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    The document discusses complex odontogenic infections, including: 1) It provides two tables that outline the borders and contents of different deep fascial spaces of the head and neck, as well as the neighboring spaces and typical approaches for incision and drainage for each space. 2) It notes that while rare, infections can spread from the sinuses or orbit to the cavernous sinus, causing a life-threatening condition called cavernous sinus thrombosis that requires aggressive treatment.

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    The document discusses complex odontogenic infections, including: 1) It provides two tables that outline the borders and contents of different deep fascial spaces of the head and neck, as well as the neighboring spaces and typical approaches for incision and drainage for each space. 2) It notes that while rare, infections can spread from the sinuses or orbit to the cavernous sinus, causing a life-threatening condition called cavernous sinus thrombosis that requires aggressive treatment.

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    The document discusses complex odontogenic infections, including: 1) It provides two tables that outline the borders and contents of different deep fascial spaces of the head and neck, as well as the neighboring spaces and typical approaches for incision and drainage for each space. 2) It notes that while rare, infections can spread from the sinuses or orbit to the cavernous sinus, causing a life-threatening condition called cavernous sinus thrombosis that requires aggressive treatment.

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    The document discusses complex odontogenic infections, including: 1) It provides two tables that outline the borders and contents of different deep fascial spaces of the head and neck, as well as the neighboring spaces and typical approaches for incision and drainage for each space. 2) It notes that while rare, infections can spread from the sinuses or orbit to the cavernous sinus, causing a life-threatening condition called cavernous sinus thrombosis that requires aggressive treatment.

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    of 2

    Complex Odontogenic Infections

    Chapter | 17 |

    Table 17-1 Borders of the Deep Fascial Spaces of the Head and Neck
    Superficial or
    Medial*

    Deep or
    Lateral

    Mandible

    Subcutaneous
    tissue and skin

    Buccinator muscle

    Quadratus labii
    superioris
    muscle

    Oral mucosa

    Quadratus labii
    superioris
    muscle

    Levator anguli oris


    muscle
    Maxilla

    Posterior belly
    digastric muscle
    Stylohyoid muscle
    Stylopharyngeus
    muscle

    Inferior and
    medial surfaces
    of mandible

    Digastric
    tendon

    Platysma muscle
    Investing fascia

    Mylohyoid muscle
    Hyoglossus muscle
    Superior
    constrictor
    muscles

    Inferior border of
    mandible

    Hyoid bone

    Mylohyoid muscle

    Investing fascia

    Investing fascia

    Anterior bellies of
    digastric
    muscles

    Sublingual

    Lingual surface of
    mandible

    Submandibular
    space

    Oral mucosa

    Mylohyoid
    muscle

    Muscles of
    tongue*

    Lingual surface of
    mandible

    Pterygomandibular

    Buccal space

    Parotid gland

    Lateral pterygoid
    muscle

    Inferior border
    of mandible

    Medial pterygoid
    muscle*

    Ascending ramus
    of mandible

    Submasseteric

    Buccal space

    Parotid gland

    Zygomatic arch

    Inferior border
    of mandible

    Ascending ramus
    of mandible*

    Masseter muscle

    Lateral pharyngeal

    Superior and middle


    pharyngeal
    constrictor
    muscles

    Carotid sheath and


    scalene fascia

    Skull base

    Hyoid bone

    Pharyngeal
    constrictors and
    retropharyngeal
    space*

    Medial pterygoid
    muscle

    Retropharyngeal

    Superior and middle


    pharyngeal
    constrictor
    muscles

    Alar fascia

    Skull base

    Fusion of alar
    and
    prevertebral
    fasciae at
    C6-T4

    Pretracheal

    Sternothyroidthyrohyoid fascia

    Retropharyngeal
    space

    Thyroid cartilage

    Superior
    mediastinum

    Space

    Anterior

    Posterior

    Superior

    Inferior

    Buccal

    Corner of mouth

    Masseter muscle
    Pterygomandibular
    space

    Maxilla
    Infraorbital space

    Infraorbital

    Nasal cartilages

    Buccal space

    Submandibular

    Anterior belly
    digastric muscle

    Submental

    Carotid sheath
    and lateral
    pharyngeal
    space
    Sternothyroidthyrohyoid
    fascia

    Visceral fascia over


    trachea and
    thyroid gland

    *Medial border.

    Lateral border.
    From Flynn TR: Anatomy of oral and maxillofacial infections. In Topazian RG, Goldberg MH, Hupp JR, editors: Oral and maxillofacial infections, ed 4, Philadelphia, PA,
    2002, WB Saunders.

