hi let's talk about the fascial spaces of the face in this video we'll talk about the clinically
relevant facial spaces of the face being the spaces that are superior to the mandible so
there are two spaces that I'd like to discuss with you today the first being the infraorbital aka the
canine facial space the infraorbital fossil space is deep to a muscle group called the quadratus
labii muscle quadratus labii muscle consists of levator labii superioris alaeque nasi
levator labii superioris muscle zygomaticus minor muscle and zygomaticus major muscle so if we were
to roughly draw the quadrilateral deep to this group of muscles it would look like that so and
we can see this region over here on the left hand side of this individual and we can see
the infraorbital nerve coming out of the inferior orbital foramen into this space so this is a an
exquisitely well named space it's into this space that odontogenic infections from maxillary teeth
may travel so if you were to have a left canine infection the root tip that would very likely
travel if it went superficially into this space hence the name canine facial space this facial
space is continuous anteriorly with the next space that I like to discuss with you the buccal fascial
space but let's just draw in that border there so there's zygomaticus major and we can see just deep
to that and a little posteriorly we have the buccinator muscle so here is buccinator it's peeking
out from the masseter they're not too keen on that line so maybe there's buccinator the the cheek
muscle and we can see you know that this space runs down to the Buccinator muscle so which is
the floor or the deep surface of the buccal facial space we can see the duct of the parotid gland
heading through and piercing buccinator there and we can also see a branch of v3 the buccal
nerve or the long buccal nerve coming out of that space one element that would be going into that
space that we don't see here would be the deep facial thing so let's take a look at that space
so here is the margin between the infraorbital space and the buccal space so everything sort of
posterior and even deep to informal space will be buccal facial space and the buccal space is going
to be contiguous not only with the infraorbital space but with two other spaces that are going to
be posterior to it so if we go a little posterior lateral we would go into the sub masseteric space
so that way and a little laterally everything deep to the masseter here and still superficial to the
ramus of the mandible would be that sub masseteric space sometimes just called the masseteric space
so let me draw these these layers for you so the the most superficial layer here would be
the masseter and deep to the masseter would be the sub masseteric space so they named that well and
then we'd have the ramus of the mandible and then deep to the ramus of the mandible we would have
the pterygomandibular space and deep to that space would be the medial pterygoid muscle keeping in
mind that the masseter and the medial pterygoid form a sling about the ramus of the mandible so
those are two muscles of mastication so on either side of the ramus of the mandible we have the sub
masseteric space which would be superficial to the ramus or the Torito mandibular space which would
be deep to the ramus so let's take a look at the lateral pharyngeal so here we can see that pterygo
mandibular line that would be a condensation of the bucco pharyngeal fascia that's the the
fascia that is investing the superior laryngeal constrictor which we can see there as well as the
buccinator muscle would extend out that way so that bucco pharyngeal fascia is upon both of these
muscles here we can see the styloid process of the temporal bone here we could see the hyoid
bone there's the lesser horn so is the stylohyoid ligament there if we were to conceptualize the
lateral foreign jewel space we want to think about an inverted pyramid the the base of that pyramid
is going to be against the basic cranium here and the apex of the pyramid is going down toward the
body of the hyoid like so and this space is going to lie lateral to the pharyngeal constrictors
specifically the superior and the middle doesn't really touch the inferior pharyngeal constrictor
at all and it is going to be subdivided by the the hyoid bone there so if we think about the
spaces that this is going to be contiguous with as we go superficial and slightly anterior to
the space we would have the trigo mandibular space in that same plane of access we'll also
have the sub masseteric space and posterior lis and deep two here so if we were to color this
in we'll also have the retropharyngeal space so that retropharyngeal space is retro or posterior
to the pharyngeal constrictor muscles and that represents a potential route of infection or
metastasis between the the pharyngeal region and the thorax so that that can be kind of a big deal
so let's let's take a look at a pathway by which infection can spread or anything really it could
be an anesthetic could be even an air embolism so let's start here with the infraorbital space
let's say we had maxillary odontogenic infection we know that posteriorly the infraorbital space
is contiguous with the buccal space and there is overlap there that buccal space is then going
to be contiguous with both the sub masseteric space and then deep to the sub masseteric space
the pterygomandibular space so everything blue here is represented as something that
is blue and labeled on here so these these green spaces we'll hear about in subsequent videos and
discussions sublingual space sublingual space is the most inferior part of the oral cavity between
the mylohyoid muscle and the in the mucosal floor of the the tongue and the submandibular space is
going to be below the level of the mandible right bordered by the digastric bellies so those spaces
can communicate with one another and they can also communicate deep to that lateral pharyngeal
space so we can see how materials can move from one space to the next and even go back to the
retro pharyngeal space and perhaps even down to the the thoracic cavity now an infection
doesn't have to make its way all the way to the thoracic cavity to pose a problem as an infection
takes root in the lateral pharyngeal space in the retro pharyngeal space this can compromise
an airway and can be very problematic in terms of of having to take care of it that would be
an emergent situation so ludwig angina is an example of an infection traveling through a
facial space or even one of these earlier fascial spaces providing pressure or a block to the the
airway hmm so that leads us to our assessment question and that is in odontogenic infection
from a maxillary canine may immediately invade which facial space so buccal facial space it'll
be in the vicinity so let's not get rid of that yet in for orbital or the canine space
yeah that sounds really good to me right lateral pharyngeal space nope too far posteriorly in deep
retro pharyngeal space way too far posterior and deep sub mesenteric space again too far posterior
so between buckle and infraorbital keeping in mind the division between the two of these would
be that posterior border of zygomaticus major the canine is going to be anterior to that so buccal
spaces out and the afforable what's even there in the name canine space is the correct answer
for receiving an odontogenic infection from a maxillary canine thank you very much for your time