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BMJ Case Reports Jul 2023This article discusses a rare ophthalmic manifestation of neonatal bacterial infection and its management, including surgical drainage. The case discussed is that of a...
This article discusses a rare ophthalmic manifestation of neonatal bacterial infection and its management, including surgical drainage. The case discussed is that of a neonate who presented with rapidly progressing ophthalmic symptoms suggestive of orbital cellulitis. The neonate also had extensive intracranial involvement and had spread to contiguous structures causing a temporal lobe abscess. As there was no local injury, a haematogenous spread was strongly considered. With blood culture and pus culture yielding the growth of , systemic antibiotics and surgical interventions were required to successfully manage the neonate. Through this case report, we emphasise that orbital infections are grave in neonates and may culminate into devastating intracranial complications; hence, it necessitates appropriate medical and surgical interventions right from hospital admission.
Topics: Infant, Newborn; Humans; Orbital Cellulitis; Abscess; Anti-Bacterial Agents; Staphylococcal Infections; Staphylococcus aureus; Cellulitis; Orbital Diseases
PubMed: 37491125
DOI: 10.1136/bcr-2022-252390 -
Antibiotics (Basel, Switzerland) Sep 2022The delayed treatment of pediatric periorbital cellulitis may have severe consequences. In addition, the antibiotic efficacy against causative bacteria may change over...
The delayed treatment of pediatric periorbital cellulitis may have severe consequences. In addition, the antibiotic efficacy against causative bacteria may change over time, and it is important to understand the appropriate antibiotic options for effective treatment in pediatric patients. We compared the changes in cultured bacteria and drug susceptibility tests between two decades, 2010-2019 and 2000-2009, to establish antibiotics for empirical use. The patient characteristics, etiologies, culture sites, and isolated bacteria, and the antibiotic susceptibility tests of the admitted pediatric patients ( = 207) diagnosed with preseptal and orbital cellulitis during 2000 to 2019, were recorded. Insect/animal bites ( = 0.084) showed an increasing trend, and sinusitis ( = 0.016) showed a significant decrease in the past decades. The most common bacteria were , and methicillin-resistant (MRSA) infections increased in recent decades ( = 0.01). Moreover, we found that vancomycin was ideal for MRSA infections. The decreasing efficacy of oxacillin correlates with the increasing proportion of MRSA in pediatric periorbital cellulitis. Our study thus offers antibiotic choices against the most common isolates that can be administered before culture results are available.
PubMed: 36289946
DOI: 10.3390/antibiotics11101288 -
The Journal of Craniofacial SurgeryThe goal of this study was to compare conventional osteotomes and Magic Saws in terms of edema and ecchymosis, in rhinoplasty patients. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The goal of this study was to compare conventional osteotomes and Magic Saws in terms of edema and ecchymosis, in rhinoplasty patients.
STUDY DESIGN
A retrospective, case-control study.
METHODS
In this prospective, randomized study, we evaluated the results of 258 rhinoplasty patients who underwent osteotomy by either conventional osteotomes or new designed saws called; "Magic Saws." On postoperative days 2 and 7, the patients were photographed by the surgeon; photographs were evaluated by another otolaryngologist, blinded from the osteotomy procedure.
RESULTS
There were no statistically differences between the groups, in terms of age, sex, weight, or average arterial blood pressure (P > 0.05). The postoperative periorbital edema (days 2 and 7) and ecchymosis (day 2) scores were significantly higher in the conventional osteotomy group, as compared to Magic Saw group (P < 0.05). However, on postoperative day 7, the differences in the periorbital ecchymosis scores between the groups, were not statistically significant (P > 0.05).
CONCLUSIONS
As compared to conventional osteotomes, Magic Saws were reported to be associated with minimal soft tissue injury, as well as decreased edema and ecchymosis, in the early postoperative period after rhinoplasty.
