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Minor Oral Surgery > Fascial Spaces > Flashcards

Fascial Spaces Flashcards

1
Q

There is evidence that the incidence of dental abscesses is related to ______________________.

A

socio-economic deprivation

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2
Q

Give an example of a serious and potentially life- threatening complication of dental sepsis

A

Spread of infection into fascial spaces of the neck

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3
Q

What is the most common cause of fascial space infection in adults?

A

odontogenic infections

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4
Q

What is the most common cause of fascial space infections in children?

A

tonsilitis

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5
Q

Aside from those of odontogenic origin, give other causes of fascial space infections

A
  • salivary gland infection
  • trauma
  • post-operative infection
  • complications related to congenital abnormalities of the neck such as infected thyroglossal duct cyst
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6
Q

What are the potential consequences of a spread of infections through the fascial spaces

A
  • risk to airway
  • systemic compromise
  • cardiovascular collapse
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7
Q

Infections in the fascial spaces in the neck can spread to … (name areas)

A
  • mediastinal or pleural cavities
  • peri-orbital or orbital tissues
  • carvenous sinus
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8
Q

How can infections in fascial spaces in the neck spread to the carvenous sinus?

A

they can travel through the facial vein

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9
Q

What is an abscess?

A

localised collection of pus

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10
Q

What is cellulitis?

A

inflammation of the subcutaneous tissues with no significant localisation of pus. It may later organise to form an abscess

Subcutaneous tissue- tissue in deepest layer of the skin

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11
Q

Define sepsis

A

The presence of systemic inflammatory response syndrome
- temperature: <36/>38
- pulse rate >90 per minute
- respiratory rate >20 per minute
- white cell count <4 or >12 x 10^9/L
- plus a confirmed infection

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12
Q

What is dysphagia?

A

subjective sensation of difficulty swallowing

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13
Q

What is dyspnoea?

A

subjective sensation of difficulty breathing

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14
Q

What is fascia?

A

fascia is loose connective tissue that lies beneath the skin, envelops the muscles and invests the internal organs

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15
Q

The vital structure of the neck are invested in _________ fascia

A

cervical

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16
Q

What are the layers of the cervical fascia?

A
  • superficial layer
  • deep layers
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17
Q

Briefly describe the location of the superficial cervical fascia

A

it lies just deep (beneath?) to the subcutaneous tissue and surrounds the whole neck. It invests the platysma muscle

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18
Q

What are the layers of the deep cervical fascia?

A
  • investing layer of deep cervical fascia
  • middle layer
  • deep layer
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19
Q

What does the investing layer of the deep cervical fascia surround?

A
  • the entire neck
  • envelops sternocleidomastoid and trapezius muscles
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20
Q

What deep cervical fascia layer divides to form capsules of the submandibular and parotid salivary glands?

A

the investing layer

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21
Q

The middle layer is also known as …

A

the preveterbral layer

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22
Q

The middle layer extends from the base of the thoracic cavity to become continuous with the …

A

pericardium

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23
Q

The middle layer invests…

A
  • pharynx
  • larynx
  • trachea
  • oesophagus
  • thyroid glands
  • strap muscles
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24
Q

The deep layer surrounds…

A
  • spine
  • paravetebral muscles
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25
Q

Between the deep fascia layers, there are spaces which contain…

A

loose connective tissue

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26
Q

What are the fascial spaces above the hyoid bone?

A
  • sub- masseteric space
  • sub-lingual space
  • sub-mandibular space
  • parotid space
  • pharyngeal space
  • parapharyngeal space (lateral pharyngeal space)
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27
Q

What are the fascial spaces along the entire length of the neck?

A
  • retropharyngeal space
  • carotid space
  • pre-vertebral space
  • danger space
28
Q

What are fascial spaces below the hyoid bone

A

visceral space

29
Q

Where is the danger space located?

A

lies between the retropharyngeal and prevertebral spaces
Extends from the base of the skull to the diaphragm

30
Q

State some symptoms of deep neck space infection

A
  • pain aroudn causative tooth or teeth
  • feeling generally unwell
  • fever and rigors
  • trismus
  • dysphagia
  • dyspnoea
  • change in voice
31
Q

How might a fascial space infection lead to a change in voice?

A
  • Hot potato voice
  • due to elevation of the tongue and floor of mouth in the oral cavity
32
Q

What do symptoms of fascial space infections often indicate ?

A

actual or impending airway compromise

33
Q

What is swinging pyrexia?

A

intermittent fever pattern

34
Q

If there is an abscess associated with a fascial space infection, what clinical sign is often associated with this?

A

swinging pyrexia

35
Q

When does septic shock occur?

A

occurs when a septic patient remains hypotensive despite aggresive attempts to restore the blood pressure

36
Q

What is ludwigs angina?

A

defined by bilateral cellulitis of the submandibular and sublingual spaces, most often arising from a lower molar tooth

37
Q

What fascial spaces does the mouth contain?

A

Sublingual
Submandibular
Submental

38
Q

There is ready communication across the midline of fascial spaces in the oral cavity. True or false.

A

True

39
Q

What are the clinical signs of ludwig angina ?

