Buccal space

The buccal space (also termed the buccinator space) is a fascial space of the head and neck (sometimes also termed fascial tissue spaces or tissue spaces). It is a potential space in the cheek, and is paired on each side. The buccal space is superficial to the buccinator muscle and deep to the platysma muscle and the skin. The buccal space is part of the subcutaneous space, which is continuous from head to toe.[1]

Buccal space
Gray380
The buccal space is located superficial to buccinator muscle.
Anatomical terminology

Structure

Boundaries

The boundaries of each buccal space are:

  • the angle of the mouth anteriorly,[1]
  • the masseter muscle posteriorly,[1]
  • the zygomatic process of the maxilla and the zygomaticus muscles superiorly,
  • the depressor anguli oris muscle and the attachment of the deep fascia to the mandible inferiorly,
  • the buccinator muscle medially (the buccal space is superficial to the buccinator),[1]
  • the platysma muscle, subcutaneous tissue and skin laterally (the space is deep to platysma),[1]

Communications

Function

Contents

In health, the space contains:

Clinical significance

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Diagram showing the origin of the upper part of the buccinator muscle to the maxilla (the middle part originates from the pterygomandibular raphe, where buccinator joins the superior constrictor muscle).
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Diagram showing the origin of the lower part of the buccinator muscle on the lateral surface of the mandible.

A hematoma may create the buccal space, e.g. due to hemorrhage following wisdom teeth surgery. Buccal space abscesses typically cause a facial swelling over the cheek that may extend from the zygomatic arch above to the inferior border of the mandible below, and from the anterior border the masseter muscle posteriorly to the angle of the mouth anteriorly.[1] Unless another space is also involved, the tissues around the eye are not swollen. It is usually treated by surgical incision and drainage, and the incision is located inside the mouth to avoid a scar on the face.[2] The incision are placed below the parotid papilla to avoid damage to the duct, and forceps are used to divide buccinator and insert a surgical drain into the buccal space. The drain is kept in place for a variable period of time following the procedure.

Long standing buccal abscesses tend to spontaneously drain via a cutaneous sinus at the inferior of the space, near the inferior border of the mandible and the angle of the mouth.[1] An untreated cutaneous sinus can cause disfiguring soft tissue fibrosis, and the tract can become epithelial lined.[3]

Odontogenic infections

Abces dentaire
An abscess originating from a tooth which has spread to involve the buccal space. Above, deformation of the cheek on the second day. Below, deformation on the third day.

Sometimes the buccal space is reported to be the most commonly involved fascial space by dental abscesses,[2] although other sources report it is the submandibular space.[1] Infections originating in either maxillary or mandibular teeth can spread into the buccal space, usually maxillary molars (most commonly) and premolars or mandibular premolars.[1] Odontogenic infections which erode through the buccal cortical plate of the mandible or maxilla will either spread into the buccal vestibule (sulcus) and drain intra-orally, or into the buccal space, depending upon the level of the perforation in relation to the attachment of buccinator to the maxilla above and the mandible below (see diagrams). Frequently infection spreads in both directions as the buccinator is only a partial barrier.[3] Infections associated with mandibular teeth with apices at a level inferior to the attachment, and maxillary teeth with apices at a level superior to the attachment are more likely to drain into the buccal space.

References

  1. ^ a b c d e f g h i j k l m n Hupp JR, Ellis E, Tucker MR (2008). Contemporary oral and maxillofacial surgery (5th ed.). St. Louis, Mo.: Mosby Elsevier. pp. 317–333. ISBN 9780323049030.
  2. ^ a b Kerawala C, Newlands C (2010). Oral and maxillofacial surgery. Oxford: Oxford University Press. pp. 374–375. ISBN 9780199204830.
  3. ^ a b Wray D, Stenhouse D, Lee D, Clark AJ (2003). Textbook of general and oral surgery. Edinburgh [etc.]: Churchill Livingstone. pp. 263–267. ISBN 0443070830.
Buccal

Buccal may refer to:

Mouth, a body cavity

Specifically the cheek

The buccal space in the mouth

Buccal administration

Buccal artery

Buccal nerve

Buccal branch of the facial nerve

Buccal fat pad

The buccal fat pad (also called Bichat’s fat pad, after Marie François Xavier Bichat, and the buccal pad of fat), is one of several encapsulated fat masses in the cheek. It is a deep fat pad located on either side of the face between the buccinator muscle and several more superficial muscles (including the masseter, the zygomaticus major, and the zygomaticus minor). The inferior portion of the buccal fat pad is contained within the buccal space. It should not be confused with the malar fat pad, which is directly below the skin of the cheek. It should also not be confused with jowl fat pads. It is implicated in the formation of hollow cheeks and the nasolabial fold, but not in the formation of jowls.

