-
The British Journal of Oral &... Apr 2019The role of corticosteroids in the management of cervicofacial infections continues to cause controversy. Systemic anti-inflammatory and immunomodulatory effects that...
The role of corticosteroids in the management of cervicofacial infections continues to cause controversy. Systemic anti-inflammatory and immunomodulatory effects that reduce swelling and improve symptoms in the head and neck may make these agents an effective addition to the antibiotics used and to surgical management, although this same effect may dull the physiological response to infection, and allow infections to progress. We have systematically reviewed the evidence for the use of corticosteroids in common cervicofacial infections following the PRISMA guidelines. MeSH terms included "head", "neck", "infection", and "glucocorticoid". In total, 31 papers were identified. Eight reported the use of corticosteroids for peritonsillar abscess (PTA), 10 for pharyngitis, four for deep neck space infection (DNSI), four for periorbital cellulitis, and five for supraglottitis. Whilst there is an established evidence base for their use in the treatment of PTA and pharyngitis, other indications need further study, and we highlight the potential pitfalls. The evidence suggests that the use of adjunctive, short-term, high-dose corticosteroids in cervicofacial infections may be safe and effective.
Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Head; Humans; Infections; Neck; Peritonsillar Abscess; Pharyngitis
PubMed: 30770139
DOI: 10.1016/j.bjoms.2019.01.010 -
Ophthalmic Plastic and Reconstructive... 2018To report surgical site infection (SSI) rates of eviscerations and enucleations with implants performed without perioperative intravenous (IV) antibiotics or... (Review)
Review
PURPOSE
To report surgical site infection (SSI) rates of eviscerations and enucleations with implants performed without perioperative intravenous (IV) antibiotics or postoperative oral antibiotics, and to give SSI prevention recommendations.
METHODS
A single-center retrospective chart review was performed after obtaining institutional review board approval. Charts were found by Current Procedural Terminology codes. Demographics, surgical indication, procedure, implant, antibiotic use, and postoperative course were recorded. SSIs occurring within 30 days after surgery were reviewed and postoperative infection rates were determined.
RESULTS
Four hundred eighty-one cases from January 1999 to December 2015 were analyzed. There were 102 eviscerations with implants, 314 enucleations with implants, 23 enucleations without implants, 23 implant exchanges, 15 implants placed secondarily after enucleation, and 4 implant removals. Seventy cases (14.6%) were given perioperative IV antibiotics, and in this group one periorbital infection occurred unrelated to orbital surgery (1.4%). Of the 411 cases (85.4%) not given perioperative IV antibiotics, 1 of 87 eviscerations with implants developed an SSI (1.1%), 2 of 273 enucleations with implants developed SSIs (0.7%), and none of the 13 enucleations without implants developed SSIs.
CONCLUSIONS
To our knowledge, this is the first published case series reporting SSI rates of enucleations and eviscerations with implants performed without perioperative IV antibiotics or postoperative oral antibiotics. With infection rates comparing favorably to other case series where antibiotics were given, the routine use of perioperative IV antibiotics and postoperative oral antibiotics for enucleations and eviscerations may not be indicated.
Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Eye Diseases; Eye Enucleation; Eye Evisceration; Humans; Male; Middle Aged; Retrospective Studies; Surgical Wound Infection
PubMed: 28072612
DOI: 10.1097/IOP.0000000000000853 -
Plastic and Reconstructive Surgery Nov 2012The use of acellular dermal matrices has been well described in the scientific literature since the early 1990 s and has been utilized for multiple applications in the... (Review)
Review
BACKGROUND
The use of acellular dermal matrices has been well described in the scientific literature since the early 1990 s and has been utilized for multiple applications in the head and neck for both aesthetic and reconstructive efforts.
METHODS
After systematically searching the PubMed database and following further refinement (based on the authors' inclusion and exclusion criteria), the authors identified 30 studies that provided information about patients who had undergone head and neck reconstruction with the use of acellular dermal matrix. Studies had to report quantifiable objective results in patients who were older than 1 year and younger than 90 years. The authors excluded single case reports, studies with fewer than 10 patients, and studies not published in English.
RESULTS
The optimal material used as an implant for reconstruction possesses the following properties: facilitation of vascular ingrowth, decreased propensity to incite inflammation, biologic inertness, resistance to infection, and ease of handling. Acellular dermal matrix possesses many of these properties and is utilized in reconstructing nasal soft tissue and skeletal support, tympanic membrane, periorbital soft tissue, extraoral and intraoral defects, oropharyngeal defects, dura mater, and soft-tissue deficits from parotidectomy. Furthermore, it is used to assist in preventing Frey syndrome following parotidectomy and surgical treatment of facial paralysis.
