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Passemard L, Hida S, Barrat A, Sakka L, Barthélémy I, Dang NP. Eyelid and periorbital necrotizing fasciitis, a severe preseptal infection, a systemic review of the literature and anatomical illustrations. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023:101498. [PMID: 37178871 DOI: 10.1016/j.jormas.2023.101498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
In necrotizing fasciitis, aggressive surgical debridement and broad-spectrum antibiotics are the cornerstone of treatment but cannot be proposed for the eyelid and periorbital area because of the risk of blindness, eyeball exposure and disfiguration. The aim of this review was to determine the most effective management of this severe infection while preserving eye function. A literature search of the PubMed, Cochrane Library, ScienceDirect and Embase databases was conducted for all articles published up to March 2022; 53 patients were included. Management was probabilistic, combining antibiotic therapy with skin (+/- orbicularis oculi muscle) debridement in 67.9 % of cases, and probabilistic antibiotic therapy alone in 16.9% of cases. Radical surgery with exenteration was performed in 11.1% of patients; 20.9% of patients had complete loss of vision, and 9.4% died of the disease. Aggressive debridement was rarely necessary possibly because of the anatomical particularities of this region.
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Affiliation(s)
- Léa Passemard
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France..
| | - Sarah Hida
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France..
| | - Antoine Barrat
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France..
| | - Laurent Sakka
- Laboratoire d'anatomie, Faculté de Médecine, Université d'Auvergne, 28, place Henri-Dunant, 63001 Clermont-Ferrand cedex 1, France..
| | - Isabelle Barthélémy
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France.; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Université d'Auvergne, Clermont-Ferrand, 63003, France..
| | - Nathalie Pham Dang
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France.; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Université d'Auvergne, Clermont-Ferrand, 63003, France..
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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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The acute necrotizing periorbital fasciitis. Clinical case. OPHTHALMOLOGY JOURNAL 2022. [DOI: 10.17816/ov100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: A rare severe, characterized by high mortality in some localizations (up to 70%) necrotizing periorbital fasciitis has not been described previously in the national literature.
AIM: to show a multidisciplinary approach to the treatment and rehabilitation of patients with periorbital necrotizing fasciitis on the example of the clinical case.
CLINICAL CASE: Patient with the acute necrotizing fasciitis of both eyelids, with the dissemination to the superficial face and neck fascies, the sepsis development is given. Monitoring of vital functions, homeostasis indicators, repeated inoculations, computed tomography, regular examination by an ophthalmologist included the control of visual functions, anterior and posterior segments, closure of the eye fissure. Conservative and surgical treatment applied by a multidisciplinary team is presented, which allowed to save the patients life, overpass the purulent-necrotic, and then the rough scar process and to achieve satisfactory anatomical and functional results.
CONCLUSION: Timely multidisciplinary treatment of periorbital necrotizing fasciitis is necessary for the life preservation, prevention of severe complications from the eye. With the threat of developing lagophthalmos, it is necessary to perform permanent blepharoraphy for 36 months after the first surgery and further surgical and pharmacological correction of scarring processes.
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Khan SA, Hussain A, Phelps PO. Current clinical diagnosis and management of orbital cellulitis. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1941876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sara A. Khan
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Ahsen Hussain
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul O. Phelps
- Department of Surgery, NorthShore University Health System, Glenview, IL, USA
- Department of Ophthalmology and Visual Science, University of Chicago Pritzker College of Medicine, Chicago, IL, USA
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McCabe GA, Hardy T, Campbell TG. Bilateral periorbital necrotising fasciitis associated with invasive group: a Streptococcus infection. BMJ Case Rep 2020; 13:13/12/e236800. [PMID: 33370943 DOI: 10.1136/bcr-2020-236800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A previously independent 56-year-old immunocompetent woman presented with septic shock in the setting of periorbital swelling and diffuse infiltrates on chest imaging. Blood cultures were positive for growth of group A Streptococcus (GAS). Broad spectrum antimicrobials were initiated with the inclusion of the antitoxin agent clindamycin. Necrosis of periorbital tissue was noted and surgical consultation was obtained. Débridement of both eyelids with skin grafting was performed. GAS was isolated from wound cultures and also observed on periorbital tissue microscopy. The final diagnosis was bilateral periorbital necrotising fasciitis (PONF) associated with invasive GAS infection. The patient had a prolonged intensive care unit course with input from multiple specialist teams. This case demonstrates the importance of early recognition and treatment of PONF, the profound systemic morbidity caused by these infections, and illustrates successful multidisciplinary teamwork.