Canine space

The canine space (also termed the infra-orbital space), is a fascial space of the head and neck (sometimes also termed fascial spaces or tissue spaces). It is a thin potential space on the face, and is paired on either side. It is located between the levator anguli oris muscle inferiorly and the levator labii superioris muscle superiorly. The term is derived from the fact that the space is in the region of the canine fossa, and that infections originating from the maxillary canine tooth may spread to involve the space. Infra-orbital is derived from infra- meaning below and orbit which refers to the eye socket.

Dental abscess

A dental abscess (also termed a dentoalveolar abscess, tooth abscess or root abscess), is a localized collection of pus associated with a tooth. The most common type of dental abscess is a periapical abscess, and the second most common is a periodontal abscess. In a periapical abscess, usually the origin is a bacterial infection that has accumulated in the soft, often dead, pulp of the tooth. This can be caused by tooth decay, broken teeth or extensive periodontal disease (or combinations of these factors). A failed root canal treatment may also create a similar abscess.

A dental abscess is a type of odontogenic infection, although commonly the latter term is applied to an infection which has spread outside the local region around the causative tooth.

Dental emergency

A dental emergency is an issue involving the teeth and supporting tissues that is of high importance to be treated by the relevant professional. Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source (orofacial pain and toothache). Depending on the type of pain experienced an experienced clinician can determine the likely cause and can treat the issue as each tissue type gives different messages in a dental emergency.

Many emergencies exist and can range from bacterial, fungal or viral infections to a fractured tooth or dental restoration, each requiring an individual response and treatment that is unique to the situation. Fractures (dental trauma) can occur anywhere on the tooth or to the surrounding bone, depending on the site and extent of fracture the treatment options will vary. Dental restoration falling out or fracturing can also be considered a dental emergency as these can impact on function in regards to aesthetics, eating and pronunciation and as such should be tended to with the same haste as loss of tooth tissue. All dental emergencies should be treated under the supervision or guidance of a dental health professional in order to preserve the teeth for as long as possible.

By contrast, a medical emergency is often more precisely defined as an acute condition which presents an immediate threat to life, limb, vision or long term health. Consequently, dental emergencies can rarely be described as medical emergencies in these terms. Some define a dental emergency in terms of the individual's willingness to attend for emergency dental treatment at any time at short notice, stating that persons who are fussy about when they are available for treatment are not true emergency cases. There are often divergent opinions between clinicians and patients as to what constitutes a dental emergency. E.g. a person may suddenly lose a filling, crown, bridge, etc. and although they are completely pain-free, still have great cosmetic concerns about the appearance of their teeth and demand an emergency treatment on the basis of perceived social disability.

Fascial spaces of the head and neck

Fascial spaces (also termed fascial tissue spaces or tissue spaces) are potential spaces that exist between the fasciae and underlying organs and other tissues. In health, these spaces do not exist; they are only created by pathology, e.g. the spread of pus or cellulitis in an infection. The fascial spaces can also be opened during the dissection of a cadaver. The fascial spaces are different from the fasciae themselves, which are bands of connective tissue that surround structures, e.g. muscles. The opening of fascial spaces may be facilitated by pathogenic bacterial release of enzymes which cause tissue lysis (e.g. hyaluronidase and collagenase). The spaces filled with loose areolar connective tissue may also be termed clefts. Other contents such as salivary glands, blood vessels, nerves and lymph nodes are dependent upon the location of the space. Those containing neurovascular tissue (nerves and blood vessels) may also be termed compartments.

Generally, the spread of infection is determined by barriers such as muscle, bone and fasciae. Pus moves by the path of least resistance, e.g. the fluid will more readily dissect apart loosely connected tissue planes, such the fascial spaces, than erode through bone or muscles. In the head and neck, potential spaces are primarily defined by the complex attachment of muscles, especially mylohyoid, buccinator, masseter, medial pterygoid, superior constrictor and orbicularis oris.Infections involving fascial spaces of the head and neck may give varying signs and symptoms depending upon the spaces involved. Trismus (difficulty opening the mouth) is a sign that the muscles of mastication (the muscles that move the jaw) are involved. Dysphagia (difficulty swallowing) and dyspnoea (difficulty breathing) may be a sign that the airway is being compressed by the swelling.

