RESUMEN
Necrotizing fasciitis of the head and neck is an uncommon, insidious infection that usually occurs secondarily to odontogenic infections, although blunt and penetrating trauma can be another cause. Of 65 total reported cases of necrotizing fasciitis, 10 (15.4%) have been fatal. This article presents a case of a mandibular fracture in a severely immunocompromised elderly patient in whom delayed treatment proved fatal. The clinician must remain suspicious of any infection refractory to antibiotic therapy alone, since necrotizing fasciitis is a rapidly progressing condition with high morbidity and potential for mortality. Rapid diagnosis, surgical treatment, antibiotic therapy, medical management, nutritional support, and early detection and treatment of complications are critical elements in the management of necrotizing fasciitis.
Asunto(s)
Fascitis Necrotizante/etiología , Fracturas Mandibulares/complicaciones , Anciano , Bacteriemia/microbiología , Terapia Combinada , Fascitis Necrotizante/microbiología , Resultado Fatal , Femenino , Infecciones por Bacterias Gramnegativas/diagnóstico , Humanos , Huésped Inmunocomprometido , Fracturas Mandibulares/cirugía , Infección de Heridas/microbiologíaRESUMEN
PURPOSE: The study examines the efficacy of antibiotic treatment in patients with traumatic cerebrospinal fluid (CSF) leakage and identifies a consistent clinical approach for better management of these patients. PATIENTS AND METHODS: A retrospective study of traumatic CSF leakage in 88 patients with craniofacial fractures was performed. The mechanism of injury, etiology and source of leakage, decision to treat conservatively (without surgery) versus aggressively (with surgery), decision to use early versus late repair, and decision to provide prophylactic antibiotic coverage were recorded. Both timing of repair and the decision to use antibiotics were compared with the incidence of meningitis resulting from CSF leakage. RESULTS: Of 48 patients treated with antibiotics, 5(10.4%) developed meningitis. In the remaining 40 who were not treated with antibiotics, only one patient acquired meningitis. Five of 53 (9.4%) patients with conservative treatment developed meningitis versus 1 of 35 (2.9%) after aggressive treatment. CONCLUSION: There was no statistically significant difference in the rate of occurrence of meningitis between the conservative and the aggressive treatment group. However, the data suggest that there may be no benefit in treating these patients with antibiotics to prevent meningitis, whereas aggressive treatment and early repair of facial fractures may, in fact, be helpful.
Asunto(s)
Otorrea de Líquido Cefalorraquídeo/etiología , Rinorrea de Líquido Cefalorraquídeo/etiología , Fracturas Craneales/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Otorrea de Líquido Cefalorraquídeo/complicaciones , Otorrea de Líquido Cefalorraquídeo/terapia , Rinorrea de Líquido Cefalorraquídeo/complicaciones , Rinorrea de Líquido Cefalorraquídeo/terapia , Distribución de Chi-Cuadrado , Niño , Preescolar , Femenino , Humanos , Masculino , Meningitis/etiología , Meningitis/prevención & control , Persona de Mediana Edad , Premedicación , Estudios Retrospectivos , Fracturas Craneales/cirugía , Factores de TiempoRESUMEN
There has been considerable confusion in the literature regarding the proper treatment of auricular hematoma. This has stemmed from an inadequate understanding of the mechanisms involved in the formation and propagation of this condition. This article reviews the literature and give suggestions as to the proper surgical management of this problem.
Asunto(s)
Deformidades Adquiridas del Oído/cirugía , Oído Externo/lesiones , Hematoma/cirugía , Drenaje , Oído Externo/cirugía , Humanos , StentsRESUMEN
The adult respiratory distress syndrome (ARDS) is a sequel to pulmonary injury that may be direct, closed chest trauma or indirect, through air or vascular passages, aspiration, or fat embolization. An understanding of this syndrome is essential for the oral surgeon who not only manages severe maxillofacial injuries but is also a member of a trauma team that manages multisystem injuries. Emphasis on pathophysiologic pathways resulting in ARDS is presented with a discussion on oxygenation and ventilation abnormalities. Application of these guidelines will assist the oral surgeon in understanding the management of patients with this acute progressive syndrome.