PRIMARY

Primary Space Infections

  • Definition: Space infections classified based on the involvement mode; include Primary Space (directly involved) and Secondary Space (indirectly involved).

Primary Space Classification

  • Directly Involved (Primary Space):

    • Maxillary Canine

    • Buccal

    • Infratemporal

    • Mandibular

    • Submental

    • Submandibular

    • Sublingual

    • Parotid duct

    • Gingival abscess

  • Indirectly Involved (Secondary Space):

    • Masseteric

    • Superficial and Deep Temporal

    • Pterygomandibular

    • Lateral

    • Retropharyngeal

    • Prevertebral

    • Carotid Sheath

    • Danger Spaces

Canine Space Infection

  • Nature: Primarily odontogenic; occasionally caused by nasal infections.

  • Common Teeth Involved: Maxillary canines, premolars, and sometimes the mesiobuccal root of maxillary first molars.

  • Abscess Dynamics: Periapical abscess discharges buccally and accumulates in the canine fossa.

Canine Space Boundaries

  • Superiorly: Muscles including levator labii superioris and zygomaticus minor.

  • Inferiorly: Caninus muscle.

  • Anteriorly: Orbicularis oris muscle.

  • Posteriorly: Buccinator muscle.

  • Medially: Anterolateral surface of maxilla.

Canine Anatomy Variations

  • Short Root Canine: Pus emerges in the buccal sulcus due to the buccinator muscle lack of attachment to bone.

  • Long Root Canine: Pus may emerge above the levator anguli oris, affecting the angular artery and vein, risking brain abscess.

Clinical Features of Canine Space Infection

  • Early Phase: Drooping of mouth angle, nasolabial fold obliteration, periorbital edema.

  • Late Phase: Marked edema, tenderness, tooth mobility.

  • Swelling: Considerable swelling of cheek and upper lip, potentially affecting eyelid.

Treatment Strategy

  • Incision and Drainage:

    • Approach: Through buccal vestibule near lateral incisor/canine, using curved mosquito forceps to enter infraorbital space.

    • Drainage: Pus evacuation with a drain secured.

Buccal Space Characteristics

  • Description: Potential space between buccinator and masseter muscle.

  • Common Involvement: Maxillary and mandibular molars; generally associated with infections from molars.

Buccal Space Boundaries

  • Anteromedially: Buccinator muscle.

  • Posteromedially: Masseter muscle.

  • Laterally: Deep fascia from parotid gland.

  • Superficially: Zygomatic process of maxilla and zygomaticus muscles.

Buccal Space Contents

  • Inclusions: Buccal pad of fat, Stenson’s duct, facial artery/vein, and nerve.

Clinical Features of Buccal Space Infection

  • Signs: Gum boil appearance if pus accumulates; possible extraoral swelling and lower eyelid edema.

  • Spread risks: Infection can extend through buccal space to infratemporal space, causing serious complications.

Incision and Drainage of Buccal Space

  • Technique: Horizontal incision through oral mucosa near premolars/molars; if pus is lateral, penetrate the muscle to evacuate.

Differential Diagnosis for Space Infections

  • Conditions:

    • Cellulitis: Caused by H. influenzae in infants.

    • Erysipelas: Rapid onset redness and swelling.

    • Crohn's Disease: Can cause recurrent abscesses in buccal space.

Infratemporal Space Description

  • Definition: Also known as Retrozygomatic Space; connects to upper pterygomandibular space.

  • Common Causes: Infection from maxillary molars, particularly unerupted third molars.

Infratemporal Boundaries

  • Lateral: Coronoid process and ramus of the mandible.

  • Medial: Medial pterygoid plate and muscles.

  • Superior: Greater wing of sphenoid and zygomatic arch.

  • Inferior: Lateral pterygoid muscle.

Infratemporal Contents

  • Contains pterygoid venous plexuses, internal maxillary artery, mandibular nerve; directly communicates with various spaces.

Clinical Features of Infratemporal Space Infection

  • Extraoral Signs: Trismus, significant swelling over the temporomandibular joint; eye often closed and proptosed.

  • Intraoral Signs: Swelling around tuberosity area; possible fever.

Treatment of Infratemporal Infection

  • Approach: Intraoral or extraoral incision based on severity, often providing drainage and securing with suture.

Potential Consequences of Infection Spread

  • Serious Risks: Involvement of the central nervous system leading to headaches and irritability; embolism from the pterygoid venous plexus to cavernous sinus can prove life-threatening.

Conclusion

  • Importance: Understanding the involved spaces and their complexities is vital in managing dental infections to avoid dire consequences.