Infratemporal space

The Infratemporal space (also termed the infra-temporal space or the infra-temporal portion of the deep temporal space) is a fascial space of the head and neck (sometimes also termed fascial spaces or tissue spaces). It is a potential space in the side of the head, and is paired on either side. It is located posterior to the maxilla, between the lateral pterygoid plate of the sphenoid bone medially and by the base of skull superiorly. The term is derived from infra- meaning below and temporal which refers to the temporalis muscle.

The infratemporal space is the inferior portion of the deep temporal space, which is one of the four compartments of the masticator space, along with the pterygomandibular space, the submasseteric space and the superficial temporal space. The deep temporal space is separated from the pterygomandibular space by the lateral pterygoid muscle inferiorly and from the superficial temporal space by the temporalis muscle laterally. The deep temporal space and the superficial temporal space together make up the temporal spaces.

Mouth infection

Mouth infections, also known as oral infections, are a group of infections that occur around the oral cavity. They include dental infection, dental abscess, and Ludwig's angina. Mouth infections typically originate from dental caries at the root of molars and premolars that spread to adjacent structures. In otherwise healthy patients, removing the offending tooth to allow drainage will usually resolve the infection. In cases that spread to adjacent structures or in immunocompromised patients (cancer, diabetes, transplant immunosuppression), surgical drainage and systemic antibiotics may be required in addition to tooth extraction. Since bacteria that normally reside in the oral cavity cause mouth infections, proper dental hygiene can prevent most cases of infection. As such, mouth infections are more common in populations with poor access to dental care (homeless, uninsured, etc.) or populations with health-related behaviors that damage one's teeth and oral mucosa (tobacco, methamphetamine, etc). This is a common problem, representing nearly 36% of all encounters within the emergency department related to dental conditions.Patients with mouth infections usually complain of pain at the affected tooth with or without fevers. Inability to fully open one's mouth, also known as trismus, suggests that the infection has spread to spaces between the jaw and muscles of mastication (masseter, medial pterygoid, and temporalis). If an abscess has formed, swelling, redness, and tenderness will be present. Depending on the location of the abscess, it will be visible intraorally, extraorally, or both. Severe infections with significant swelling may cause airway obstruction by shifting/enlarging soft tissue structures (floor of mouth, tongue, etc.) or by causing dysphagia that prevents adequate clearance of saliva. This is a medical emergency and may require endonasal intubation or tracheotomy to protect one's airway. The development of stridor, shortness of breath, and pooling oral secretions may indicate impending airway compromise due to a worsening mouth infection. Other rare but dangerous complications include osteomyelitis, cavernous sinus thrombosis, and deep neck space infection.

Pericoronitis

Pericoronitis (from the Greek peri, "around", Latin corona "crown" and -itis, "inflammation") also known as operculitis, is inflammation of the soft tissues surrounding the crown of a partially erupted tooth, including the gingiva (gums) and the dental follicle. The soft tissue covering a partially erupted tooth is known as an operculum, an area which can be difficult to access with normal oral hygiene methods. The synonym operculitis technically refers to inflammation of the operculum alone.

Pericoronitis is caused by an accumulation of bacteria and debris beneath the operculum, or by mechanical trauma (e.g. biting the operculum with the opposing tooth). Pericoronitis is often associated with partially erupted and impacted mandibular third molars (lower wisdom teeth), often occurring at the age of wisdom tooth eruption (15-24). Other common causes of similar pain from the third molar region are food impaction causing periodontal pain, pulpitis from dental caries (tooth decay), and acute myofascial pain in temporomandibular joint disorder.

Pericoronitis is classified into chronic and acute. Chronic pericoronitis can present with no or only mild symptoms and long remissions between any escalations to acute pericoronitis. Acute pericoronitis is associated with a wide range of symptoms including severe pain, swelling and fever. Sometimes there is an associated pericoronal abscess (an accumulation of pus). This infection can spread to the cheeks, orbits/periorbits, and other parts of the face or neck, and occasionally can lead to airway compromise (e.g. Ludwig's angina) requiring emergency hospital treatment. The treatment of pericoronitis is through pain management and by resolving the inflammation. The inflammation can be resolved by flushing the debris or infection from the pericoronal tissues or by removing the associated tooth or operculum. Retaining the tooth requires improved oral hygiene in the area to prevent further acute pericoronitis episodes. Tooth removal is often indicated in cases of recurrent pericoronitis, extensive decay, or tooth impaction.

Pterygomandibular space

The pterygomandibular space is a fascial space of the head and neck (sometimes also termed fascial spaces or tissue spaces). It is a potential space in the head and is paired on each side. It is located between the medial pterygoid muscle and the medial surface of the ramus of the mandible. The pterygomandibular space is one of the four compartments of the masticator space.

