Facial spaces are anatomical areas filled with loose connective
tissue.
• They are pathways for the spread of odontogenic infections.
• Understanding these spaces is crucial for diagnosis and
management.
• Helps prevent life-threatening complications like Ludwig’s
angina.
Classification of Fascial Spaces
• Divided into primary and secondary spaces.
• Primary spaces: Submental, Submandibular, Sublingual.
• Secondary spaces: Pterygomandibular, Masseteric, Temporal,
Parapharyngeal, Retropharyngeal.
• Today’s focus: Mandibular (lower jaw) facial spaces.
PRIMARY MANDIBULAR SPACES
submental
buccal
submandibular.
Sublingual
SUBMENTAL
The submental space is a fascial space of the head and neck.
It is a potential space located between the mylohyoid muscle
superiorly and the platysma muscle inferiorly, under the chin in
the midline.
The space coincides with the anatomic region termed the
submental triangle, part of the anterior triangle of the neck.
ANATOMICAL BOUNDARIES
The boundaries of the submental space are:
the mylohyoid muscle superiorly
the investing layer of deep cervical fascia (which in turn is
covered by the platysma muscle) inferiorly
the inferior border of the mandible anteriorly
the hyoid bone posteriorly
the anterior bellies of the digastric muscles laterally.
The midline mesially
COMMUNICATIONS
The communications of the submental space are:
1. The submandibular spaces posterolaterally.
2. The sublingual space superiorly (via erosion through the
mylohyoid)
CONTENTS
Its contents are
1. Submental lymph nodes
2. Areolar connective tissue
3. The anterior jugular veins
Facial spaces are anatomical areas filled with loose connective
tissue.
• They are pathways for the spread of odontogenic infections.
• Understanding these spaces is crucial for diagnosis and
management.
• Helps prevent life-threatening complications like Ludwig’s
angina.
Classification of Fascial Spaces
• Divided into primary and secondary spaces.
• Primary spaces: Submental, Submandibular, Sublingual.
• Secondary spaces: Pterygomandibular, Masseteric, Temporal,
Parapharyngeal, Retropharyngeal.
• Today’s focus: Mandibular (lower jaw) facial spaces.
PRIMARY MANDIBULAR SPACES
submental
buccal
submandibular.
Sublingual
SUBMENTAL
The submental space is a fascial space of the head and neck.
It is a potential space located between the mylohyoid muscle
superiorly and the platysma muscle inferiorly, under the chin in
the midline.
The space coincides with the anatomic region termed the
submental triangle, part of the anterior triangle of the neck.
ANATOMICAL BOUNDARIES
The boundaries of the submental space are:
the mylohyoid muscle superiorly
the investing layer of deep cervical fascia (which in turn is
covered by the platysma muscle) inferiorly
the inferior border of the mandible anteriorly
the hyoid bone posteriorly
the anterior bellies of the digastric muscles laterally.
The midline mesially
COMMUNICATIONS
The communications of the submental space are:
1. The submandibular spaces posterolaterally.
2. The sublingual space superiorly (via erosion through the
mylohyoid)
CONTENTS
Its contents are
1. Submental lymph nodes
2. Areolar connective tissue
3. The anterior jugular veins
The buccal space (also termed the buccinator space) is a fascial
space of the head and neck
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 subcutaneous space, which is
continuous from head to toe.
ANATOMIC BOUNDARIES
The boundaries of each buccal space are:
1. The angle of the mouth anteriorly
2. The masseter muscle posteriorly
3. The zygomatic process of the maxilla and the zygomaticus
muscles superiorly
4. The depressor anguli oris muscle and the attachment of the
deep fascia to the mandible inferiorly
5. The buccinator muscle medially (the buccal space is superficial
to the buccinator)
COMMUNICATION
1. To the pterygomandibular space, infratemporal space,
submasseteric space, or even to the lateral pharyngeal space
posteriorly
2. To the infraorbital (canine) space superiorly
CONTENTS
In health it contains:
1. the buccal fat pad
2. the parotid duct (Stenson's duct)
3. the anterior facial artery and vein
4. the transverse facial artery and vein
The submandibular space is a fascial space of the head and neck
It is a potential space, and is paired on either side, located on the
superficial surface of the mylohyoid muscle between the
anterior and posterior bellies of the digastric muscle.
The space corresponds to the anatomic region termed the
submandibular triangle, part of the anterior triangle of the neck
COMMUNICATIONS
The communications of the submandibular space are:
1. Medially and anteriorly to the submental space (located
medial to the paired submandibular spaces, separated from
them by the anterior bellies of the digastric muscles).
2. Posteriorly and superiorly to the sublingual space (located
above the mylohyoid muscle) and inferiorly to the lateral
pharyngeal space.
CONTENTS
In health, the contents of the space are:
1. The submandibular gland, which largely fills the space.
2. Branches of the facial artery.
3. Lymph nodes.
The sublingual space is a fascial space of the head and neck
It is a potential space located below the mouth and above the
mylohyoid muscle, and is part of the suprahyoid group of fascial
spaces.
ANATOMIC BOUNDARIES
The sublingual space is V-shaped, with the apex pointing to the
anterior.
