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Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
Space 1 – Superficial to superficial fascia Space 2 – Group of spaces surrounding cervical strap muscles lying superficial to sternothyroid-thyrohyoid division of middle layer of deep cervical fascia. Space 3 – Space lying superficial to visceral division of middle layer of deep cervical fascia Space 3A – Carotid sheath space or viscerovascular space (Lincoln’s High way) Space 4 – Space lies between alar & prevertebral division of posterior layer of deep cervical fascia (Danger space) Space 4A – Posterior triangle space posterior to carotid sheath Space 5 - Prevertebral space Space 5A- Space enclosed by Prevertibral fascia.
Space 3 contains pretracheal, retropharyngeal and lateral pharyngeal spaces. Space 5A- Space enclosed by Prevertibral fascia posterior to transeverse processes of vertibrae .
Anteriorly- orbicularis oris , zygomaticus major Deep – buccopharygeal fascial Superiorly -Zygomatic arch
Repated buccal space infection suspects crohn’s disease
Anteriorly - Orbicularis oris m.
Blunt dissection to prevent damage to facial artery, vein and nerve
Infection may cross genial muscles to involve space of other side. Hot potato voice.
Care is taken not to injure sublingual galnd, lingual nerve , submand duct
Three ‘fs’ of Ludwig’s Angina feared fatal (often) fluctuant (rarely)
Intraoral apprch provides more dependent drainage and prevents contraction of temporalis fiblres againts drainage. If passed medial to coronoid process then it willenter deep temporal space Extraoral approach – if trismus is there
Medially- g wing of spghenoid also
Ant- maxillary tuborosity
Optic neuritis is complication Pterygoid plexus makes this infection dangerous coz emmisory veins connect it to cavernous sinus ..therefore it can spread to cav sinus and can cause hdch phtpho nausea vmtn drwsns.
Intraoral approach – krugers apprch
Osteomyelitis with sequestrum in the ramus of mandible. Necrosis of muscle
Prevent injury to the facial n.
Space divided into 2 compartments anterior and posterior by the styloid process. Its connections with carotid sheath alarms a great danger when this space is involved.
Mri of right parapharyngeal and retropharyngeal fascitis A –Thickening of retropharyngeal soft tissues B-thickning of nasopharyngeal and prevertibral soft tissues.
Space infection. by Dr. Amit Suryawanshi .Oral & Maxillofacial Surgeon, Pune , India
Dr. Amit T. Suryawanshi
Oral and Maxillofacial Surgeon
Contact details :
Email ID - firstname.lastname@example.org
Mobile No - 9405622455
• Anatomy of fascia
• Host defense and infection
• Microbiology and antibiotic therapy
• Stages of infection
• Definition of fascial spaces
• Classification of fascial spaces
• Anatomy of fascial spaces
• Diagnosis of Space infection
• Recent advances
Space infections of head and neck are very common
in Oral and maxillofacial practice. Although most of
the infections can be managed successfully with
minimal or no complication, some can produce
serious morbidity or even death. Depending on the
virulence of microorganisms and host resistance,
bacterial infections have the potential to spread
beyond the bony confines of jaw bones into
surrounding soft tissues.
They flow following the path of least resistance ,
into loose areolar connective tissue of fascia
surrounding the muscles. This tissue is destroyed by
hyaluronidases and collagenases produced by
bacteria, thus opening the potential SPACES
surrounding the muscles. Thus such innocuous
periapical infections have a potential to develop
into life-threatening deep fascial infections.
Early extraction of offending tooth and incision
and drainage tend to shorten the usual course of
infection and minimize the chances of further
In new era of antibiotics, incidence of death
due to infection is reduced but due to developing
drug resistance, there is outbreak of new range of
infections requiring invention of newer antibiotics.
For accomplishment of proper management,
maxillofacial surgeon must understand
physiologic and anatomic factors that influence
the spread and localization of dental infections.
Burns (1811) first described fascial space as an
anatomical entity and gave their clinical significance.
In 1836 Wilhelm Frederick von Ludwig described his
observations concerning repeated occurrences of
inflammation of throat. Hence most severe orofacial
Infection at that time was named as Ludwigs angina.
Greek author Parker(1879) gave vivid descriptions of
infections which produced inflammation oral cavity,
tonsil and larynx.