Spatium

In anatomy, a spatium or anatomic space is a space (cavity or gap). Anatomic spaces are often landmarks to find other important structures. When they fill with gases (such as air) or liquids (such as blood) in pathological ways, they can suffer conditions such as pneumothorax, edema, or pericardial effusion. Many anatomic spaces are potential spaces, which means that they are potential rather than realized (with their realization being dynamic according to physiologic or pathophysiologic events). In other words, they are like an empty plastic bag that has not been opened (two walls collapsed against each other; no interior volume until opened) or a balloon that has not been inflated.

Examples of anatomic spaces (or potential spaces) include:

Axillary space

Buccal space

Canine space

Cystohepatic triangle

Deep perineal space

Deep temporal space

Epidural space

Extraperitoneal space

Fascial spaces of the head and neck

Infratemporal space

Intercostal space

Intermembrane space

Interstitial spaces

Mental space

Pericardial space

Intraperitoneal space

Pleural space

Potential space

Pterygomandibular space

Quadrangular space

Retroperitoneal space

Retropharyngeal space

Retropubic space

Subarachnoid space

Subdural space

Sublingual space

Submandibular space

Submasseteric space

Traube's space

Submasseteric space

The submasseterric space (also termed the masseteric space) is a fascial space of the head and neck (sometimes also termed fascial spaces or tissue spaces). It is a potential space in the face over the angle of the jaw, and is paired on each side. It is located between the lateral aspect of the mandible and the medial aspect of the masseter muscle and its investing fascia. The term is derived from sub- meaning "under" in Latin and masseteric which refers to the masseter muscle. The submasseteric space is one of the four compartments of the masticator space. Sometimes the submasseteric space is described as a series of spaces, created because the masseter muscle has multiple insertions that cover most of the lateral surface of the ramus of the mandible.

Toothache

Toothache, also known as dental pain, is pain in the teeth or their supporting structures, caused by dental diseases or pain referred to the teeth by non-dental diseases. When severe it may impact sleep, eating, and other daily activities.

Common causes include inflammation of the pulp, usually in response to tooth decay, dental trauma, or other factors, dentin hypersensitivity, apical periodontitis (inflammation of the periodontal ligament and alveolar bone around the root apex), dental abscesses (localized collections of pus, alveolar osteitis ("dry socket", a possible complication of tooth extraction), acute necrotizing ulcerative gingivitis (a gum infection), temporomandibular disorder.

Pulpitis is reversible when the pain is mild to moderate and lasts for a short time after a stimulus (for instance cold); or irreversible when the pain is severe, spontaneous, and lasts a long time after a stimulus. Left untreated, pulpitis may become irreversible, then progress to pulp necrosis (death of the pulp) and apical periodontitis. Abscesses usually cause throbbing pain. The apical abscess usually occurs after pulp necrosis, the pericoronal abscess is usually associated with acute pericoronitis of a lower wisdom tooth, and periodontal abscesses usually represent a complication of chronic periodontitis (gum disease). Less commonly, non-dental conditions can cause toothache, such as maxillary sinusitis, which can cause pain in the upper back teeth, or angina pectoris, which can cause pain in the lower teeth. Correct diagnosis can sometimes be challenging.

Proper oral hygiene helps to prevent toothaches by preventing dental disease. The treatment of a toothache depends upon the exact cause, and may involve a filling, root canal treatment, extraction, drainage of pus, or other remedial action. The relief of toothache is considered one of the main responsibilities of dentists. Toothache is the most common type of pain in the mouth or face It is one of the most common reasons for emergency dental appointments. In 2013, 223 million cases of tooth pain occurred as a result of dental caries in permanent teeth and 53 million cases occurred in baby teeth. Historically, the demand for treatment of toothache is thought to have led to the emergence of dental surgery as the first specialty of medicine.

Trismus

Trismus, also called lockjaw, is reduced opening of the jaws (limited jaw range of motion). It may be caused by spasm of the muscles of mastication or a variety of other causes. Temporary trismus occurs much more frequently than permanent trismus. It is known to interfere with eating, speaking, and maintaining proper oral hygiene. This interference, specifically with the patient's ability to swallow properly, results in an increased risk of aspiration. In some instances, trismus presents with altered facial appearance. The condition may be distressing and painful for the patient. Examination and treatments requiring access to the oral cavity can be limited, or in some cases impossible, due to the nature of the condition itself.

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