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Affiliation(s)
- Grace Anne McCabe
- Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Thomas Hardy
- Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Thomas Gordon Campbell
- Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia .,Department of Surgery, University of Melbourne and Centre for Eye Research Australia, East Melbourne, Victoria, Australia
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Landeen KC, Mallory PW, Cervenka BP. Bilateral Ocular Necrotizing Fasciitis in an Immunosuppressed Patient on Prescription Eye Drops. Cureus 2020; 12:e9129. [PMID: 32789070 PMCID: PMC7417090 DOI: 10.7759/cureus.9129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Preseptal cellulitis is an infection of ocular tissue that is often unilateral and caused by extension of sinonasal disease. In rare instances it can lead to life-threatening necrotizing fasciitis. We present here a unique case of bilateral preseptal cellulitis incited by local conjunctivitis caused by prescription eye drops. The patient was immunosuppressed, which allowed her local inflammation to progress to severe infection and, ultimately, to necrotizing fasciitis. This necessitated serial debridement by ophthalmology and otolaryngology teams and a prolonged course of intravenous antibiotics monitored by an infectious disease team. Despite these interventions, the patient’s vision did not return to baseline and she had persistent cosmetic and functional deformity. This case is unique due to the inciting incident of new prescription eye drops, the patient’s immunosuppressed state leading to severity of infection, and the severe bilateral disease burden.
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Affiliation(s)
- Kelly C Landeen
- Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - Paul W Mallory
- Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, USA
| | - Brian P Cervenka
- Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, USA
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Ting CF, Lam J, Anastas C. Subgaleal haematoma as a cause of periorbital necrotising fasciitis: a case report. Orbit 2019; 39:143-146. [PMID: 31106630 DOI: 10.1080/01676830.2019.1606834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Subgaleal haematoma in adulthood and periorbital necrotising fasciitis are unusual occurrences that have not been reported together. We discuss the first observed case of a 35-year-old female with periorbital necrotising fasciitis postulated to be caused by subgaleal haematoma following head trauma that was successfully managed with antibiotics and surgery.
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Affiliation(s)
- Chloe Ft Ting
- Department of Ophthalmology, Fremantle Hospital, Perth, Australia
| | - Jonathan Lam
- Department of Ophthalmology, Fremantle Hospital, Perth, Australia
| | - Con Anastas
- Department of Ophthalmology, Fremantle Hospital, Perth, Australia
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8
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Chang P, Moreno-Coutiño G. Periocular dermatoses. Int J Womens Dermatol 2017; 3:206-218. [PMID: 29234715 PMCID: PMC5715233 DOI: 10.1016/j.ijwd.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 07/18/2017] [Accepted: 08/03/2017] [Indexed: 02/07/2023] Open
Abstract
The periocular area may be affected by infectious or noninfectious diseases such as inflammatory dermatoses, systemic disease, drug reactions, benign and malignant lesions, traumatic lesions, and esthetic complications. We present a review of the most common periocular dermatoses.
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Affiliation(s)
- P Chang
- Dermatology Service, Social Security General Hospital - IGSS, Guatemala City, Guatemala
| | - G Moreno-Coutiño
- Mycology Section, Department of Dermatology, Dr. Manuel Gea Gonzalez General Hospital, Mexico City, Mexico
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Periorbital Necrotizing Fasciitis Secondary to Candida parapsilosis and Streptococcus pyogenes. Ophthalmic Plast Reconstr Surg 2017; 33:S31-S33. [PMID: 25902389 DOI: 10.1097/iop.0000000000000476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Necrotizing fasciitis is most often caused by either polymicrobial bacterial infections or by Gram-positive organisms, such as Streptococcus or Staphylococcus; however, rare cases of fungal necrotizing fasciitis have been reported. Candida parapsilosis is an emerging fungal pathogen. This fungus grows in either a yeast or pseudohyphal form. C. parapsilosis has been reported to cause keratitis, intraocular infection, and seeding of frontalis slings. C. parapsilosis is a commensal of human skin and can be acquired by nosocomial spread. Necrotizing fasciitis due to Candida has rarely been reported, but to date C. parapsilosis has not been identified as the causative organism in necrotizing fasciitis. This is the first documented case of human periocular soft tissue infection by C. parapsilosis, and also the first report providing evidence of mycotic infection in a necrotizing fasciitis concurrently infected by Streptococcus pyogenes.