CONCLUSIONS
Use of acellular dermal matrix for head and neck reconstruction has expanded exponentially and is validated in many studies. Further prospective randomized control trials are warranted to further investigate the efficacy of acellular dermal matrix in head and neck reconstruction.
Topics: Absorbable Implants; Acellular Dermis; Collagen; Ear; Esthetics; Face; Head; Humans; Neck; Ophthalmologic Surgical Procedures; Oral Surgical Procedures; Parotid Gland; Postoperative Complications; Plastic Surgery Procedures; Rhinoplasty; Treatment Outcome
PubMed: 23096983
DOI: 10.1097/PRS.0b013e31825eff7a -
Acta Ophthalmologica Nov 2013Necrotizing fasciitis (NF) is a severe infection characterized by rapidly progressing necrotizing infection of the superficial fascia with secondary necrosis of the... (Review)
Review
Necrotizing fasciitis (NF) is a severe infection characterized by rapidly progressing necrotizing infection of the superficial fascia with secondary necrosis of the overlying skin. Periorbital NF is uncommon because of the excellent blood supply to that area; nevertheless, it can sometimes result in death. The aim of this study is to present a systematic review and analyse the factors associated with death. We carried out a systematic literature review of all cases of periorbital NF published in the English language over the past 20 years and present the predisposing conditions, triggering factors, organisms causing NF, presence or absence of toxic shock and the prognosis. The significance of various risk factors leading to death was analysed. We traced a total of 94 patients with periorbital NF from 61 reports. There were no triggering incidents in 25 cases (26.6%). In 48 cases (51.1%), the organism responsible for NF was Group A beta haemolytic Streptococcus. Toxic shock occurred in 29 (30.9%) cases, and loss of vision in 13 (13.8%). Surgical debridement was carried out in 80 (85.1%) cases. There were eight cases (8.5%) of death. This seems to be less than previously reported figures. Toxic shock syndrome (p < 0.001), type 1 infections (p = 0.018), facial involvement (p = 0.032) and blindness because of periorbital NF (p = 0.035) were significantly associated with mortality. Mortality caused by NF arising from the periorbital area seems to be on the decline. However, it is important to recognize it early and institute treatment to avoid toxic shock that leads to death. Type 1 infections, although rare in periorbital area, are not associated with immunocompromised status and nevertheless carry a significant risk of mortality. Major morbidity is loss of vision followed by soft-tissue defects affecting function and cosmesis.
Topics: Eye Infections, Bacterial; Fasciitis, Necrotizing; Humans; Necrosis; Orbital Diseases; Risk Factors; Skin; Streptococcal Infections
PubMed: 22520175
DOI: 10.1111/j.1755-3768.2012.02420.x -
American Journal of Rhinology & Allergy 2012Pott's puffy tumor (PPT) is a frontal subperiosteal abscess associated with underlying frontal bone osteomyelitis. It represents a well-known source of sinogenic... (Review)
Review
BACKGROUND
Pott's puffy tumor (PPT) is a frontal subperiosteal abscess associated with underlying frontal bone osteomyelitis. It represents a well-known source of sinogenic intracranial infection, but the orbital complications related to this entity are rarely reported. The goal of this study was to characterize the orbital involvement in PPT.
METHODS
We performed a systematic review through a Medline search (1950-2010). The authors reviewed all cases of PPT, selecting those explicitly describing orbital complications associated with PPT.
RESULTS
We screened 139 articles, of which 93 reported cases of PPT. Of these, 35 articles described a total of 42 cases presenting simultaneous orbital complications. Eyelid and/or periorbital edema was the most common finding in patients with orbital involvement, and preseptal cellulitis is by far the most prevalent orbital complication in PPT. Postseptal involvement (orbital cellulitis, subperiosteal abscess of the orbit, and orbital abscess) is much rarer. Although treatment of the classic PPT is surgical, only a minority of patients with orbital infection required orbital drainage. Most reported patients made a full recovery, without permanent sequelae.
CONCLUSION
Orbital infections are possible in patients with PPT. In contrast to surgical treatment of the frontal subperiosteal abscess, the orbital complications can be treated conservatively most of the time. Early diagnosis and aggressive therapy of the underling PPT are essential to avoid severe local or systemic complications.
