Conservative management of streptococcal necrotizing periorbital fasciitis following primary VZV infection.

A 45-year old male patient, with a past history of illicit drug abuse and hepatitis C, presented with a 2 day history of worsening eyelid edema. Examination of the globe was impossible due to eyelid fusion caused by extensive soft tissue damage. Based on the examination, a diagnosis of necrotic fasciitis secondary to VZV infection was Romamade. The patient received empirical treatment with intravenous acyclovir, meropenem and vancomycin. CT imaging demonstrated no ocular involvement. Lesions were cultivated, revealing presence of Streptococcus pyogenes. Intravenous clindamycin was added to his course. Improvement was gradually observed. The patient received treatment for a total of 21 days, resulting in excellent final outcome. His final visual acuity was 0.9 on a Snellen chart, without signs of ocular inflammation. No surgical intervention was required and lesions fully healed with conservative management. Clinical outcomes depend on prompt treatment initiation, whilst delay in the diagnosis can prove fatal.

Colour Doppler ultrasonography of the ophthalmic artery: flow parameters in normal subjects. The significance of the resistance index.

BACKGROUND: The aim of this study was to assess the flow characteristics in ophthalmic arteries and to detect their possible relationships to those in the common and internal carotid arteries. METHODS: Sixty healthy subjects (age range 20-74 years) with normal vascular findings, stratified by age and sex were recruited to the study. A colour Doppler ultrasound examination of the neck arteries was performed, followed by a colour Doppler ultrasound examination of the 120 ophthalmic arteries included. Peak systolic velocity, end diastolic velocity and resistance index (RI) of the common carotid, internal carotid and ophthalmic arteries, as well as the insonation depth of the ophthalmic arteries were measured. RESULTS: The mean values (standard deviation) of the measured parameters for the ophthalmic arteries were: insonation depth: 38.38 mm (2.60 mm), peak systolic velocity: 34.71 cm/sec (6.38 cm/sec), end diastolic velocity: 7.95 cm/sec (1.70 cm/sec), resistive index: 0.77 (0.04). The resistance index of the ophthalmic arteries was, in all cases, greater than that of the ipsilateral common carotid artery which in turn, was greater than that of the internal carotid. The value of the index in the ophthalmic arteries, when the circulation is normal in the extra- and intracranial arteries is rarely lower than 0.70. CONCLUSIONS: When an inversion of the ratio between the resistance index of the ophthalmic artery and that of the common carotid or an index value lower than 0.70 in the ophthalmic artery is observed, further investigation is needed as this situation cannot be considered normal. The resistance index seems to be the most reliable parameter for the estimation of normal circulation in ophthalmic arteries.

[Laryngeal insufficiency as a post-traumatic complication of facial skull injury]. / Larynxinsuffizienz als posttraumatische Komplikation einer Gesichtsschädelverletzung.

Laryngeal incompetence is characterised by incoordination in deglutition and fluid leakage around the tracheostomy tube. It occurs very rarely and is attributed to injury of the recurrent laryngeal nerve. To our experience this condition demands no treatment and gradually disappears. In this paper we present a case of a 24-year-old male patient with facial fractures presenting laryngeal incompetence.

Neurophysiological and neuro-otological study of homozygous beta-thalassemia under long-term desferrioxamine (DFO) treatment.

This report presents data on visual evoked potentials (VEPs) and brainstem auditory evoked potentials (BAEPs), as well as neurologic, ophthalmologic and otologic assessments performed on 120 patients with beta-thalassemia major undergoing long-term DFO treatment. A total of 32 patients showed abnormal VEPs and 14 abnormal BAEPs; seven had both VEP and BAEP abnormalities; 12 had sensorineural hearing loss (SNHL); 18 had conductive hearing loss, while 14 showed a combination of SNHL and conductive hearing loss. After DFO administration was modified (taking in consideration the serum ferritin levels) patients with abnormal findings were retested. The values of 15 patients of 23 who underwent VEP examinations had been normalized. Eleven of 15 who repeated the BAEP test had also gained normal values. The audiogram had not returned to normal in any patient with SNHL. In a second repetition of the examinations, no change was observed. It is concluded that in a great percentage of thalassemics at least one of the above examinations shows abnormal values. These abnormalities are mostly reversible, and probably reflect a dysfunction of the visual or auditory system, due either to DFO neurotoxicity or to iron overload or both.

Plasma cell myeloma of the jaws.

Solitary myeloma may be the first manifestation of the disseminated form, known as multiple myeloma, and characterized by multiple skeletal lesions, general metabolic alterations, impairment of renal function and eventually death. Involvement of the jaws is not unusual, although infrequently reported. We present 2 cases, where oral involvement was the first indication of the disease.

