口腔颌面外科学（中山大学）11口腔颌面部感染课件

ORAL AND MAXILLOFACIAL INFECTION Liang Yu-jie Department of oral and maxillofacial surgery Guanghua school of stomatology Pericoronitis Definition The Inflammation occurrence around the soft tissue of the tooth coronal when the third molar was impacted or unerupted frequently around mandibular third molar rare around maxillary third molar Etiology Anatomy imbalance degenetate of the jaw and tooth not enough room to erupt pocket around the corona bacteria and food to fill in easy to be injuried Compromised defense or the bacterial virulence boost up Clinical presence Acute pericoronitis pain, swelling, redness submandibular lymphadenopathy trismus a general condition of malaise moderate elevation of temperature Examination unerupted tooth covered by inflammatory gingival flap Infection may direct spread or diffuse by lymphatic retromolar area - subperiosteal abscess - break through muscle - subcutaneous abscess - fistula mandibular oblique line - first molar - subperiosteal abscess - fistula backward along medial and lateral of mandibular ramus - Fascia space infection Diagnosis Easy to diagnosis It is importance to use a probe to examine the existence of tooth X-ray Differentiate: inflammation from first and second molar, malignant tumor from retromolar area Treatment acute inflammation: diminish inflammation、ease pain、incision and draining、boost the body defense chronic inflammation: tooth extraction Infection of fascia spaces in oral and maxillofacial region Introduction fascia space exist only as potential spaces, but become “real spaces“ when infection invading infection origins secondary to dental or adenogenous infection differentiated with infection secondary to malignant tumor Infraorbital space Superior: inferior margin of the orbit Inferior: alveolar process of maxilla Mesial: margin of periform aperture Lateral: zygomatic-maxillary suture Infraorbital space Infraorbital space Clinical features swelling of cheek, lower eyelid, upper lip drooping of angle of mouth nasolabial fold obliterated odema of lower eyelid Infraorbital space Infraorbital space Infraorbital space Infraorbital space Infraorbital space Buccal space Superior: inferior margin of zygomatic arch Inferior: inferior margin of mandible Anterior: corner of the mouth Posterior: anterior margin of masseter muscle Interior: buccinator muscle Buccal space Buccal space & Masseteric-buccal space Buccal space Etiology odontogenic (most frequently) adenophlegmon of the facial lymphnodes injury of skin or mucosa Buccal space Clinical features Buccal space Spread of infection Buccal space Buccal space Treatment Intraoral access the abscess fluctuates intraorally in the most of cases avoid injuring the facial nerve for esthetic reasons Masseteric space Superior: zygomatic arch Inferior: inferior border of mandible Lateral: masseter muscle Medial: ramus of mandible Posterior: parotid gland & its fascia Anterior: buccal space Masseteric space Etiology pericoronitis of mandibular 3rd molar infection of mandibular molars parotitis Masseteric space Clinical features swelling severe trismus absence of fluctuation Complication marginal osteomyelitis Treatment extraoral access Masseteric space Pterygomandibular space Superior: lower head of lateral pterygoid muscle Inferior: inferior border of mandible Lateral: ramus of mandible Medial: medial pterygoid muscle Posterior: parotid gland & its fascia Anterior: buccal space/ pterygomandibular raphe Pterygomandibular space Superior: lower head of lateral pterygoid muscle Inferior: inferior border of mandible Lateral: ramus of mandible Medial: medial pterygoid muscle Posterior: parotid gland & its fascia Anterior: buccal space/ pterygomandibular raphe Pterygomandibular space Etiology pericoronitis of mandibular 3rd molar infection of mandibular molars parotitis block anethesia of inferior alveolar nerve Pterygomandibular space Clinical features slight extraoral swelling beneath the angle of the mandible /absence of extraoral swelling severe trismus difficulty in swallowing displacement of the uvula and lateral pharyngeal wall Pterygomandibular space Clinical features Pterygomandibular space Treatment Temporal space Temporal space Superficial temporal Lateral: temporalis fascia Medial: temporalis muscle Deep temporal Lateral : temporalis muscle Media: temporal bone & greater wing of sphenoid Etiology usually secondary to primary involvement of the masticator, pterygopalatine, infratemporal spaces Temporal space Temporal space Clinical features Superficial temporal swelling, trismus, severe pain Deep temporal less swelling, trismus, difficult to diagnose Temporal space For superficial or deep temporal space For osteomyelitis For multiple space infection Temporal space Treatment Infratemporal space Superior: infratemporal surface of the greater wing of the sphenoid Inferior: inferior of lateral pterygoid muscle Lateral: ramus of mandible below level of zygomatic arch Medial: lateral plate of the pterygoid process & the lateral wall of the pharynx Posterior: styloid process & stylohyoid muscle Anterior: maxilla Infratemporal space Clinical features swelling in front of the external ear over the zygomatic arch trismus In severe cases swelling involves whole side of face optic neuritis may also develop intracranial infection Infratemporal space Treatment Sublingual space Superior: mucosa of floor of mouth Inferior: mylohyoid muscle Lateral & Anterior : mandible Medial: lingual septum Posterior: muscles of the tongue &hyoid bone Sublingual space Etiology infection of mandibular tooth Sublingual space Clinical features swelling in floor of the mouth elevation of the tongue pain and difficulty in swallowing Sublingual space Treatment Submandibular space Superior: mylohoid muscle Inferior: skin Lateral: mandible Posterior: posterior belly of digastric muscle Anterior: anterior belly of digastric muscle Submandibular space Etiology infection of mandibular tooth lymphadenitis pyogenic infection of submandibular gland Submandibular space Clinical