raphe, superiorly by the zygomatic arch. Only 4 cases of buccal abscess were reporter without any data for inflammation in the temporal or deep temporal space. It communicates with the pterygopalatal, infratemporal, submandibular, and lateral pharyngeal spaces. The buccal space is bounded anterior to the masticator space and lateral to the buccinator muscle with no true superior or inferior boundary and consists of adipose tissue the buccal fat pad that fills the greater part of the space, the stensen duct, the facial artery and vein. Intraoral incision and drainage of an oral vestibular abscess. Canine space infections may occur by spread of infection from the buccal space. Management of the mass in the buccal space springerlink. A periapical abscess refers to a tooth in which the pulp is infected, usually secondary to tooth decay. Treatment of localized infection was probably the first primitive. Submandibular space infection arising from grossly decayed primary molar with systemic. The buccal space is situated between the zygomatic arch above, inferior border of the mandible below, anterior border of masseter posteriorly, zygomatic major and depressor.
Oral management implications dental abscesses usually occur due to a combination of poor dental hygiene and consumption of sugary or starchy food and drink. What every practitioner needs to know this is a broad subject area. To describe the clinical presentation and specific features of buccal space tumors. Pdf the main objective of the study was a to differentiate cellulitis and abscess in buccal space region, b to study the ultrasonographic anatomy of. The buccal space, also known as the buccinator space, is one of the seven suprahyoid deep compartments of the head and neck. Fascial spaces also termed fascial tissue spaces or tissue spaces are potential spaces that exist between the fasciae and underlying organs and other tissues. Treatment of buccal space infections of odontogenic etiology in a patient with. The patient was a 94yearold man, who complained that he had found it hard to open his mouth and that his cheek had been swollen for the previous 2 weeks. The buccal space is located superficial to buccinator muscle. Fascial spaces of the head and neck pocket dentistry. Phlegmon in the buccal, temporal and deep temporal space. The most commonly involved space was submandibular followed by buccal. Normal lymph nodes were rarely discernible from the facial neurovascular bundles.
There is no real boundary between the buccal space and the submandibular space inferiorly. The topics to be covered include odontogenic orofacial space infections. Pdf ultrasonographic evaluation of inflammatory swellings. Buccal space abscesses typically cause a facial swelling over the cheek that may extend from the zygomatic arch above to the inferior border of the mandible below, and from the anterior border the masseter muscle posteriorly to the angle of the mouth anteriorly. Incision and drainage for facial space abscess buccal. We present a case report of buccal swelling, secondary to. Jun 04, 2016 the buccal space may serve as a conduit as there is a lack of fascial compartmentalization in the superior, inferior, and posterior directions, which permits the spread of pathology both to and from the buccal space. Teeth involved in various types of space infections. Purulent drainage is expressed after blunt instrumentation. All dentists should be comfortable with prompt diagnosis and management of these types of infections. Signs and symptoms of a canine space abscess might include swelling that obliterates the nasolabial fold. However, the development of a submasseteric abscess from maxillary molars.
Prompt treatment should be initiated in order to avoid severe. Since the major purpose of imaging is to define the likely anatomic origin and also the extent of a given lesion, thorough knowledge of the normal anatomy of the buccal space is essential, and this knowledge can aid the physician in narrowing down the list of possible. Nocardia in buccal space abscess an oral manifestation. Other deep om a mild buccal space infection to a severe life. A case report article pdf available march 2014 with 220 reads how we measure reads. Infection in this space has a dramatic appearance and may cause trismus. It also examines the spread of dental infections from the. Odontogenic infections oi are often seen as swelling in the superficial and deep spaces of the maxillofacial region. Other muscles in the masticator space were less frequently involved in buccal space infection. Early recognition and treatment of established cases are necessary to prevent. Surgical access to the buccal space infections may be easily accomplished through the intraoral approach. Canine space it is the region between anterior surface of maxilla and overlying levator muscles of upper lip.
Primary mandibular submental, sublingual, buccal, submandibular. This space is filled with adipose tissue termed the buccal fat pad, the parotid duct, the facial artery and vein, lymphatic channels, the minor salivary glands and the branches of the facial and mandibular nerves. The pterygomandibular space contains the mandibular neurovascular bundle, lingual nerve, and part of the buccal fat pad. 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. However, recurrent buccal space infections can be seen as a complication of crohns. Buccal space and submasseteric space infection represented 7. Pdf phlegmon in the buccal, temporal and deep temporal.
