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Inflammatory Markers as Predictors for Prolonged Duration of Hospitalization in Maxillofacial Infections. J Clin Med 2023; 12:jcm12030871. [PMID: 36769517 PMCID: PMC9917481 DOI: 10.3390/jcm12030871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
Despite the progress made in diagnosing and treating maxillofacial infections, the course of infection can be unpredictable, leading to severe complications, prolonged hospitalization, and substantial financial costs to health care services. It is important to determine whether various serum inflammatory marker levels on admission may predict a prolonged hospital stay in these patients. To analyze the role of CRP, white blood cell count (WBC), and neutrophil-to-lymphocyte ratio (NLR) in predicting the prolonged duration of hospitalization in maxillofacial infections, we performed a retrospective study by collecting paper records data from 108 patients who met our inclusion criteria. The patients were divided into two groups according to the duration of hospitalization (group A < 5 days and group B ≥ 5 days). The predictor variables were CRP, WBC, and NLR, and the outcome variable was the duration of hospitalization. This study confirmed a positive linear correlation (p < 0.001) between the predictors and the outcome variable. The optimal cut-off values for WBC are 11,030 white blood cells/μL and 63 mg/L for CRP. Levels that exceed these optimal values predict a duration of hospitalization of over (≥) 5 days. Serum WBC and CRP on admission may predict the duration of hospitalization in patients with MFI.
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Ahmadzada S, Rao A, Ghazavi H. Necrotizing fasciitis of the face: current concepts in cause, diagnosis and management. Curr Opin Otolaryngol Head Neck Surg 2022; 30:270-275. [PMID: 35906981 DOI: 10.1097/moo.0000000000000820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Necrotizing fasciitis of the face is uncommon but potentially life threatening. With adequate multidisciplinary treatment, mortality and has significantly improved. This article highlights current concepts and supporting literature in the management of facial necrotizing fasciitis. RECENT FINDINGS Management of necrotizing fasciitis involving the face requires a multisciplinary team approach, including early medical and surgical intervention. With early haemodynamic support, broad spectrum antibiotics and aggressive surgical debridement, mortality has reduced significantly. Soft-tissue reconstruction can be effectively utilized once the infection has been adequately treated. Although some adjunctive treatment such as vacuum assisted closure dressing has shown to be of benefit, other treatments such as hyperbaric oxygen remains controversial. SUMMARY Necrotizing fasciitis is an aggressive soft tissue involving that rapidly spreads along fascial planes. Necrotizing fasciitis involving the face is rare owing to its rich blood supply but is also difficult to manage due to the complex regional anatomy. Common sources are odontogenic, sinugenic, peritonsillar or salivary gland infections and often polymicrobial. The principles of treatment include early and aggressive haemodynamic support, broad spectrum antibiotics and aggressive surgical debridement. Often times repeat debridements following close monitoring is required. Reconstructive options are viable only after the infection has been adequately treated. Although mortality has significantly improved, mediastinal involvement, multiple comorbidities and delayed treatment confers a worse prognosis.
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Affiliation(s)
- Sejad Ahmadzada
- University of Sydney, Sydney
- Department of Otolaryngology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Amshuman Rao
- University of Sydney, Sydney
- Department of Otolaryngology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Hossein Ghazavi
- Department of Otolaryngology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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Odontogenic Maxillofacial Space Infections: A 5-Year Retrospective Review in Navi Mumbai. J Maxillofac Oral Surg 2018; 18:345-353. [PMID: 31371872 DOI: 10.1007/s12663-018-1152-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022] Open
Abstract
Purpose The aim of this study is to comprehensively review and analyse pure odontogenic maxillofacial space infections in a tertiary care hospital in Navi Mumbai over a period of 5 years. Methods A retrospective analysis of 315 patients treated at Dr. D. Y. Patil Dental College and Hospital at Nerul, Navi Mumbai, from January 2007 to December 2011 was done. Multiple variables were analysed. Localised infections like dentoalveolar infections without space involvement and infection of non-odontogenic cause were excluded from the study. Results Analysis of the records was done. Majority of patients were from lower socioeconomic background and were daily wage workers who had either consulted a general physician or a general dental practitioner or had self-medicated themselves before presenting to us with acute symptoms. Early recognition and prompt treatment involving intravenous antibiotics with extraction of involved tooth/teeth and incision and drainage helped in resolution of infections in a span of 72 h. Medically compromised patients had longer duration of hospital stay as compared to the patients who had no underlying medical condition. Majority of space infections involved multiple spaces and local anaesthesia with sedation was found to be the satisfactory mode of anaesthesia. Complications were very few. Conclusion We concurred that any form of odontogenic maxillofacial space infection should be rendered prompt and aggressive treatment and hospitalisation should be recommended wherever required.