Topics: Adolescent; Adult; Bacterial Infections; Child; Child, Preschool; Edema; Eyelids; Humans; Infant; Infant, Newborn; Middle Aged; Orbital Diseases; Pott Puffy Tumor; Young Adult
PubMed: 22487279
DOI: 10.2500/ajra.2012.26.3746 -
The British Journal of Ophthalmology Dec 2010Necrotising fasciitis involving the periorbita is a devastating infection. Potential outcomes range from severe disfigurement, loss of the eye and even to death. Early... (Review)
Review
Necrotising fasciitis involving the periorbita is a devastating infection. Potential outcomes range from severe disfigurement, loss of the eye and even to death. Early recognition is critical, although its initially non-distinctive appearance frequently delays diagnosis and treatment. Herein, the authors have performed a systematic review of previously published cases including clinical features, diagnoses and differential diagnoses, pathological characteristics and management. Periorbital necrotising fasciitis is seen mainly in adults with a female predominance (54%); about one-half (47%) of the patients were previously healthy. The infection can follow local blunt trauma (17%), penetrating injuries (22%) and face surgery (11%), but in about one-third of cases (28%) no cause was identified. Non-specific erythema and localised painful swelling of the eyelids characterise the earliest manifestation of the disease, followed by formation of blisters and necrosis of the periorbital skin and subcutaneous tissues. The causative organism in periorbital infection was mainly β-haemolytic Streptococcus alone (50%), occasionally in combination with Staphylococcus aureus (18%). The overall mortality rate was 14.42%. The main risk factor for mortality was the type of causative organism, since all reported cases of death were caused by β-haemolytic Streptococcus alone or associated with other organisms. Unlike necrotising fasciitis affecting other body sites, there was not a strong correlation with age >50 years or the presence of associated chronic illness. Management of periorbital necrotising fasciitis is then based on early distinction of symptoms and signs and aggressive multidisciplinary treatment. Thus, the delay between initial debridement and initiating parenteral broad-spectrum antibiotic therapy should be considered the most critical factor influencing morbidity and mortality.
Topics: Anti-Bacterial Agents; Debridement; Diagnosis, Differential; Early Diagnosis; Eyelid Diseases; Fasciitis, Necrotizing; Female; Humans; Male; Risk Factors; Streptococcal Infections
PubMed: 19897473
DOI: 10.1136/bjo.2009.167486 -
Journal of Paediatrics and Child Health Jun 2006There are few detailed data on the age-specific incidence and clinical pattern of pneumococcal cellulitis in children. We conducted a retrospective review of cellulitis... (Review)
Review
AIM
There are few detailed data on the age-specific incidence and clinical pattern of pneumococcal cellulitis in children. We conducted a retrospective review of cellulitis as a subset of prospectively collected laboratory-identified invasive pneumococcal disease (IPD) and performed a systematic review of published literature.
METHODS
Prospective laboratory surveillance in urban regions of New South Wales, Australia, 1 June 1997-31 December 2001. Medical notes reviewed for each identified case and defined literature search strategy applied.
RESULTS
There were 1067 cases of IPD in children aged 0-17 years; 38 (3.3%) were cellulitis (32 periorbital, 6 buccal). Compared with other types of IPD, a greater proportion of cellulitis cases occur in children<2 years (30/38, 79% vs. 617/1029, 60.0%; P=0.004) in whom underlying illness was less common (0/30, 0% vs. 53/590, 9%; P=0.06). Initially, another diagnosis was made in 13 (34%) of cases; only five had a lumbar puncture, all normal. Of the 239 cases of pneumococcal cellulitis documented in the literature, 28 (11.7%) had the diagnosis made by means other than positive blood culture and 95% were facial or orbital with underlying illness (6%) and associated meningitis (1.9%) uncommon.
CONCLUSION
Cellulitis is an uncommon focus in IPD in children, and is almost always facial. Most cases occur under 2 years of age, are seldom associated with meningitis or other complications, and are frequently not recognised on admission.
Topics: Adolescent; Age Distribution; Cellulitis; Child; Child, Preschool; Female; Humans; Incidence; Infant; Male; New South Wales; Pneumococcal Infections; Population Surveillance; Retrospective Studies; Sex Distribution; Urban Population
PubMed: 16737477
DOI: 10.1111/j.1440-1754.2006.00872.x