The term “ Quinsy “ was given by Muckleston in
In 1929 Mosher called Viscerovascular space as
Space of the body of mandible is described
by Coller & Iglesias. (1935)
Functions of the fascia
• Acts as a musculovenous pump-
• Limits outward expansion of muscles as they
• Contraction of muscles compresses the
intramuscular veins (push the blood towards the
• Determine the direction of spread of infection
Infections and Host defense
• In establishing presence of an infection, interaction
occurs among three factors.
In state of Homeostasis , balance exists among
these three and disease occurs when imbalance
Host vs Microbe relationship
Infection occurs when
host is immunocompromised
or when pathogenesity
and number of microbes
Invading host is more.
Stages of infection
Infections generally pass through these 4 stages before they
undergo complete resolution.
• Stage I – Inoculation
Time between exposure of microorganism and the first set of
symptoms . During 1-3 days, Swelling is soft, mildly tender,
doughy in consistency
• Stage II – cellulitis
Chronic stage-fistulous/sinus tract or osteomyelitis
During 3-7 days, centre of lesion begins to soften
Stage III –After day 5 underlying abcess undermines
skin or mucosa making it compressible.
Stage IV - Finally there is resolution of abcess that
may be spontaneous or after surgical drainage. During
resolution phase, the involved region is firm on
palpation due to process of removing tissue
and bacterial debris.
Differences between cellulitis and abscess
Characteristics Cellulitis Abscess
Duration. Acute phase Chronic phase
Pain Severe and generalised Localised
Size Large. Small
Localization Diffuse borders Well-demarcated
Palpation Doughy / indurated Fluctuant
Presence of pus No Yes
Degree of seriousness Greater Less
Bacteria. Aerobic Anaerobic/mixed
Staphylococcus causes –osteomyelitis and abscess
Streptococcus causes- cellulitis
• In an abscess, common causative organisms are
anaerobic (Higher percentage) & Aerobic.
• Fusobacterium + strep. Milleri – cause aggressive
The fascial spaces in head and neck are the
potential spaces between the various layers of
fascia normally filled with loose connective
Tissue and bounded by anatomical barriers, usually
of bone, muscle or fascial layers.
(Ref – Moore-1975)
CLASSIFICATION OF FASCIAL SPACES
GRODINSKY AND HOLYOKE (1938)
Space 1 – Superficial to superficial fascia
Space 2 – Group of spaces surrounding cervical strap muscles
lying superficial to sternothyroid-thyrohyoid division
of middle layer of deep cervical fascia.
Space 3 – Space lying superficial to visceral division of middle
layer of deep cervical fascia
Space 3A – Carotid sheath space or viscerovascular space
(Lincoln’s High way)
Space 4 – Space lies between alar & prevertebral division of
posterior layer of deep cervical fascia (Danger space)
Space 4A – Posterior triangle space posterior to carotid sheath
Space 5 - Prevertebral space
Space 5A- Space enclosed by Prevertibral fascia.
• Hollinshead’s classification(1958)
Infrahyoid spaces -
A) Pretracheal / previsceral
2. Visceral space
3. Other space
I. Cavity within carotid sheath
II. Space between 2 layers of prevertebral fascia
BASED ON MODE OF INVOLVEMENT
1. Direct Involvement. (Primary Spaces)
»Maxillary Spaces – Canine, buccal infratemporal
»Mandibular Spaces – Submental,
Submandibular, Sublingual, Buccal
2. Indirect involvement (Secondary Spaces)
»Superficial and deep temporal
»Lateral and retro pharyngeal
»Prevertebral, parotid, carotid
sheath,peritonsillar and danger spaces.
Surgical anatomy of deep facial
spaces of head and neck
The buccal space occupies the portion of subcutaneous space
between the fascial skin and buccinator muscle.
• ANTERIORLY - Corner of mouth
muscle, Pterygomandibular space
• SUPERFICIAL- skin and Subcutaneous tissue
• DEEP- Buccinator muscle
• SUPERIORILY - Maxilla, Infraorbital space
• INFERIORLY - Lower border of mandible.
Infection from maxillary premolars, molars and
Relation of root with buccinator muscle
Dome shaped swelling on the
anterior aspect of cheek extending
anteroposteriorly from corner of
mouth to angle of mandible and
superoinferiorly from level of
zygomatic arch to inferior border of
• CONTENTS OF BUCCAL SPACE:-
• Buccal pad of fat
• Stensons (Parotid duct)
• Anterior and transverse facial artery and vein.
MUSCLE RELATED – Buccinator muscle
Infraorbital, pterygomandibular, infratemporal space
TREATMENT:- (I & D)
• Antibiotic prophylaxis.
