Fascial Space Infections

Fascial spaces are the spaces that exist between the various organs and the fascia surrounding them. Usually, these spaces do not exist when the patient is healthy. When there is an infection of the associated structures adjoining the fascia, these spaces open up due to the spread of infection and collection of pus. The infections involving these fascial spaces are termed as space infections. Space infections in the facial region are mostly due to spread of infection from the decayed upper and lower teeth. The various symptoms associated with these fascial space infections of the facial region involve difficulty in opening the mouth, swelling in the region involved, constitutional symptoms like fever. In more severe cases when there is a secondary spread of infection from one space to another, there may be difficulty in swallowing and difficulty in breathing. The infection in these conditions usually spreads through the least path of resistance. 

The fascial spaces in the facial region are defined by the muscles forming the floor of the mouth, cheek muscles, muscles assisting in mastication, and the muscles around the oral cavity. These infections are treated by a method known as incision and drainage. The incision for draining the pus is placed either intraorally or extra-orally depending upon the severity of the situation. The abscess cavity is explored for any pus pockets. After completely draining the abscess, a drain is placed into the cavity and sutured to the incision to allow for drainage. The decayed tooth causing the infection must also be removed. If these infections are left untreated they may extend to the adjoining fascial spaces and lead to fatal complications. Sometimes these infections can spontaneously drain by forming a cutaneous sinus near the angle of mouth or near the lower border of the lower jaw. Prompt surgical treatment with incision and drainage followed by empirical antibiotic therapy helps the patients to recover early from these potentially fatal conditions. The obtained pus from drainage must be sent for culture sensitivity examination to start a more specific antibiotic therapy. Medically compromised patients when affected by these infections are more likely to be predisposed to serious complications. They should be treated with extra attention to avoid any untoward consequences.