If it progresses further without resolution andor treatment, an abscess, which is a pusfilled cavity, typically caused by anaerobic organisms forms. Dentoalveolar infections can be defined as pusproducing or pyogenic infections associated with the teeth and surrounding supporting structures, such as the periodontium and the alveolar bone. Diagnosis and management of odontogenic oral and facial infections june 1, 2014 by william l. Management of odontogenic buccal space infection in patient with. The buccal space, also known as the buccinator space, is one of the seven suprahyoid deep compartments of the head and neck gross anatomy the buccal spaces are paired fatcontaining spaces on each side of the face forming cheeks. Drainage of abscess, cyst, hematoma from dentoalveolar structures page 2 incision and drainage in conjunction with extractions it. In the present case significant fascial asymmetry was observed in the buccal and temporal region. The buccal space is an anatomical compartment lying anterior to the masticator space and lateral to the buccinator muscle.
However, the tumor also occurs in extrapleural sites, including the peritoneum, me. Dec 19, 2016 the buccal space occupies the portion of subcutaneous space between the fascial skin and buccinator muscle. Incision and drainage for facial space abscess buccal space. For claims with a date of service on or after october 1, 2015, use an. By far the most common etiology of buccal space infections is odontogenic. Each space is enveloped by the superficial investing layer of the deep cervical fascia it is located between the buccinator and platysma muscles, therefore it is. When infection is involved in the buccal space, the space can serve as a conduit. If left untreated, infections of this space will eventually spontaneously drain via the medial or lateral canthus of the eye, as this is the path of least. Hi nicky, the consultants who will be dealing with deep fascial infections of head and neck will be oral and maxillofacial surgeons if the cause of the infection is oral or tooth related and in case the cause of the infection is not oral then the best bet will be a general physician who will diagnose and send you to the respective departments for further treatment. Pdf management of odontogenic buccal space infection in. Shahriari and others published oral and maxillofacial infections.
Unlikely case of submasseteric abscess originating from a. The most commonly involved space was submandibular followed by buccal space fig. Buccal space associated with temporal space dumb bell shaped appearance. The buccal space was involved in 11 29% of 38 patients with mandibular infection. Case reports annals and essences of dentistry incongruous. Cervicofacial space abscesses require a more vigorous approach to drainage, and even the buccal space abscesses, which can theoretically be incised intraorally, are better approached from outside the mouth. Feb 09, 2014 the most commonly involved space was submandibular followed by buccal space fig. The role of corticosteroids in treatment of msi should be explored further. Ct and mr imaging of the buccal space and buccal space masses. 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. All these anatomic paths are reason for rapid spreading of the infection. He had a shallow oral wound caused by an improperly fitting denture. The buccal space sometimes becomes involved when infection of the maxillary molars occurs superior to the attachment of the buccinator muscles.
Submasseteric abscess is a rare complication that commonly has dental origins, particularly the mandibular third molars. Mar 09, 2017 the relative risk of fascial space infection is related to the location of the space in relation to the anatomy of the head and neck. Lowrisk anatomical areas include the region of the facial vestibule of the mandible, the body of the mandible, the buccal vestibule of the mandible, and the palate. However, when treating patients with bleeding disorders such as hemophilia, the clini cian must pay special attention to treatment planning and. Solitary fibrous tumor of the buccal space brian l. Frequently infection spreads in both directions as the buccinator is only a partial barrier. Keywords maxillofacial space infections, abscess, odontogenic infections, systemic steroids, adjunctive management 1. Space infection is infection spreading to the facial spaces in the head and neck region from one or many teeth infected. Cillo, in mischs avoiding complications in oral implantology, 2018. It is characterized by overgrowth of mixed pathogenic. Feb 19, 2014 clinical features obliteration of nasolabial fold.
603 558 503 1418 32 65 1297 1022 1268 815 47 154 1100 46 1104 1049 1005 106 485 187 1058 1269 1010 1654 608 1137 78 1426 704 1462 1145 261 1120 1352 1060 881 263 571