• Intra oral horizontal vestibular
• Extra oral (2 stab) incisions
below the lower border of the
mandible with No. 11 blade.
• Drainage – Hemostat is passed
from anterior incision and
taken out from the posterior
incision then the rubber drain
is inserted and secured with
pins and dressing is done.
Canine space / Infraorbital space
Anteriorly – Nasal cartilage
Posteriorly- Buccal space
Superficially – Quadratus labi superioris
Deep- Lavator anguli oris, anterior
surface of maxilla
Medially – Levator labi superioris alaque
Laterally – Zygomaticus major,
Superiorly – Quadratus labi superioris
Inferiorly - Oral mucosa ,Orbicularis oris
• Maxillary canine, rarely from maxillary first
• Rarely from nasal & upper lip infections.
Canine space / Infraorbital space
• Clinical features:
• Swelling lateral to the nose
• Obliteration of the
• Swelling of the upper lip,
• Oedema occurs in lower
eyelid leading to closure of
• Contents – Angular artery and vein,
• Neighboring spaces – Buccal space
• Antibiotic prophylaxis
• Incision is made intraorally high in the
maxillary labial vestibule.
• Small hemostat is inserted through levator
anguli oris into abcess cavity.
• Drainage with drain secured.
ANTERIORLY – Anterior bellly of digastric
POSTERIORLY – Posterior bellly of digastric
muscle, stylohyoid, stylopharyngeous
LATERALLY -skin, superficial fascia,
SUPERFICIAL- Platysma, Investing fascia
DEEP- Myelohyoid, Hyoglossus, superior
INFERIORILY -Anterior & posterior
bellies of the diagastric
SUPERIORILY -Inferior medial aspect of
mandible & mylohyoid
• Infection from Mandibular molars.
• From sublingual space
• Infections from middle third of the tongue,
posterior part of floor of the mouth.
• From submental space / submental lymph
• Infection from the submandibular gland
Swelling begins at lower
border of mandible extends
to the level of hyoid bone in
a shape of inverted cone.
• Superficial lobe of submandibular salivary gland
& submandibular lymph nodes, facial artery &
Neighboring spaces –
Submental, sublingual, lateral pharyngeal, buccal
and submandibular space of other side.
• I & D through Extra-oral
• Incision – 2 stab incisions
are given over the
dependent part below the
lower border of mandible
in the neck (shadow) of the
• Curved hemostat is
inserted & Blunt dissection
through subcutaneous fat
not to damage facial A,
anterior facial vein and the
• Drainage – Drain is placed
& dressing is given
• ANTERIORLY - Lingual surface of
• POSTERIORLY - Submandibular
• INFERRIORLY - Mylohyoid muscle
• SUPERIORIL -oral mucosa
• MEDIALLY- - geniohyoid,
genioglossus & styloglossus
• LATERALLY - lingual aspect of
• Mandibular premolars and molars, trauma
•Swelling in anterior part of
floor of the mouth on the
affected side displacing
tongue medially and
•Interferes with swallowing
and is extremely painful.
•Elevation of tongue to palate
causes airway compromise.
• Sublingual artery and vein
• Lingual nerve.
• Deep part of submandibular salivary gland and its duct
• Sublingual salivary gland
Neighboring spaces –
Submandibular, Lateral pharyngeal, visceral(trachea,
• Antibiotic prophylaxis
• Incision is made Intraorally over lingual sulcus at the base
of the alveolar process.
• Haemostat is passed beneath sublingual gland in an
antero posterior dissection and drain is placed.
• When infection crosses midline, same incision is made
bilaterally, hemostat is passed through floor of mouth
from one side to other & drain is placed
ANTERIORLY – Inferior border of
POSTERIORLY – Hyoid bone
• LATERALLY – Anterior bellies of the
• SUPERIORILY – Mylohyoid muscle
• INFERIORILY – skin, investing fascia
• SUPERFICIAL – Investing fascia
• DEEP – Anterior bellies of digastric
• From lower anteriors.
• Secondarily due to infection from submental
lymph nodes which drain lower lip, skin
overlying chin, anterior part of floor of the
mouth, tip of the tongue & sublingual tissues.
• Symphysis fracture.
Swelling is limited to the
point of the chin & to the
region immediately below
• MUSCLE RELATED – mentalis muscle
• CONTENTS – submental lymph nodes and anterior
Extraoral Incisions are made bilaterally (two
stab incisions) through skin, subcutaneous
tissue and platysma muscle at most inferior
aspect of swelling.