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Viviano M, Addamo A, Cocca S. A case of bisphosphonate-related osteonecrosis of the jaw with a particularly unfavourable course: a case report. J Korean Assoc Oral Maxillofac Surg 2017; 43:272-275. [PMID: 28875143 PMCID: PMC5583203 DOI: 10.5125/jkaoms.2017.43.4.272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/28/2016] [Accepted: 11/10/2016] [Indexed: 11/15/2022] Open
Abstract
Bisphosphonates are drugs used to treat osteoclast-mediated bone resorption, including osteoporosis, Paget disease, multiple myeloma, cancer-related osteolysis, and malignant hypercalcemia. The use of these drugs has increased in recent years as have their complications, especially bisphosphonate-related osteonecrosis of the jaw (BRONJ), which more frequently affects the mandible. Here we report a case of BRONJ with a particularly unfavorable course due to cervical inflammation that developed into necrotizing fasciitis, followed by multiorgan involvement leading to septic shock and death.
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Affiliation(s)
- Massimo Viviano
- Department of Medical Biotechnologies, Dentistry Clinic, University of Siena, Siena, Italy
| | - Alessandra Addamo
- Department of Medical Biotechnologies, Dentistry Clinic, University of Siena, Siena, Italy
| | - Serena Cocca
- Department of Medicine, Surgery and Neurosciences, ENT Clinic, University of Siena, Siena, Italy
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Bali RK, Sharma P, Gaba S, Kaur A, Ghanghas P. A review of complications of odontogenic infections. Natl J Maxillofac Surg 2015; 6:136-43. [PMID: 27390486 PMCID: PMC4922222 DOI: 10.4103/0975-5950.183867] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Life-threatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. Complications include airway obstruction, mediastinitis, necrotizing fascitis, cavernous sinus thrombosis, sepsis, thoracic empyema, Lemierre's syndrome, cerebral abscess, orbital abscess, and osteomyelitis. The incidence of these "space infections" has been greatly reduced by modern antibiotic therapy. However, serious morbidity and even fatalities continue to occur. This study reviews complications of odontogenic infections. The search done was based on PubMed and Google Scholar, and an extensive published work search was undertaken. Advanced MEDLINE search was performed using the terms "odontogenic infections," "complications," and "risk factors."
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Affiliation(s)
- Rishi Kumar Bali
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Parveen Sharma
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Shivani Gaba
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Avneet Kaur
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Priya Ghanghas
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
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Sarna T, Sengupta T, Miloro M, Kolokythas A. Cervical Necrotizing Fasciitis With Descending Mediastinitis: Literature Review and Case Report. J Oral Maxillofac Surg 2012; 70:1342-50. [DOI: 10.1016/j.joms.2011.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 10/17/2022]
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Zhang C, Tang Y, Zheng M, Yang J, Zhu G, Zhou H, Zhang Z, Liang X. Maxillofacial space infection experience in West China: a retrospective study of 212 cases. Int J Infect Dis 2009; 14:e414-7. [PMID: 19889560 DOI: 10.1016/j.ijid.2009.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 07/08/2009] [Accepted: 08/16/2009] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Our objectives were to analyze the clinical features of maxillofacial space infection (MSI) patients admitted to the West China Hospital of Stomatology over a five-year period, and to identify potential risk factors associated with life-threatening complications. METHODS A retrospective medical chart review was performed and the sociodemographic and clinical characteristics of patients with MSI were evaluated. RESULTS A total of 212 patients were enrolled in this study, including 125 males (59.0%) and 87 females (41.0%), with an age range of 1-88 years (median 47.5 years). The most common cause of MSI was odontogenic infection (56.1%). The submandibular space was the space most commonly involved in both single space and multiple space infections (37.5% and 29.1%, respectively). One hundred and two patients (48.1%) self-medicated before admission, and the time from onset of symptoms until presentation was longer in those who self-medicated compared with those who did not (p=0.028). Fifty-seven patients (26.9%) had life-threatening complications and six died (2.8%). In multivariate analysis, age, self-medication, admission temperature, respiratory difficulty, and underlying diseases were found to be risk factors for life-threatening complications. The most common occupation of the patients was farmer (54.7%). Among the farmers, 72.4% had an odontogenic etiology; however, 91.7% of the farmers with odontogenic space infections had not undergone dental treatment before admission. CONCLUSIONS Our experience suggests that the management of MSI should be more aggressive when the above risk factors are present, in order to avoid life-threatening complications. In addition, considering the poor medical conditions in the rural areas of West China, standard dental care and services should be provided in the future to replace self-medication.
