Methicillin-resistant Staphylococcus aureus as a cause of neonatal suppurative parotitis: a report of two cases and review of the literature.

Suppurative parotitis is an uncommon entity identified in newborns. While Staphylococcus aureus has been frequently identified as the causative pathogen among the few patients diagnosed with neonatal suppurative parotitis (NSP), there has only been one prior case described in the literature that was due to methicillin-resistant Staphylococcus aureus (MRSA). Because of its virulence, MRSA presents new and substantial challenges for the surgeon; we describe two cases of NSP caused by MRSA and the subsequent surgical intervention necessitated for cure. We also include a review of all cases of NSP described in the English-language literature.

Upper lid transconjunctival versus transcutaneous approach for fracture repair of the lateral orbital rim.

The use of the lower eyelid transconjunctival approach in the setting of orbital trauma has becoming increasingly popular in recent years. However, experience has found that access to the lateral orbital rim can be somewhat limited with this type of incision. Many authors supplement the approach with a lateral canthotomy in order to gain adequate access laterally. Although usually well tolerated, there can be side effects associated with this incision. We examine the upper lid transconjunctival approach to the lateral orbital rim. Furthermore, we compare this technique to the more traditional transcutaneous approaches used for orbital trauma. We have found this technique to be safe, effective, and to cause no more complications than the more traditional approaches.

Anterior palate sensory impairment after septal surgery.

BACKGROUND: This study was performed to present a series of patients who experienced anterior palatal sensory impairment after nasal septal surgery. This phenomenon has not been reported in the English literature to date. METHODS: We reviewed 107 septal surgeries done by the same surgeon over a 3-year period. One hundred one surgeries were septoplasty by technique of submucous resection, three surgeries were septal perforation repairs using a mucosal advancement flap from the nasal floor, two surgeries were excisions of benign septal neoplasms, and one surgery was a closed reduction of a nasal septal fracture. RESULTS: Overall, 3/107 patients (2.8%) experienced postoperative numbness of the anterior palate. Two of these patients underwent septoplasty, and the third patients underwent repair of septal perforation. A chisel was used to resect a portion of the maxillary crest posterior to the nasal spine in 11 patients, including the 3 patients who reported postoperative numbness. Suction cautery was also used in one of the 3 patients to address bleeding of the nasopalatine artery. Two patients reported concomitant palatal paresthesias with numbness, and both had recovery of normal sensation at 3 months follow-up. The third patient, in whom cautery was used, continued to experience numbness 1 year postoperatively. CONCLUSION: Sensory impairment of the anterior palate may result from surgery of the nasal septum and appears to be associated with chisel of the maxillary crest. Cautery should be avoided near the nasopalatine foramen. The relevant surgical anatomy of the nasopalatine nerve is reviewed and discussed in the context of these cases.