Drain & dressings are placed.
• The original description of the disease was given by Wilhelm
Friedrich von Ludwig.
1. Rapidly spreading gangrenous cellulitis.
2. Originates in the region of submandibular gland but never
involves one single space and
3. Arises from extension by continuity and not by lymphatics.
4. Produces gangrene with serosanguinous, putrid infiltration
but very little or no frank pus.
Ludwig’s angina is acute, aggressive
and rapidly spreading cellulitis of
the submandibular and sublingual
spaces bilaterally and of the
Bilateral swelling below chin
extending inferiorly at the level of
- Airway compromise occur quickly
and with little fore warning.
- Drooling, dysphagia and neck stiffness are
- Anteriorly protruding tongue is present
- Trismus is usually absent.
Principles of Management of Ludwig’s
• Securing the airway.
• Antibiotics & hydration.
• External surgical exploration with bilateral through
and through drainage of the submandibular spaces
with simultaneous exploration of the submental and
• Medical supportive therapy
• Review and re-evaluation in the post op period
Incision for surgical drainage of Ludwig’s Angina
Classic method – Not used nowadays Bilateral through and though drainage
- Ref – Laskin Vol. 2 pg no. 249
There are 5 masticatory spaces .
1. Superficial temporal space
2. Infratemporal space
3. Deep temporal space
4. Submassetric space
5. Pterygomandibular space
• Infection from maxillary and mandibular
Superficial temporal space
•swelling above & below
the zygomatic arch
causing a dumbell shaped
• Severe pain & trismus
• Contents- Temporal fat pad, temporal branch
of the facial nerve.
• Neighboring spaces – Buccal , Deep temporal.
Intraorally vertical incision made medial to the upper
extent of the anterior border of the mandibular ramus.
• Haemostat passed superiorily along the lateral aspect
of the coronoid process to enter superficial temp. space
• Intra oral approach good
• Extra-oral incision horizontal incision
• Haemostat is passed medially to enter superficial
• Drainage drain is placed, dressing is given.
Deep Temporal space
• Laterally medial surface of temporalis m.
• Medially Temporal bone
• Below the level of zygomatic arch both the
spaces communicate with each other and with
the infratemporal space.
• Intraorally vertical incision made medial to the
upper extent of the anterior border of the
• Haemostat passed supero-medially to enter
deep temporal space.
• Through blunt dissection deep temporal space is
approached through temporalis muscle
• Drainage drain is placed, dressing is given.
• Anteriorly, -Infratemporal surface of the maxilla
• Posteriorly,- the articular tubercle of the temporal
bone, mandibular condyle
• Superiorly, - Greater wing of the sphenoid below
the infratemporal crest
• Inferiorly, - Medial pterygoid muscle
• Medially - lateral pterygoid plate
• Laterally, - Ramus of mandible
• Intraoral and extraoral approach
• Intraorally, incision is made into buccolabial fold
lateral to maxillary third molar. (Kruger)
• Curved hemostat is inserted behind max.
tuberosity superomedially within the cavity and
drain is inserted.
• Intraorally vertical incision made medial to the
upper extent of the anterior border of the
• Curved hemostat is passed superiorly into
infratemporal region and drain is inserted.
• Extraoral approach in presence of severe
It consists of horizontal incision above the
zygomatic arch and then curved hemostat is
directed in inferior and medial direction to
enter infratemporal space followed by
insertion of drain.
Anteriorily Buccal space
Posteriorily parotid fascia and retromandibular portion of the
Laterally masseter muscle
Medially lateral surface of the mandibular ramus
Superiorily zygomatic arch
Inferiorly – Inferior border of mandible
– Periocoronal infection, periapical infection with
mandibular third molars (linguoversion with root
- Fracture of angle of mandible
– Swelling over the angle of mandile from
the level of the zygomatic arch to
inferior border of mandible , anteriorily
to anterior border of masseter and
posteriorly to posterior border of
– Deep seated severe throbbing pain
– Tenderness over the mandibular
• Masseteric artery and vein
• Buccal, pterygomandibular, superficial
temporal, parotid space
• Incision Intra oral approach - vertical incision along the
external oblique line of the mandible starting at the level of the
occlusal plane and extending downward and forward in buccal
sulcus opposite 2nd molar.
Haemostat is passed along lateral aspect of ramus beneath
masseter muscle to enter submasseteric space. drainage is
• Incision Extra oral incision - beneath angle of mandible.
• Blunt dissection through masseter muscle fibres.
