Masticatory space infection

MASTICATORY SPACE INFECTION

1. Masticatory Space Infection DR. SWATI SAHU MDS FELLOW ORAL & MAXILLOFACIAL SURGERY

2. Masticatory space There are 5 masticatory spaces. Pterygomandibular space Submassetric space Superficial temporal space Infratemporal space Deep temporal space

3. PTERYGOMANDIBULAR SPACE INFECTION Boundries : Anterior -Buccal Space Posterior -Parotid gland with lateral pharyngeal space Superior - Lateral pterygoid muscle Inferior -Inferior border of mandible Deep or Lateral - Medial surface of ascending ramus of mandible

4. Contents - Inferior Alveolar neurovascular bundle. Lingual & auriculotemporal nerves. Mylohyoid nerve & vessels Etiology - Infected mandibular 3 rd molars Pericoronitis Infected needles or contaminated LA solutions.

5. Spread of infection Superiorly to the infratemporal space. Medially to lateral pharyngeal space. To submandibular space.

6. Clinical features Absence of extra-oral swelling Severe trismus. Difficulty in swallowing. Anterior bulging of half of soft palate & tonsillar pillars with deviation of uvula to unaffected side.

7. Treatment Intraoral -vertical incision(1.5cm) made on anterior & medial aspect of→ ramus of mandible→sinus forceps→opened and closed and withdrawn→pus drained and sutured. Extraoral - incision made at an angle of mandible→sinus forceps→pus drained &sutured.

8. SUBMASSETERIC SPACE INFECTION Boundaries - Superiorly -zygomatic arch Inferiorly - inferior border of mandible Laterally - medial surface of masseter muscle. Medially - lateral surface of ramus of mandible. Posteriorly - parotid gland and its facia. Anteriorly - buccal space & buccopharyngeal fascia.

9. Contents - Masseteric artery and vein Etiology Pericoronitis related to vertical or distoangular impaction of third molar. Fracture of angle of mandible

10. Clinical features External facial swelling is moderate. Tenderness over angle of mandible. Limited mouth opening. Pyrexia &malaise. Necrosis of muscle.

11. Treatment Incision &drainage Intraoral approach -done on the lower part of ramus→sinus forceps →downward and backward→drain inserted and secured Extraoral approach -incision is placed behind the angle of mandible→Hilton’s method→rubber drain inserted and secured.

12. TEMPORAL SPACES Superficial temporal- Laterally - temporalis fascia . Medially -temporalis muscle. Deep temporal- Laterally - temporalis muscle. Medially -temporal bone & greater wing of sphenoid

13. SUPERFICIAL TEMPORAL SPACE INFECTION LIKELY CAUSES – Upper Molars Lower Molars CONTENTS – Temporal fat pad Temporal branch of facial n.

14. NEIGHBOURING SPACES – Buccal Deep temporal CLINICAL FEATURES - Pain , trismus , swelling may or may not be present . APPROACH FOR INCISION & DRAINAGE – Intraoral Extraoral Intraoral- extraoral

15. INFRATEMPORAL & DEEP TEMPORAL SPACE INFECTION LIKELY CAUSES – Upper Molars CONTENTS – Pterygoid plexus Internal maxillary a. and v. Mandibular div. of trigeminal n. Skull base foramina

16. NEIGHBOURING SPACES – Buccal Superficial temporal Inf . petrosal sinus CLINICAL FEATURES - Marked trismus Swelling of face in front of ear, over TMJ , behind zygomatic process Eyes is closed & proptosed APPROACH FOR INCISION & DRAINAGE – Intraoral Extraoral Intraoral- extraoral

17. Thank you