Orbital apex syndrome.

The orbital apex syndrome is a very rare complication of fractures of the facial skeleton, as well as other conditions and is characterized by blindness, fixed dilated pupils, proptosis, ptosis of the eye and ophthalmoplegia. We are reporting such a case we had the opportunity of treating.

Benign neurogenic tumors of the oral cavity.

Neurogenic tumors are rare in the oral cavity, particularly so when malignant. Traumatic neuroma, although usually included with neurogenic tumors, is a reactive process rather than a true neoplasm. Neurofibroma and schwannoma derive from nerve fibers, the perineurium, the endoneurium and the neurolemmomal cells. They present histological differences. The neurofibroma may present in solitary and generalized types; the latter also known as neurofibromatosis or von Recklinghausen's disease of the skin. We here report typical cases of benign neurogenic tumors of the oral cavity.

Chondrosarcoma of the orofacial region. Review of the literature and report of two cases.

Chondrosarcoma of the jaws arises from vestigial rests and is considered a rare entity, although it is more common than its benign counterpart. Occasionally it may be extremely difficult under the microscope to decide whether a case is benign or malignant. The treatment of choice is surgical with wide margins. In our review of the literature we found 169 cases of oro-facial chondrosarcoma including two from our Institution. There was a 2:1 male/female ratio and the maxilla was involved twice as frequently as the mandible. Over half of the cases were between 20 and 50 years old.

Aneurysmal bone cyst of the jaws. Review of the literature and report of 2 cases.

Strictly speaking, the aneurysmal bone cyst is not a true cyst. It is a lesion characterized by replacement of bone by fibro-osseous tissue containing blood-filled cavernous spaces. It is usually treated by surgical curettage, and access within the jaws may sometimes be difficult. We reviewed the world literature and found 63 cases of aneurysmal bone cysts involving the face, 22 reported in the maxilla, and 63 in the mandible. One was found in the zygomatic arch. Of the patients reported, 88% were younger than 30 years old; there was an equal sex distribution. Included in this report, are two cases of our own, one involving the maxilla and one the mandible.

Traumatic Le Fort III osteotomy.

A case of a Le Fort III type of fracture is described which resulted after its reduction, in the correction of pre-existing Class III skeletal relationship.

The superior orbital fissure syndrome.

The superior orbital fissure syndrome is a very rare condition, characterized by a fixed dilated pupil, ptosis and proptosis of the eye and ophthalmoplegia. We have had the opportunity to observe a number of such cases, and now report four of them.

Odontogenic keratocysts: review of the literature and report of sixteen cases.

Sixteen cases of odontogenic keratocyst are reported. Two of the patients had basal cell nevus syndrome. The provisional diagnosis in most of the 16 cases was other than odontogenic keratocyst, and the presenting symptoms were usually swelling, pain, and sinus tract formation. The treatment varied from simple enucleation to marsupialization, homogenous bone grafting, and iliac bone grafting. There was a 25% recurrence rate, mostly associated with treatment by enucleation, cysts that were parakeratinized or difficulty in removing the lesion.

Fractures of the facial skeleton in the edentulous patient.

An evaluation was made of 112 fractures that occurred in 66 edentulous patients in a 10 year period. There was an average of 1.7 fractures per person. 104 fractures occurred in the mandible and 75% of these were treated without intermaxillary fixation or were not treated at all. In 28.5% of the cases no treatment was provided other than soft or liquid diet and appropriate instructions. As a group, the condylar fractures were those that were left with no treatment to a greater extent than any other group, apart from the Le Fort type of fracture; the latter being very few in absolute numbers. The age group associated with the edentulous state quite often suffers from conditions that may prohibit aggressive treatment. These conditions may be aggravated by the accident and, by the time the patient is ready for maxillofacial surgery, one has to contemplate (and discuss with the patient) the advantages and disadvantages of a procedure. It appears that aesthetics are of minor importance (to a certain degree) for elderly patients and small deviations from the normal (both in appearance and function) are acceptable to them, considering the prospect of an operation or of the prolonged discomfort, such as that associated with intermaxillary fixation. The advisability of the latter should be assessed carefully in view of the respiratory impairment that it may cause in patients whose airway may already be compromised.(ABSTRACT TRUNCATED AT 250 WORDS)

Ossifying fibroma of the jaws. Review of the literature and report of 16 cases.

Ossifying fibroma is a fibro-osseous lesion rarely occurring in the jaws, although more often than in other bones of the skeleton. It is not clear whether it represents a distinct entity or a certain stage of the fibro-osseous condition. We are presenting our experience with 16 cases of ossifying fibroma treated with local excision or resection and bone graft. Their radiographic picture varied significantly from one case to another. One case was peripheral and one recurred.