    Figure 17-5 A, Infraorbital space abscess that is about


    to drain medial to the attachment of the levator labii
    superioris muscle. B, Infraorbital space abscess with
    chronic cutaneous drainage medial to the levator labii
    superioris muscle. (A, From Topazian RG, Goldberg
    MH, Hupp JR, editors: Oral and maxillofacial infections,
    ed 4, Philadelphia, PA, 2002, Saunders. B, From
    Topazian RG, Goldberg MH, Hupp JR, editors:
    Oral and maxillofacial infections, ed 4, Philadelphia,
    PA, 2002, Saunders.)

    323

    Part | IV |

    Infections

    Table 17-2 Relations of the Deep Fascial Spaces of the Head and Neck

    Space

    Likely Causes

    Contents

    Neighboring
    Spaces

    Approach for Incision


    and Drainage

    Buccal

    Upper premolars
    Upper molars

    Parotid duct
    Anterior facial artery and vein

    Infraorbital
    Pterygomandibular

    Intraoral (small)
    Extraoral (large)

    Lower premolars

    Transverse facial artery and vein


    Buccal fat pad

    Infratemporal

    Infraorbital

    Upper canine

    Angular artery and vein


    Infraorbital nerve

    Buccal

    Intraoral

    Submandibular

    Lower molars

    Submandibular gland
    Facial artery and vein
    Lymph nodes

    Sublingual
    Submental
    Lateral pharyngeal
    Buccal

    Extraoral

    Submental

    Lower anterior teeth


    Fracture of symphysis

    Anterior jugular vein


    Lymph nodes

    Submandibular (on
    either side)

    Extraoral

    Sublingual

    Lower premolars
    Lower molars
    Direct trauma

    Sublingual glands
    Whartons ducts

    Submandibular
    Lateral
    Pharyngeal

    Intraoral
    Intraoral-extraoral

    Lingual nerve
    Sublingual artery and vein

    Visceral (trachea and


    esophagus)

    Mandibular division of
    trigeminal nerve

    Buccal

    Intraoral

    Inferior alveolar artery and vein

    Lateral pharyngeal
    Submasseteric
    Deep temporal
    Parotid
    Peritonsillar

    Intraoral-extraoral

    Masseteric artery and vein

    Buccal

    Intraoral

    Pterygomandibular
    Superficial temporal
    Parotid

    Intraoral-extraoral

    Pterygomandibular

    Submasseteric

    Lower third molars


    Fracture of angle of mandible

    Lower third molars


    Fracture of angle of mandible

    Infratemporal and
    deep temporal

    Upper molars

    Pterygoid plexus
    Interior maxillary artery and
    vein
    Mandibular division of
    trigeminal nerve
    Skull base foramina

    Buccal
    Superficial temporal
    Inferior petrosal sinus

    Intraoral
    Extraoral
    Intraoral-extraoral

    Superficial
    temporal

    Upper molars
    Lower molars

    Temporal fat pad


    Temporal branch of facial nerve

    Buccal
    Deep temporal

    Intraoral
    Extraoral
    Intraoral-extraoral

    Lateral pharyngeal

    Lower third molars


    Tonsils
    Infection in neighboring
    spaces

    Carotid artery
    Internal jugular vein
    Vagus nerve
    Cervical sympathetic chain

    Pterygomandibular
    Submandibular
    Sublingual
    Peritonsillar
    Retropharyngeal

    Intraoral
    Intraoral-extraoral

    From Flynn TR: Anatomy of oral and maxillofacial infections. In Topazian RG, Goldberg MH, Hupp JR, editors: Oral and maxillofacial infections, ed 4, Philadelphia, PA,
    2002, WB Saunders. With permission.

    the sinuses, they can follow the common ophthalmic vein through
    the superior orbital fissure and extend directly into the cavernous
    sinus. This is the anterior route to the cavernous sinus. Intravascular
    inflammation caused by the invading bacteria stimulates the clotting pathways, resulting in a septic cavernous sinus thrombosis.

    324

    Cavernous sinus thrombosis is an unusual occurrence that is rarely


    the result of an infected tooth. Like orbital cellulitis, cavernous sinus
    thrombosis is a serious, life-threatening infection that requires aggressive medical and surgical care. Cavernous sinus thrombosis has a high
    mortality even today. Figure 17-11 illustrates the rapid extension of

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