The canine space lies between the anterior surface of the maxilla and levator labii superioris muscle of the face. Erosion of a maxillary tooth infection through the alveolar bone into the canine space leads to abscess formation, although cutaneous infections from the upper lip and nose are rare sources. Unilateral facial redness, pain, and swelling lateral to the nose with obliteration of the nasolabial fold are characteristic. Severe upper lip and lower eyelid swelling may cause drooling at the corner of the mouth or eye. Maxillofacial CT scan may aid in differentiating these lesions.
Management and Disposition
Parenteral broad-spectrum antibiotic therapy including anaerobic coverage is indicated. Dental or oral surgical consultation for incision and drainage is the most definitive treatment for canine space abscesses. Extraction or endodontic treatment of the involved anterior maxillary teeth is usually necessary.
Loss of the nasolabial fold is usually present with canine space abscesses, but may not be seen with buccal space abscesses.
Canine space infections may lead to orbital cellulitis and cavernous sinus thrombosis.
Although these patients may drool when significant upper lip swelling is present, they typically do not have trismus, dysphagia, or odynophagia.
Canine Space Abscess. Unilateral facial swelling lateral to the nose with associated redness and the typical loss of the nasolabial fold is shown. The maxillary canine tooth is usually the source of this process. (Photo contributor: Frank Birinyi, MD.)