Topics: Case-Control Studies; Ecchymosis; Edema; Humans; Osteotomy; Postoperative Complications; Retrospective Studies; Rhinoplasty
PubMed: 34267120
DOI: 10.1097/SCS.0000000000007844 -
Otolaryngology--head and Neck Surgery :... Oct 2020Sinusitis is a common pediatric illness that can be complicated by periorbital or intracranial extension. Patients can be managed with antimicrobials alone or in...
OBJECTIVES
Sinusitis is a common pediatric illness that can be complicated by periorbital or intracranial extension. Patients can be managed with antimicrobials alone or in conjunction with surgical intervention. This article examines management patterns and outcomes in pediatric patients presenting with complicated sinusitis.
STUDY DESIGN
Case series with chart review.
SETTING
Tertiary care pediatric hospital.
SUBJECTS AND METHODS
An evaluation of 168 pediatric patients with complicated sinusitis with periorbital complications presenting at a single institution from 2008 to 2018 was performed. Demographics, disease characteristics, in-hospital management, and outcomes were recorded and analyzed.
RESULTS
The most common complication was orbital cellulitis, seen in 49% of children. Surgical intervention occurred in 49% of patients, with 36% receiving medical therapy followed by surgery (MTS). Chandler I patients underwent surgical intervention 30% of the time, Chandler II patients 29%, and Chandler III patients 83%. Nineteen percent of initially nonoperative patients started on ampicillin-sulbactam required MTS vs 57% of those started on other antibiotic regimens ( = .01). Twelve percent of initially nonoperative Chandler I to II patients started on ampicillin-sulbactam needed MTS vs 40% started on other antibiotic regimens. Hospital charges for operative patients were $45,056 vs $14,311 for nonoperative patients ( < .01). Hospital charges for patients with surgery followed by medical therapy (SMT) were $45,563 vs $44,393 for MTS ( = .92).
CONCLUSION
Nonoperative early stage patients started on ampicillin-sulbactam had a lower risk of MTS. MTS did not cost significantly more than SMT, and there were no significant outcome differences seen.
Topics: Administration, Intravenous; Ampicillin; Anti-Bacterial Agents; Child; Combined Modality Therapy; Female; Hospital Charges; Hospitals, Pediatric; Humans; Male; Ohio; Orbital Cellulitis; Sinusitis; Sulbactam; Treatment Outcome
PubMed: 32396416
DOI: 10.1177/0194599820918832 -
Paediatric Drugs Dec 2019Orbital and preseptal cellulitis are most commonly caused by organisms that originate in the upper respiratory tract or from the skin. There is significant variation in... (Review)
Review
Orbital and preseptal cellulitis are most commonly caused by organisms that originate in the upper respiratory tract or from the skin. There is significant variation in antibiotics used, but ampicillin-sulbactam, ceftriaxone, metronidazole, clindamycin, amoxicillin, amoxicillin-clavulanate, cefuroxime, and vancomycin are often used in the treatment of these infections. The choice of antibiotic, however, is only one consideration. It is also important that antibiotics are dosed to optimize their pharmacodynamic target attainment. Like other serious infections, therapy can be transitioned from initial intravenous therapy to an oral regimen when there are clear signs of clinical and laboratory improvement. The total duration of therapy for these infections have also been decreasing in recent years with durations of approximately 2 weeks becoming more common, even for orbital or subperiosteal infections. Antimicrobial stewardship programs can work closely with providers who manage these infections to create pathways, choose optimal antibiotics and dosage, transition from intravenous to oral therapy, and provide shortest effective durations.
Topics: Anti-Bacterial Agents; Antimicrobial Stewardship; Child; Humans; Orbital Cellulitis
PubMed: 31608423
DOI: 10.1007/s40272-019-00357-3 -
Journal of Cosmetic Dermatology Apr 2020Hyaluronic acid (HA) is a popular, nonsurgical, temporary technique that is commonly used in the periocular region to restore volume in areas that have undergone volume...
