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