Oral Surgery · patient case question
The infection at tooth 4, a maxillary premolar, is most likely to spread into which space?
Patient case: Extraction, infection and a difficult healing
demo: 44-year-old female
chief: Severe throbbing pain and a foul taste four days after an extraction, plus swelling from a separate upper tooth.
history: Osteoporosis treated with intravenous zoledronic acid for three years. She smokes. She had corrective surgery for tetralogy of Fallot in childhood with no residual defect.
meds: Zoledronic acid, calcium and vitamin D.
findings: The socket at site 32 is empty of clot with exposed bone and exquisite tenderness. There is no purulence. Separately, tooth 4 is grossly carious with vestibular swelling and tenderness.
Show answer and explanation
Correct answer: A. The buccal space
- A. Correct. The maxillary premolar root apices sit above the buccinator attachment relative to the alveolar bone in most cases, so pus that perforates the buccal plate escapes into the buccal space, producing cheek swelling.
- B. The sublingual space is entered from mandibular teeth whose apices lie above the mylohyoid line, chiefly the premolars and first molar.
- C. The lateral pharyngeal space is reached from mandibular third molars and from spread through the pterygomandibular space.
- D. The canine space is entered when infection arises from the maxillary canine, whose long root apex lies above the levator anguli oris attachment. That is the classic canine space source, and it matters because of the risk of cavernous sinus thrombosis.