BACKGROUND
Hyaluronic acid (HA) is a popular, nonsurgical, temporary technique that is commonly used in the periocular region to restore volume in areas that have undergone volume loss, as well as adjusting the height and contour of the eyebrow.
AIMS
Due to the location of glands, nerves, and vasculature, the facial anatomy should be well understood to avoid injections into areas that may result in complications.
PATIENT/METHODS
A 54-year-old woman presented for a cosmetic consultation to address "puffy eyelids". She states she had HA filler injected along the orbital ridge inferior to the eyebrow and medially at the glabellar crease two years prior. Two months after her injection, she began to notice upper eyelid edema, xerophthalmia, and dryness of her nasal mucous membranes. Extensive evaluation and imaging were done by physicians of different specialties with a negative workup.
RESULTS
A total of 60 units of hyaluronidase were injected into the areas of previous filler placement over a three-week period. This resulted in complete resolution of the patient's presenting symptoms.
CONCLUSION
Familiarity with potential adverse events is arguably the most important aspect of treating patients with HA filler. The anatomy of the orbit and lacrimal system are important to keep in mind when evaluating symptoms related to possible long-term complications of retained filler injections. Reporting this case should raise awareness about this potential adverse event and further explain the delicate anatomy of the periorbital area.
Topics: Dermal Fillers; Edema; Eyelid Diseases; Eyelids; Female; Humans; Hyaluronic Acid; Hyaluronoglucosaminidase; Middle Aged; Rejuvenation; Treatment Outcome; Xerophthalmia
PubMed: 31441981
DOI: 10.1111/jocd.13111 -
World Journal of Plastic Surgery May 2020Several methods have been used to decrease the periorbital edema and ecchymosis after rhinoplasty. In this study, we evaluated the efficacy of hirudoid and dexamethasone...
BACKGROUND
Several methods have been used to decrease the periorbital edema and ecchymosis after rhinoplasty. In this study, we evaluated the efficacy of hirudoid and dexamethasone in reduction of the periorbital edema and ecchymosis.
METHODS
Sixty patients who underwent primary rhinoplasty were randomly divided into 3 groups. Group H received hirudoid cream, 3 times per day for 5 days from postoperative-day (POD). Group D received 10 mg of dexamethasone IV, immediately before surgery; and group C (control) received neither dexamethasone nor hirudoid. Two surgeons who were unaware of administered medications rated the severity of edema and intensity of ecchymosis, on 2, 5, and 7 POD.
RESULTS
On 2 POD, the edema in group D was significantly lower than groups H and C; but there was no significant difference in severity and intensity of ecchymosis between 3 groups. On 7 POD, the intensity of ecchymosis was significantly lower in group H in comparison to group C. When the difference between 2 and 7 POD was evaluated, the resolution of severity of edema and intensity of ecchymosis was significantly better in group H (<0.001).
CONCLUSION
Hirudoid was shown to be effective in reducing edema and ecchymosis after rhinoplasty. The use of dexamethasone was effective in prevention of periorbital edema at early postoperative days, but it was not effective on resolution of ecchymosis.
PubMed: 32934922
DOI: 10.29252/wjps.9.2.128 -
Ear, Nose, & Throat Journal May 2021The size, shape, and symmetry of the nose contribute significantly to the facial aesthetic, so it is understandable why rhinoplasty is one of the most popular cosmetic...
BACKGROUND
The size, shape, and symmetry of the nose contribute significantly to the facial aesthetic, so it is understandable why rhinoplasty is one of the most popular cosmetic procedures undertaken nowadays. Several factors are associated with the rates of both success and postoperative complications of rhinoplasty.
AIM
To determine the relationship between nasal skin thickness and postoperative periorbital ecchymosis and edema among patients who underwent rhinoplasty at King Abdulaziz University Hospital.