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Necrotizing Fasciitis of the Periorbital Region Complicated by Combined Central Retinal Artery Occlusion, Central Retinal Vein Occlusion, and Posterior Ciliary Occlusion. Ophthalmic Plast Reconstr Surg 2017; 33:e75-e76. [PMID: 27556345 DOI: 10.1097/iop.0000000000000770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 50 year-old man on immunosuppressive agents presented with left eye vision loss, periorbital swelling, pain, and ophthalmoplegia. The patient was clinically found to have a central retinal artery and vein occlusion. A CT scan was performed which demonstrated intraorbital fat stranding, however the patient lacked sinus disease. The etiology of the orbital infection was held in question. The area was debrided in the operating room, and the specimen demonstrated group A streptococcal species consistent with necrotizing fasciitis. Periorbital necrotizing fasciitis should be suspected in patients with rapidly progressive orbital symptoms without sinus disease as lack of surgical intervention can result in poor outcomes. The unusual aspect to this case is the mechanism of vision loss, as the authors hypothesize that there was vascular infiltration of the infection resulting in the central retinal artery occlusion and central retinal vein occlusion which have not been previously reported secondary to necrotizing fasciitis of the orbit.
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11
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Proia AD. Periocular necrotizing fasciitis in an infant. Surv Ophthalmol 2017; 63:251-256. [PMID: 28300549 DOI: 10.1016/j.survophthal.2017.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 11/18/2022]
Abstract
Periocular necrotizing fasciitis developed in a 12-month-old boy with swelling of both eyes and redness and a discharge from the left eye approximately 36 hours after blunt trauma. Computed tomography revealed preseptal and soft-tissue edema on the left side, but no signs of orbital involvement, orbital fractures, or drainable abscess in the anterior left lower eyelid. The inflammatory signs worsened over the next day, and there was purulent discharge from the left lower eyelid and an abscess and necrosis of the lower eyelid skin. He did well following surgical debridement and treatment with intravenous antibiotics. His course highlights the difficulty in diagnosing necrotizing fasciitis and the necessity for prompt surgical debridement and empirical broad-spectrum antibiotic therapy.
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Affiliation(s)
- Alan D Proia
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.
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12
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Triple diagnostics for early detection of ambivalent necrotizing fasciitis. World J Emerg Surg 2016; 11:51. [PMID: 27766113 PMCID: PMC5057419 DOI: 10.1186/s13017-016-0108-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/29/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. Over the last decade time to surgery decreased and outcome improved, most likely due to increased awareness and more timely referral. Early recognition is key to improve mortality and morbidity. However, early referral frequently makes it a challenge to recognize this heterogeneous disease in its initial stages. Signs and symptoms might be misleading or absent, while the most prominent skin marks might be in discrepancy with the position of the fascial necrosis. Gram staining and especially fresh frozen section histology might be a useful adjunct. METHODS Retrospective analysis of 3 year period. Non-transferred patients who presented with suspected necrotizing fasciitis are included. ASA classification was determined. Mortality was documented. RESULTS In total, 21 patients are included. Most patients suffered from severe comorbidities. In 11 patients, diagnoses was confirmed based on intra-operative macroscopic findings. Histology and/or microbiotic findings resulted in 6/10 remaining patients in a change in treatment strategy. In total, 17 patients proved to suffer necrotizing fasciitis. In the cohort series 2 patients died due to necrotizing fasciitis. CONCLUSION In the early phases of necrotizing fasciitis, clinical presentation can be ambivalent. In the present cohort, triple diagnostics consisting of an incisional biopsy with macroscopic, histologic and microbiotic findings was helpful in timely identification of necrotizing fasciitis.
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Rajak SN, Figueira EC, Haridas AS, Satchi K, Uddin JM, McNab AA, Rene C, Sullivan TJ, Rose GE, Selva D. Periocular necrotising fasciitis: a multicentre case series. Br J Ophthalmol 2016; 100:1517-1520. [DOI: 10.1136/bjophthalmol-2015-307445] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 01/13/2016] [Accepted: 01/16/2016] [Indexed: 11/04/2022]
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[Eyelid swelling with reduced general state of health]. Ophthalmologe 2015; 113:341-3. [PMID: 26377102 DOI: 10.1007/s00347-015-0129-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Khurana S, Pushker N, Naik SS, Changole MD, Ghonsikar V, Bajaj M. Periorbital necrotising fasciitis in infants: Presentation and management of six cases. Trop Doct 2015; 45:188-93. [DOI: 10.1177/0049475515575671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To present the clinical features and management of infants presenting with periorbital necrotising fasciitis (NF). Methods Retrospective case series. Results Six children were studied. The age at presentation was in the range of 5–11 months (median, 8 months). All children presented with acute onset eyelid inflammation and necrosis with fever, lethargy and poor oral intake. The management included intravenous antibiotics and repeated surgical debridement. The infection healed by 2–3 weeks in all cases, resulting in cicatricial ectropion and lagophthalmos. Full thickness skin grafting (with a Hughes tarso-conjunctival graft in one child) was performed in all patients at 3–5 weeks subsequently. Repeat surgery was required in three children. Adequate globe coverage and cosmesis was achieved in five children. Conclusion NF of eyelids is a potentially fatal infection that requires urgent and vigorous management and heals with sequelae that may need more than one surgical intervention over a period of time. Adequate cosmetic and functional outcomes can be achieved.