– Drainage with plastic or rubber catheter to withstand muscle contraction.
– Anterior Buccal space
– Posterior deep portion of
– Laterally medial surface of
ramus of mandible
– Medially Lateral aspect of
the medial pterygoid m.
– Superiorly lateral pterygoid
– Inferiorly – Inferior border of
from impacted mandibular molars
, from contaminated needle during I.A.N.B
– Trismus, Dysphagia, Dyspnoea
– No external evidence of swelling
– Anterior bulging of half the soft palate and the anterior
tonsillar pillar with deviation of uvula to the unaffected side.
– If Peritonsillar abscess (Less trismus, no dental involvement)
– Mandibular division of trigeminal nerve
– Inferior alveolar artery and vein
• Neighboring spaces -
– Deep temporal spaces
– Lateral pharyngeal space
– Buccal space
– Submasseteric space
– Parotid space
TREATMENT: I & D
• If trismus is severe.
-Extraoral mandibular nerve block or G.A. is given
• Incision intra oral incision in the mucosal area between
medial aspect of ramus and the pterygomandibular
• Blunt dissection using hemostat.
• Extra oral incision is made below the angle of mandible.
Lateral pharyngeal space infections
• It lies immediately posterior and lateral to
• Anatomically the lateral pharyngeal space
may be thought of as an inverted pyramid
shape-the base of the pyramid being the
skull base and the apex the hyoid bone.
– Superiorly Base of skull
– Inferiorly Hyoid bone
– Medially superior pharyngeal
– Laterally medial pterygoid m.,
capsule of parotid gland
– Posteriorly carotid sheath
,styohyoid, styloglossus, &
This is a cone – shaped space
– Sublingual spaces
– Submandibular spaces
– Pterygomandibular spaces
– Lateral spread from tonsillar abscess, pharyngitis,
parotitis, otitis, mastoiditis
– Abcess from the region of 38,48
– Surgical displacement of roots of 38,48 into this space
Lateral pharyngeal space infection
• Firm swelling with
surrounding erythema lateral
and anterior to
• Difficulty in flexing and
turning of neck.
• Trismus secondary pterygoid
• Hospitalization with I.v. antibiotics.
• Airway protection.
• Rapid surgical drainage.
• Surgical approach always through neck not through
• Incision is made at the level of hyoid bone across the
• Suppurative jugular venous thrombosis.
• Patient will have shaking chills, high fever.
• Tenderness at the mandibular angle and along
Peritonsillar space infection
• pharyngitis .
• Severe sore throat, dysphagia,
and referred otalgia.
• The speech is muffled and
classically described as hot
• Trismus is not present
• According to recent
literature,needle aspiration is
done instead of incision and
• (JOMS,Vol 51,2009)
Parotid space infection
• superiorly zygomatic arch
• Inferiorly lower border of mandible
• Anteriorly posterior border of the mandible
• Posteriorly Retromandibular region
– Space formed by splitting of the superficial layer surrounding the
parotid gland and lies posterior to the masticator space.
– Parotid gland
– Parotid lymph nodes
– Facial n.
– Retromandibular vein
– External carotid artery
– From extension of infection from submasseteric,
pterygomandibular, lateral pharyngeal spaces,
– Blood-borne infection, retrograde infections through the
The symptoms of parotitis include pain and
induration over the involved gland.
Purulent marked swelling of the angle of the jaw
without associated trismus or pharyngeal
Secretions may sometimes be expressed after
massage from the parotid depth.
Very characteristic pitting edema of the gland is
pathognomic for parotid gland abscess.
Deep neck infections
• All involve only posterior side of neck.
c) Prevertebral space
d)Visceral vascular space (within the carotid
Retropharyngeal space is the potential space sandwiched
between alar and prevertebral layers of deep layer of the
deep investing fascia.
Extension Base of the skull
Most dangerous of all types of deep
neck infections (Danger space)
1. Lymph nodes and fat.
Sagittal section of retropharyngeal space
1. Only fat
• Children less than 4 yrs commonly affected.
• Sore throat, dysphagia,
• Hot potato voice.
•Refusal to take food.
•Slight neck rigidity.
•Noisy breathing due to
Late Clinical features -
•Neck tilts towards involved
inability to flex the neck.
may occur if abscess is not
ruptured or drained.
Diagnosis of the soft tissue radiograph for
retropharyngeal space infection
• Look at the prevertebral or
retropharyngeal soft tissue
• In the area of 2nd and 3rd CV,
shadow should be less than 7mm
• In the area of 6 cervical vertebra
soft tissue shadow is behind the
trachea and includes the thickness
of esophagus making it approx.