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Affiliation(s)
- Chunxu Zhang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People's Republic of China
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Lee JT, Hsiao HT, Tzeng SG. Facial necrotizing fasciitis secondary to accidental bite of the upper lip. J Emerg Med 2008; 41:e5-8. [PMID: 18514470 DOI: 10.1016/j.jemermed.2007.11.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 04/02/2007] [Accepted: 11/06/2007] [Indexed: 11/16/2022]
Abstract
We describe a case with facial wounds over the left upper lip that became contaminated with saliva. A facial necrotizing fasciitis developed 2 days after injury. This produced a serious and almost fatal infection.
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Affiliation(s)
- Jui-Tien Lee
- Department of Plastic and Reconstructive Surgery, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan
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Abstract
PURPOSE To document the step-by-step reconstructive surgical rehabilitation, over a 12-month period, of a patient with severe periocular necrotising fasciitis. METHODS This is a retrospective interventional case note review of a 68-year-old man who developed necrotising fasciitis a few days after an insect bite. He had severe facial cellulitis with subsequent necrosis of all four eyelids despite broad spectrum antibiotics. RESULTS The initial management included performing a wide surgical debridement, with the removal of infected and necrotic tissue extending bilaterally from the forehead to the mouth. Split skin grafts were used to cover the extensive tissue defects. Subsequent horizontal eyelid shortening and full-thickness skin was required to correct severe cicatricial ectropions, eyelid displacement and improve lagophthalmos. CONCLUSIONS Necrotising fasciitis is an acute fulminant infection of the subcutaneous fat and deep fascia. The initial appearance may look like cellulitis but necrosis quickly follows. Facial disease with extensive periocular involvement represents a significant management challenge.
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Affiliation(s)
- Cornelia Poitelea
- Department of Ophthalmology, Eastbourne District General Hospital, East Sussex, U.K.
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Abstract
Cervicofacial necrotizing fasciitis is a necrotizing soft tissue infection of face and neck spreading at the level of fascia. It has been described as a putrid ulcer, phagedaena, and hospital gangrene. It has a high mortality rate, and presents a challenge to anesthesiologists who must secure an airway to deliver anesthesia safely. We report a case of cervicofacial necrotizing fasciitis in which the patient underwent repeated radical surgical debridement of face and neck, including a mandibulectomy. These critically ill patients often present with sepsis and multiple system organ failure. Extensive preoperative evaluation, invasive monitoring, and possibly the use of vasopressors and inotropes are essential in treating these patients. The tracheas of these patients should remain intubated after initial debridement. Tracheostomy should be performed early. Antibiotic therapy, nutritional support, early debridement, and hyperbaric oxygen therapy all help to decrease mortality in these patients.
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Affiliation(s)
- Mehmood A Durrani
- Department of Anesthesiology, West Virginia University Hospital, Morgantown, WV 26506-9134, USA.
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Umeda M, Minamikawa T, Komatsubara H, Shibuya Y, Yokoo S, Komori T. Necrotizing fasciitis caused by dental infection: a retrospective analysis of 9 cases and a review of the literature. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:283-90. [PMID: 12627098 DOI: 10.1067/moe.2003.85] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Necrotizing fasciitis of the head and neck is an uncommon, potentially fatal soft tissue infection characterized by extensive necrosis and gas formation in the subcutaneous tissue and fascia. The aims of this study were to describe the condition of this rare disease and to find factors affecting the mortality. STUDY DESIGN Nine of our new cases and 125 reported cases in the English-language literature with necrotizing fasciitis of dental origin were reviewed. RESULTS Two of our 9 patients had some form of systemic disease such as diabetes, cardiac insufficiency, renal failure, or cerebral infarction, whereas the other 7 had no particular general complications. A computed tomography examination was useful for detecting gas formation in the deep neck. All 9 patients underwent extensive debridement within 24 hours, and good results were obtained. In contrast, 24 of the 125 reviewed patients died despite therapy. Factors affecting the mortality were associated diseases such as diabetes or alcohol abuse, delay of surgery, and the complication mediastinitis. CONCLUSION Necrotizing fasciitis is still a potentially fatal disease. Early and aggressive debridement may reduce mortality.