Its boundaries are:
1. The mucosa of the floor of the mouth and the tongue
superiorly
2. The mylohyoid muscle inferiorly
3. The medial surface of the mandible anteriorly
4. The muscles along the base of the tongue (geniohyoid and
genioglossus muscles) posteriorly and medially
COMMUNICATION
The sublingual space communicates:
Posteriorly around the posterior free border of the mylohyoid
muscle with the submandibular space.
Infections of the sublingual space may also erode through the
mylohyoid, or spread via the lymphatics to the submandibular
and submental spaces.
CONTENTS
The sublingual space contains:
1. A number of blood vessels and nerves, e.g., the lingual artery
and nerve, the hypoglossal nerve, and the glossopharyngeal
nerve.
2. The sublingual salivary gland. Saliva from the sublingual gland
drains through several small excretory ducts in the floor of the
mouth. Sometimes a more distinctive duct can be recognized,
known as Bartholin's duct.
3. The deep part of the submandibular gland and the
submandibular duct (Wharton's duct)
4. Some extrinsic tongue muscle fibers.
SECONDARY MANDIBULAR SPACES
1- masseteric
2- pterygomandibular
3- temporal spaces
It is a potential space in the face above 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 masseteric refers to the masseter muscle.
ANATOMICAL BOUNDARIES
the anterior margin of the masseter muscle anteriorly
the parotid gland posteriorly
the zygomatic arch superiorly
the inferior border of the mandible inferiorly
the lateral surface of the mandibular ramus medially (masseteric
space is superficial to the mandible)
the masseter muscle posteriorly (the masseteric space is deep to
the masseter).
COMMUNICATIONS
The communications of each masseteric space are:
to the buccal space anteriorly
to the pterygomandibular space (around the posterior margin of
the mandibular ramus to its medial surface) and the parotid
space posteriorly
to the superficial temporal space superiorly.
CONTENTS
In health, the space contains:
the masseteric artery
the masseteric vein.
PTERYGOMANDIBULAR
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.
ANATOMICAL BOUNDARIES
The boundaries of each pterygomandibular space are:
the posterior border of the buccal space anteriorly
the parotid gland posteriorly
the lateral pterygoid muscle superiorly
the inferior border of the mandible (lingual surface) inferiorly
the medial pterygoid muscle medially (the space is superficial to
the medial pterygoid)
the ascending ramus of the mandible laterally (the space is deep
to the ramus of the mandible)
COMMUNICATION
The communications of each pterygomandibular space are:
to the buccal space anteriorly
to the lateral pharyngeal space and peritonsillar space medially
(around the medial pterygoid muscle)
to the submasseteric space posteriorly (around the ramus of the
mandible)
to the parotid space posteriorly
to the deep temporal/infratemporal space superiorly
CONTENT
In health, the space contains:
1. The mandibular division of the trigeminal nerve
2. The inferior alveolar artery and vein
3. The sphenomandibular ligament.
TEMPORAL SPACES
Location:
posterior and superior to the masseteric and pterygomandibular
spaces
Bounded:
laterally by the temporalis fascia and medially by the temporal
bone
TWO COMPONENTS:
1. Superficial temporal space:
located between the temporal fascia laterally and the temporalis
muscle medially
2. Deep temporal space:
located between the temporalis muscle laterally and the
temporal bone and greater wing of sphenoid
3. Continuous with the infratemporal space. The infratemporal
space is the inferior portion of the deep temporal space.
SUPERFICIAL TEMPORAL
Contents:
1. Temporal fat pad
2. Temporal branch of facial nerve
Neighboring spaces:
1. Buccal
2. Deep temporal
INFRATEMPORAL AND DEEP TEMPORAL
Contents:
1. Pterygoid plexus
2. Internal maxillary artery and vein
3. Mandibular division of trigeminal
4. Skull base foramina
Neighboring spaces:
1. Buccal
2. Superficial temporal
3. Inferior petrosal sinus
MASTICATOR
This term is sometimes used and is a collective name for the
submasseteric (masseteric), pterygomandibular, superficial
temporal, and deep temporal spaces.
The masticator spaces are paired structures on either side of the
head.
They communicate freely with one another and are
simultaneously involved.
Each masticator space also contains the sections of the
mandibular division of the trigeminal nerve and the internal
maxillary artery.
Ludwig’s Angina
• Severe cellulitis involving submental, submandibular, and
sublingual spaces.
• Bilateral and rapidly progressive.
• Causes tongue elevation and airway obstruction.
• Requires urgent intervention: airway management, IV
antibiotics, surgical drainage.
REFERENCES
Kenneth M. Hargreaves, Stephen Cohen; web, Louis H. Berman,
eds. (2010). Cohen's pathways of the pulp (10th ed.). St. Louis,
Mo.: Mosby Elsevier. pp. 590–595.
Norton NS (2007). Netter's Head and Neck Anatomy for
Dentistry. Philadelphia PA: Saunders Elsevier. pp. 460–472.
Hupp JR, Ellis E, Tucker MR (2008). Contemporary oral and
maxillofacial surgery (5th ed.). St. Louis, Mo.: Mosby Elsevier. pp.
317–333.