RESUMEN
We report a case of cervicofacial necrotizing fasciitis that developed after blepharoplasty, an occurrence that, to our knowledge, has not previously been reported in the medical literature. A patient who presented to our institution 3 days after undergoing blepharoplasty of the upper eyelid was diagnosed as having fulminant fasciitis involving extensive areas of the face, scalp, and neck. We review the case in detail and discuss clinical and radiological clues to diagnosis, surgical and medical management, wound care, and subsequent scar contracture. This case emphasizes the need for individualized, appropriate postoperative care and for an awareness of this rare, potentially fatal complication. Early recognition and aggressive treatment of cervicofacial fasciitis can arrest its rapid progression and prevent devastating sequelae.
Asunto(s)
Párpados/cirugía , Fascitis Necrotizante/etiología , Complicaciones Posoperatorias/etiología , Anciano , Músculos Faciales , Fascitis Necrotizante/epidemiología , Fascitis Necrotizante/terapia , Femenino , Humanos , Músculos del Cuello , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/terapia , Cuero CabelludoRESUMEN
An AIDS patient was seen in respiratory difficulty with a superior mediastinal mass. Examination revealed a candida fungoma. To the best of our knowledge, this is the only case of its nature. The differential diagnosis and management of this patient are presented in detail.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Enfermedades de la Tráquea/etiología , Adulto , Candida albicans/aislamiento & purificación , Humanos , Masculino , Ventilación Pulmonar , Ruidos Respiratorios , Enfermedades de la Tráquea/microbiología , Enfermedades de la Tráquea/fisiopatologíaRESUMEN
The recommended treatment of penetrating traumatic facial nerve injuries associated with immediate, total paralysis of the ipsilateral facial muscles generally includes facial nerve exploration and repair. We reviewed our experience with bullet injuries to the extratemporal facial nerve to determine the efficacy of this approach. Five patients with immediate, total facial nerve paralysis caused by bullet wounds near the extratemporal facial nerve were seen between July 1990 and December 1992. Of four patients who underwent surgical exploration, only one demonstrated complete transection of the facial nerve. Two of these four were followed up with serial electroneuronography, which demonstrated complete degeneration within the first week after injury. The fifth patient was followed up with serial electroneuronography without complete degeneration, and partial recovery was observed. We conclude that penetrating bullet injuries with immediate, total facial paralysis may not necessarily be associated with transection of the facial nerve. We propose a method of treating patients with these injuries using electroneuronography.
Asunto(s)
Traumatismos del Nervio Facial , Parálisis Facial/etiología , Heridas por Arma de Fuego/complicaciones , Adulto , Nervio Facial/fisiopatología , Nervio Facial/cirugía , Estudios de Seguimiento , Humanos , Masculino , Degeneración Nerviosa/fisiología , Resultado del Tratamiento , Heridas por Arma de Fuego/cirugíaRESUMEN
Open node biopsy was the method of choice for diagnosing human immunodeficiency virus (HIV) infection before serologic testing became available. Currently, the otolaryngologist is often called on to assist in the management of HIV-positive patients with troublesome cervical adenopathy. Today's questions are: what is the place of fine-needle aspiration (FNA), and when is open cervical node biopsy indicated. A retrospective review was undertaken of 93 consecutive cervical node biopsies performed by our department during the 5-year period from 1985 to 1989. Twenty of the patients who underwent biopsy were HIV-positive. Of these twenty, ten carried an established diagnosis of acquired immune deficiency syndrome (AIDS). Seventeen of these patients underwent FNA before biopsy. In the eight patients with persistent generalized lymph-adenopathy (PGL) and nontender, nonenlarging nodes, pathologic analysis revealed lymphoid hyperplasia. Five of these patients had antecedent FNA, none demonstrating any pathologic changes. Of the twelve patients with enlarging or tendon nodes, the diagnosis of mycobacterial adenitis was made in eight, Nocardial infection in two, Burkitt's lymphoma in one, and metastatic Kaposi's sarcoma in one. In four of the patients diagnosed with mycobacterial infections, FNA yielded cytologic evidence of acid-fast bacilli and open lymph node biopsy added nothing. In contrast, FNA failed to reveal the diagnosis in both patients with Nocardial infection, and in the two patients with neoplastic disease. We conclude that cervical node biopsy is not indicated in the HIV or AIDS patient with nontender or nonenlarging nodes.(ABSTRACT TRUNCATED AT 250 WORDS)