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Affiliation(s)
- Masahiro Umeda
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kobe University.
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Nakamura S, Inui M, Nakase M, Kamei T, Higuchi Y, Goto A, Tagawa T. Clostridial deep neck infection developed after extraction of a tooth: a case report and review of the literature in Japan. Oral Dis 2002; 8:224-6. [PMID: 12206404 DOI: 10.1034/j.1601-0825.2002.01801.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A rare case of severe deep neck infection caused by clostridia after extraction of the left lower canine is presented. The patient was a 63-year-old Japanese woman who had a history of diabetes. The pertinent literature in Japan is reviewed and discussed.
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Affiliation(s)
- Shinnosuke Nakamura
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Mie University, Tsu, Japan.
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Safak MA, Haberal I, Kiliç D, Göçmen H. Necrotizing Fasciitis Secondary to Peritonsillar Abscess: A New Case and Review of Eight Earlier Cases. EAR, NOSE & THROAT JOURNAL 2001. [DOI: 10.1177/014556130108001111] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Necrotizing fasciitis is a potentially fatal soft-tissue infection that occurs only rarely in the head and neck region. Broad-spectrum parenteral antibiotics and surgical debridement are the mainstays of treatment. Until now, only eight cases of necrotizing fasciitis secondary to peritonsillar abscess have been described in the English-language literature. In this article, we report a new case that occurred in an otherwise healthy 43-year-old woman. In addition to standard treatment, the patient underwent a hot tonsillectomy. After 23 months of follow-up, she is in good health.
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Affiliation(s)
- Mustafa Asim Safak
- ENT Clinic, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ilknur Haberal
- ENT Clinic, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
| | - Dilek Kiliç
- Infectious Diseases Clinic, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
| | - Hakan Göçmen
- ENT Clinic, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
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Obiechina AE, Arotiba JT, Fasola AO. Necrotizing fasciitis of odontogenic origin in Ibadan, Nigeria. Br J Oral Maxillofac Surg 2001; 39:122-6. [PMID: 11286446 DOI: 10.1054/bjom.2000.0585] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We reviewed eight patients with necrotizing fasciitis of odontogenic origin. There were three women and five men, mean age 58 (range 46-72), and none had any associated medical condition such as diabetes. All cases had symptoms of toothache for a mean duration of 34 days (range 26-42) before they sought treatment. Infection originated in the molar teeth region, and initially presented as an odontogenic or periodontal abscess. The clinical features of necrotizing fasciitis became apparent only after the superficial fascia had been invaded. The transient unusually reddish hue for a dark skin might be explained by the fact the deep fascia and muscles were affected before the superficial fascia and skin. Necrosis of the skin began in the submandibular region and progressed downwards. The necrotic area was less than the extent of infection. Antimicrobial treatment, debridement, and fasciotomy improved healing. Delay before appropriate treatment had an adverse affect on outcome, and one patient died.
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Affiliation(s)
- A E Obiechina
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria
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Whitesides L, Cotto-Cumba C, Myers RA. Cervical necrotizing fasciitis of odontogenic origin: a case report and review of 12 cases. J Oral Maxillofac Surg 2000; 58:144-51; discussion 152. [PMID: 10670592 DOI: 10.1016/s0278-2391(00)90327-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE This article reviews the demographics, presentation, cause, clinical findings, and treatment of 12 cases of cervical necrotizing fasciitis of odontogenic origin. PATIENTS AND METHODS A retrospective chart review of 12 cases treated between 1987 and 1997 was done. RESULTS Most cases resulted from an abscessed mandibular molar. The most common significant medical conditions in the patient's history were diabetes, hypertension, obesity, and substance abuse. All patients were treated surgically within 24 hours of admission. Hyperbaric oxygen (HBO) was used as adjunctive treatment in all cases. The average length of hospital stay was 31 days. All patients recovered. CONCLUSION Early surgical intervention and the use of HBO decreases morbidity and improves the clinical outcome.
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Affiliation(s)
- L Whitesides
- Hyperbaric Medicine, R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore 21201, USA
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Harper JL. Discussion. J Oral Maxillofac Surg 2000. [DOI: 10.1016/s0278-2391(00)90328-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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