Group A streptococcal fasciitis after submental tumescent liposuction.

Tumescent liposuction is a procedure with a good safety record. Local infection is rare but can result in devastating consequences. We report a rare case of group A streptococcal fasciitis complicating tumescent liposuction and highlight the importance of early diagnosis and treatment of this condition. A 62-year-old woman presented 8 days after submental liposuction and a platysmal plication procedure with signs and symptoms of cervical fasciitis. Microbiological analysis confirmed a group A streptococcal infection. By using early aggressive medical and surgical treatments, the disease was arrested before the onset of any necrotizing process. A high index of suspicion is required to make an early diagnosis of this potentially disfiguring and life-threatening infection.

Is tracheotomy decannulation possible in oxygen-dependent children?

OBJECTIVE: The goal was to determine whether decannulation can be safely achieved in children with persistent oxygen requirements. DESIGN: The study was a prospective evaluation of 12 oxygen-dependent children at a tertiary care academic children's medical center. METHODS: Twelve tracheotomy-dependent children with persistent oxygen requirements were evaluated for decannulation. Patients requiring more than 35% FiO(2) were not considered. Direct laryngoscopy and bronchoscopy were performed in all patients. Two required single-stage laryngotracheoplasty to correct subglottic stenosis, 1 required tracheal resection, and 7 required removal of suprastomal granulation tissue. Oxygen was administered after decannulation through a nasal cannula. RESULTS: Decannulation was successful in 92% (11 of 12) of patients. At final follow-up, oxygen requirements decreased in 58% of patients after decannulation. CONCLUSIONS: Decannulation can be successful in children who remain oxygen dependent; conversion to a more physiologic airway may be an adjunct to reducing or eliminating their oxygen demand.

Sinus lateralis in endoscopic ethmoidectomy.

OBJECTIVE: To characterize the anatomy of the sinus lateralis and enable a more accurate and safe approach to endoscopic ethmoidectomy. STUDY DESIGN: An anatomic study of 33 cadaver heads providing a prospective evaluation of 50 ethmoid sinuses. The sinus lateralis, in particular, was thoroughly examined and typical variations were classified into four categories. A technique using the sinus lateralis as a critical landmark is described which allows calculated removal of anterior ethmoid cells in a posterior-to-anterior direction, avoiding inadvertent entry into the posterior ethmoid. Prospective evaluation of this technique in 12 pediatric patients found it to be safe and particularly useful for neophyte endoscopic surgeons. METHODS: Endoscopic examination of 50 cadaver sinuses using 0-, 30-, and 70-degree, 4-mm telescopes to dissect the anterior ethmoid. The characteristics of each sinus lateralis were documented. To confirm the endoscopic findings, we grossly examined each specimen. RESULTS: Four different categories of sinus lateralis formation were identified: type I (n = 22), posterosuperior extension to skull base; type II (n = 15), posterior extension to sphenoid face; type III (n = 8), abrupt termination posterior to ethmoid bulla; and type IV (n = 5), extension into posterior ethmoid through dehiscent basal lamella. CONCLUSIONS: The sinus lateralis is a consistent feature of the anterior ethmoid. Type I and II patterns are most conducive to the aforementioned technique. Type III is the most difficult to identify endoscopically, whereas type IV is most apt to encourage an unplanned posterior ethmoidectomy. Regardless of the chosen ethmoidectomy technique, careful assessment of the sinus lateralis should enable more accurate and safe removal of ethmoid disease with reduced complications.