Children – 14mm wide
adults – 22mm wide
- Finally, the lateral radiograph will show the curve of the cervical spine
- Loss of the curve is a strong indication of retropharyngeal space infection.
- Tipping of the head forward in sniffing position to maintain an open airway.
• Is formed by the deep cervical fascia.
• It extends from skull base to coccyx
• Facia attaches to the transverse process of the cervical vertebra
dividing this space into anterior and posterior compartments.
Anterior compartment contains:
-Prevertebral and scalene muscles
Posterior compartment contains:
-Posterior vertebral elements.
Diagnostic Imaging for Space infections
Plain film. MRI
• Diagnostic imaging starts with a plain film study
of pharyngeal or cervical airways.
• Views taken
– AP view
– Lateral view
• Plain film findings:
- In the AP view the normal cervical airway should
appear symmetrical over the middle third of the
- Lateral view – In the adult the width of the
prevertebral soft tissue should not exceed 7mm
at the C3 level and 20mm at C7 level.
Who should be hospitalized ???
Signs & symptoms of
• level of consciousness
• Evidence of meningeal
• Eyelid edema & abnormal
• Does the Investing Layer of the Deep Cervical Fascia
- Nash, Lance M.Sc November 2005
Journal of American society of anesthesiologists
The placement of the superficial cervical plexus block
has been the subject of controversy. Although the
investing cervical fascia has been considered as an
impenetrable barrier, clinically, authors went on a trial and
found that the placement of the block deep or superficial to
the fascia provides the same effective anaesthesia.
• Conclusion of study:
This study provides anatomical evidence to
indicate that the so-called investing cervical fascia
does not exist in the anterior triangle of the neck.
Here the author’s findings strongly suggest that
deep potential spaces in the neck are directly
continuous with the subcutaneous tissue.
• Surgical vs ultrasound-guided drainage of deep neck space
abscesses: a randomized controlled trial: surgical vs
-Vincent L Biron, George Kurien
Journal of Otolaryngology - Head and Neck Surgery 2013,
• Introduction -
Deep neck space abscesses are relatively common head and
neck surgery emergencies and can result in significant
morbidity . Traditionally, surgical incision and drainage (I&D)
with antibiotics has been the mainstay of treatment. Some
reports have suggested that ultrasound-guided drainage is a
less invasive and effective alternative in selected cases.
• Seventeen patients were recruited .They found a
significant difference in mean Length of hospital
stay between patients who underwent USD
(3 days) vs I&D (5 days).They identified significant
cost savings (41%) in comparison to I&D.
Ultrasound drainage of deep neck space
abscesses in a certain cases is effective, cost
saving & safe as it is less invasive. Still this
remains a controversial topic whether to follow
Incision and drainage or ultrasound drainage.
Effective antibiotics for severe infections caused
by resistant bacteria are needed urgently. The
speed with which bacteria develop resistance to
antibiotics, in contrast with the slow development
of new drugs, has led some experts to develop
FDA approved newer antibiotics
(Brand name )
Quinupristin/ dalfopristin (1999)
methicillin-susceptible S. aureus and
Moxifloxacin (1999 )
G+ and G-, including multi-drug resistant
G+; including MRSA
Cefditoren pivoxil (2001)
methicillin-susceptible S. aureus and
Daptomycin (2003 )
G+, including MRSA
Tigecycline (2005 )
G+ and G-Dalbavancin
(2004 ) G+ (including VRE and
(Brand name )
G+ and G-Telavancin
(2007) G+ (including MRSA)
Ceftobiprole (2007) G+ and G-Oritavancin
(2011) G+ (including MRSA)
Iclaprim (2012) G+ (including MRSA)
We being Oral & maxillofacial surgeons must
understand anatomy of fascial spaces, spread of
infection and proper management for the
prevention of further complications and betterment
of health of the patient.
• Oral &maxillofacial Infections-Topazian
• Oral & Maxillofacial Surgery-Laskin Vol. II
1. Does the Investing Layer of the Deep Cervical Fascia Exist?
- Nash, Lance M.Sc November 2005 Journal of American society of
2. Surgical vs ultrasound-guided drainage of deep neck space
abscesses: a randomized controlled trial: surgical vs ultrasound
-Vincent L Biron, George Kurien Journal of Otolaryngology - Head and Neck
Head and Neck space infections (Dissertation )
University of sydney.