Origin and progression of Odontogenic Infection; Buccal space infection/abscess vs vestibular abscess
Odontogenic infection are mainly originated from
- Periapical
- Peridontal
Periapical Origin:
The caries in the tooth as progress into the power cause pulpal necrosis and subsequent bacterial invasion into the periapical tissue. This is the most common origin of odontogenic infection.
Once the periapical tissue has become inoculated with bacteria and an active infection is established the infection spreads equally in all directions. The infection spreads through the cancellous bone till it encounters a cortical plate. If this cortical plate is thin the infection invades through the bone and into surrounding soft tissue.
Periodontal origin:
As a result of deep periodontal pockets this allows inoculation of bacteria into the underlying soft tissue by penetration through the bone.
Progression of infection:
When the infection penetrates through the cortical plate it spreads into predictable anatomic locations determined by two factors.
- Thickness of bone overlying the root Apex
- relationship of the site of perforation of bone to muscle attachment of maxilla and mandible.
The infection will spread either Buccally or or lingually/ palatally where the overlying bone is thin so that infection is easy to perforate.
Buccal space infection /abscess vs vestibular abscess
In figure A, since the overlying bone on the palatal aspect of the root is thin in the infection has spread palatally.
In figure B, since the overlying bone on the labial aspect of the root is thin the infection has spread labially.
If the infection has eroded through to the facial aspect of the alveolar process and is inferior to the attachment of buccinator muscle which results in an infection that appears as a vestibular abscess.
if the infection has eroded through the bone superior to the attachment of buccinator muscle it results as buccal space infection.
if the infection has eroded through the bone superior to the attachment of the buccinator muscle and is expressed as an infection of the buccal space because the buccinator muscle separates the buccal and vestibular spaces
Buccal space infection /abscess vs vestibular abscess
muscle attachment, vestibular abscess results. B, If apex is higher than muscle attachment, the adjacent fascial space is involved.
Similarly in the mandible, mylohyoid muscle determines whether the infection that drains lingually to sublingual space or to sub mandibular space.
If the infection is lingually superior to mylohyoid muscle, it is referred to as sublingual space infection.
If the infection is lingually below the mylohyoid muscle, it is referred to as sub mandibular space infection.
Conclusion: The origin and spread of infection determines the anatomical location of the infection.
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