An examination of posttraumatic, postsurgical orbital deformities: conclusions drawn for improvement of primary treatment.

A retrospective analysis was carried out on the records of 317 patients operated on by the senior author (S.A.W.) for orbital fractures between 1975 and 2007. Two hundred forty of the patients had been previously operated on elsewhere and required further correction (posttraumatic, postsurgical orbital deformity). A smaller group of patients (n = 77) were operated on primarily. The two groups were not, of course, similar, because the posttraumatic, postsurgical orbital deformity group had been operated on by a variety of surgeons with varying levels of experience and ability, and the group of patients operated on primarily had a larger percentage of fractures in the pediatric age group, because of the practice being partially based in a children's hospital, and a larger percentage of severe, compound orbital injuries, because of statewide referrals. Nevertheless, a number of causes for reoperation seen in the posttraumatic, postsurgical orbital deformity group were not seen in the primarily operated group. These included lower eyelid retraction attributable to use of the subciliary incision, displacement and extrusion of alloplastic materials, and fixation of fractures in a nonreduced position. These differences validate, in the authors' opinion, the application of the basic principles of craniofacial reconstruction set forth by Paul Tessier, listed in the text, to both the primary and secondary treatment of posttraumatic orbital deformities.

Osteomyelitis of the mandibular symphysis caused by brown recluse spider bite.

BACKGROUND: Brown recluse spider bites cause significant trauma via their tissue toxic venom. Diagnosis of these injuries and envenomation is difficult and many times presumptive. Treatment is varied and dependent upon presentation and course of injury. MATERIALS AND METHODS: We present a case of a previously unreported incidence of osteomyelitis of the mandible as a result of a brown recluse spider bite. A review of the literature and discussion of diagnosis and treatment of brown recluse spider bites are presented. RESULTS: Osteomyelitis of the mandible causing a chronic wound was the presenting finding of a patient with a history of spider bite and exposure to brown recluse spiders. Operative debridement and wound closure resulted in successful treatment. Brown recluse spider envenomation varies in its presentation and treatment is based on the presenting clinical picture. CONCLUSION: Treatment regimens for brown recluse spider bite envenomation should include the basics of wound care. Systemic antibiotics, topical antimicrobials, dapsone, and surgical debridement are valuable adjuncts of treatment, as indicated, based on the clinical course.

Nonvenomous bite injuries of the foot: case reports and review of the literature.

Animal bite injuries to humans are relatively common, however, bite injuries to the lower extremity and more specifically the foot are relatively uncommon. Foot injuries, once infected, may lead to further complications, such as soft tissue loss, bone loss, and the need for amputation. Patients with preexisting medical conditions, such as peripheral vascular disease and diabetes, are especially at risk for such complications. In this article, 2 recent cases are detailed and the literature to examine these injuries of the foot is reviewed.