A
  • firm swelling of FoM, resulting in elevation of the tongue
  • submandibular and sublingual spaces become tense and tender
  • accompanying:
  • dysphagia
  • trismus
  • respitatory embarrassment
40
Q

The cellulitis in ludwigs angina may spread an involve the…

A

lateral pharyngeal space

41
Q

How are patients with ludwigs angina treated?

A
  • (following urgent referral to hospital)
  • urgent antibiotic therapy
  • surgical drainage
  • may require additional airway support
42
Q

How should infections of deep neck space be investigated in the dental setting?

A
  • check temperature
  • check basic vital signs (pulse and respiratory rates)
  • plain radiograph if patient can tolerate it
  • in cases of trismus, OPT can be taken
  • when referring, send imaging with patient to avoid un-necessary repeated radiation exposure
43
Q

What investigations are carried out for deep neck space infections in the hospital?

A
  • blood tests
  • ultrasound and/or CT scan
  • microbiological investigations
44
Q

Briefly describe the sublingual space

A

it is bounded bythe submucosa of the floor of the mouth superiorly and the mylohyoid muscle inferiorly

45
Q

Briefly describe the submandibular space

A

lies between the mylohyoid muscle, superficial fascia, platysma and skin.
Contains submandibular gland and lymph nodes

46
Q

Briefly describe the submental space

A

lies between the mylohyoid muscle and the skin, just beneath the chin. Contains submental lymph nodes

47
Q

Briefly describe the submasseteric space

A

bounded by the lateral border of the mandible and the medial aspect of the masseter

48
Q

Describe the pharyngeal (lateral pharyngeal) space

A

extends from base of skull to hyoid bone level

contains internal carotid artery, internal jugular vein, cranial nerves IX to XIII and the sympathetic chain

49
Q

Describe the position of the retropharyngeal space

A

this space lies behind thepharynx and oesophagus between the skull base and mediastinum

50
Q

What are the signs and symptoms of an infection in the sublingual space

A
  • swollen, red FoM
  • little ot no extra-oral sign of swelling
  • elevation of tongue may result in dysarthria, dysphagia and/or dyspnoea
51
Q

What are the signs and symptoms of an infection in the submandibular space?

A
  • painful red swelling of the neck immediately below the border of the mandible
  • involvement of the muscles of mastication results in trismus
52
Q

What are the signs and symptoms of infection in the submental space?

A

swelling and erythema of the chin

53
Q

What are the signs and symptoms of infection in the submasseteric space?

A

pain and swelling over the angle of the mandible plus trismus

54
Q

What are the signs and symptoms of infection in the parapharyngeal space?

A
  • examination of the oropharynx reveals deviation of the uvulae to the opposite side by displaced tonsil and lateral pharyngeal surface
  • there may be trismus
  • swelling of lateral neck
  • involvement of vital structures may include internal jugular vein thrombosis, horners syndrome and meningitis
55
Q

What are the signs and symptoms of an infection in the retropharyngeal space?

A
  • the patient will be unwell and complain of severe sore throat
  • Dysphagia and limitation of neck movement
56
Q

What is horners syndrome?

A

Caused by involvement of the sympathetic chain and is characterised by:
- ptosis (drooping eyelid), miosis (constricted pupil) and anhydrosis (lack of sweating affecting one side of the face)

57
Q

Outline some suitable treatment options for a stable patient with localised swelling and minimal soft tissue involvement

A
  • local treatment including pilp extirpation
  • extraction of the tooth
    *all with or without antibiotics
58
Q

The acute odontogenic abscess in ludwigs angina is often polymicrobial in nature. Give examples of bacteria found in these abscesses

A
  • they are often facultative anaerobes e.g. viridans sterptococci, steropococcus anginosus
  • some can be strict anaerobes like prevotella and fuscobacterium species
59
Q

How are septic patients treated ?

A
  • treated aggressively with fluid resuscitation
  • early and empirical administration of antibiotics
60
Q

What are the requirements for the drainage of a neck space?

A

Under general anaesthetic in an operating theatre

61
Q

What is the consequence of severe airway compromise resulting from a neck space infection?

A
  • tracheostomy tube
  • post operative admission into intensive care
62
Q

What is the purpose of surgical exploration of affected spaces in ludwigs angina?

A
  • although there is often no collection of pus, surgical exploration of the affected spaces is performed to decompress the neck
63
Q

What adjuncts can be used following surgical intervention of neck space infections?

A
  • surgical drains placed until infection is resolved
  • corticosteroids (dexamathasone) may be given to reduce oedema
64
Q

Antibiotic therapy can be used as a substitute for removal of the source of infection. True or false

A

false

65
Q

What are the potential consequences of odontogenic infections spreading to neck fascial spaces ?

A
  • sepsis
  • life threatening airway compromise
66
Q

What does an initial ABCD assessment of neck space infection comprise of?

A
  • can the patient speak normally without drooling saliva
  • is the patients breathing rate less than 20 per minute and effortless
  • is the pulse rate less than 90 beats per minute
  • is the patient fully conscious and coherent

Minor Oral Surgery (36 decks)

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