METHODOLOGY
A prospective study was conducted among all patients operated on for rhinoplasty at King Abdulaziz University Hospital in the Department of Otolaryngology, Riyadh, Saudi Arabia, between May and December 2018. To determine the relationship between nasal skin thickness and postoperative periorbital edema and ecchymosis, demographic data (gender, age), mean nasal skin thickness, surgical factors (time of surgery, extent of intraoperative bleeding), and scoring for periorbital ecchymosis and edema were obtained. The statistical analysis was done by comparing means and frequency using analysis of variance.
RESULTS
A total of 54 patients participated in this study with ages ranging from 19 to 33 years and a mean age of 24.43. According to this study, postoperative edema presentation on the first, third, and seventh days upon examination was higher among patients with thicker nasal skin (6 mm), and results are statistically significant ( = .001). Ecchymosis was also higher among patients with thicker nasal skin (6 mm) on day 1 examinations, but there was no correlation with nasal thickness during the other examinations. Therefore, there is some degree of correlation between ecchymosis and nasal skin thickness overall, but the results are not significant ( = .26).
CONCLUSION
This study concludes that the severity of edema and ecchymosis correlates with nasal skin thickness. The degree of edema and ecchymosis was higher during the initial postoperative examinations, but following that, it was reduced and completely diminished by the 21st day post-surgery.
Topics: Adult; Ecchymosis; Edema; Female; Humans; Male; Nose; Postoperative Complications; Postoperative Period; Predictive Value of Tests; Prognosis; Prospective Studies; Rhinoplasty; Skin; Skinfold Thickness; Treatment Outcome; Young Adult
PubMed: 31566001
DOI: 10.1177/0145561319868452 -
Indian Journal of Otolaryngology and... Mar 2020To study the clinical presentation and management outcomes in a series of patients with invasive rhino-orbital-cerebral mucormycosis presenting to a tertiary care center...
To study the clinical presentation and management outcomes in a series of patients with invasive rhino-orbital-cerebral mucormycosis presenting to a tertiary care center in central India. Medical records of eleven consecutive cases of invasive rhino-orbital-cerebral mucormycosis were reviewed. All clinically diagnosed cases, confirmed on microbiological examination were included. Their demographic data, clinical manifestations, underlying systemic conditions, microbiological and radiological reports, medical treatments, and surgical interventions were recorded and analyzed. There were nine male and two female patients with mean age of 46.8 years. Uncontrolled diabetes mellitus was noted in all patients. One patient had history of renal transplantation. The common presenting features were-ophthalmoplegia (73%), diminution of vision, (64%) proptosis (36%) and periorbital swelling (27%). CT scan/MRI revealed sino-orbital involvement in eight cases and rhino-orbital-cerebral involvement in three cases. Ethmoid sinus (100%) was the commonest paranasal sinus involved. KOH preparation and histopathology revealed broad aseptate filamentous fungi branching at right angles with tissue invasion. Culture on sabouraud's dextrose agar showed growth of mucor species. All patients received intravenous amphotericin B and had undergone radical debridement of involved sinuses. The mean duration of follow up was 13 months. All survived except three, who developed cerebral mucormycosis. Rhino-orbital-cerebral mucormycosis is a fetal fungal infection requiring multidisciplinary approach. Uncontrolled diabetes mellitus is the main predisposing factor. Early diagnosis, reversal of predisposing co-morbidities, aggressive medical and surgical management are vital in managing this highly aggressive disease.
PubMed: 32158665
DOI: 10.1007/s12070-019-01774-z -
Brazilian Journal of Otorhinolaryngology 2023The present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz &...
OBJECTIVE
The present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability.
METHODS
Clinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae.
RESULTS
143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler's and Mortimore & Wormald's classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-value < 0.0001). Complications were present at higher rates in the OA group compared to the other three groups.
CONCLUSIONS
ARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima's classification system proved valid, simple, and effective for categorizing orbital complications of ARS.
Topics: Humans; Retrospective Studies; Abscess; Rhinitis; Orbital Cellulitis; Sinusitis; Acute Disease; Orbital Diseases
PubMed: 37678009
DOI: 10.1016/j.bjorl.2023.101316