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Affiliation(s)
- Saurbhi Khurana
- Doctor, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Professor, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sreedhara S Naik
- Doctor, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Milind Devidas Changole
- Doctor, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vishnukant Ghonsikar
- Doctor, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mandeep Bajaj
- Professor, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Abstract
PURPOSE To describe a modified wound closure technique in cases of necrotizing fasciitis and to describe its efficacy and usefulness. METHODS The clinical characteristics of patients that underwent extensive debridement and modified wound closure were recorded and documented. RESULTS Seven patients (5 males, 2 females; mean age = 40.9 years, standard deviation = 25.3 years) underwent debridement and modified wound closure. At discharge from the hospital, 6 patients (84.7%) achieved vision of 20/25 of better, although 1 patient lost all vision in the affected eye. Six patients (84.7%) experienced improvement in their visual acuity between admission to and discharge from the hospital. After a mean follow-up interval of 6.3 months, 5 patients (71.4%) did not require additional reconstructive interventions. CONCLUSIONS In cases of periorbital necrotizing fasciitis, extensive debridement with a modified wound closure is a technically feasible intervention and produced excellent clinical, functional, and aesthetic results.
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Casey K, Cudjoe P, Green JM, Valerio IL. A Recent Case of Periorbital Necrotizing Fasciitis—Presentation to Definitive Reconstruction Within an In-Theater Combat Hospital Setting. J Oral Maxillofac Surg 2014; 72:1320-4. [DOI: 10.1016/j.joms.2014.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 02/03/2014] [Indexed: 01/01/2023]
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Mellington FE, Bacon AS, Abu-Bakra MAJ, Martinez-Devesa P, Norris JH. Orbital compressed air and petroleum injury mimicking necrotizing fasciitis. J Emerg Med 2014; 47:e69-72. [PMID: 24915744 DOI: 10.1016/j.jemermed.2014.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 02/08/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Orbital injury secondary to petroleum-based products is rare. We report the first case, to our knowledge, of a combined compressed air and chemical orbital injury, which mimicked necrotizing fasciitis. CASE REPORT A 58-year-old man was repairing his motorcycle engine when a piston inadvertently fired, discharging compressed air and petroleum-based carburetor cleaner into his left eye. He developed surgical emphysema, skin necrosis, and a chemical cellulitis, causing an orbital compartment syndrome. He was treated initially with antibiotics and subsequently with intravenous steroid and orbital decompression surgery. There was almost complete recovery by 4 weeks postsurgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Petroleum-based products can cause severe skin irritation and necrosis. Compressed air injury can cause surgical emphysema. When these two mechanisms of injury are combined, the resulting orbitopathy and skin necrosis can mimic necrotizing fasciitis and cause diagnostic confusion. A favorable outcome is achievable with aggressive timely management.
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Affiliation(s)
| | - Annette S Bacon
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | | | - Pablo Martinez-Devesa
- Ear, Nose and Throat Department, John Radcliffe Hospital, Headington, Oxford, United Kingdom
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Courtney-Brooks M, Scalici J, Henretta MS, Modesitt SC, Jazaeri AA, Cantrell LA, Duska LR. Vulvar necrotizing soft tissue infection: A review of a multi-disciplinary surgical emergency and management in the modern era. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 5:6-9. [PMID: 24371682 PMCID: PMC3862329 DOI: 10.1016/j.gynor.2013.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 02/05/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Madeleine Courtney-Brooks
- Thornton Gynecology Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA 22908, USA
- Corresponding author at: University of Virginia Health System, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, PO Box 800712, Charlottesville, VA 22908, USA. Fax: + 1 434 982 3271.
| | - Jennifer Scalici
- Thornton Gynecology Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Melissa S. Henretta
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Susan C. Modesitt
- Thornton Gynecology Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Amir A. Jazaeri
- Thornton Gynecology Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Leigh A. Cantrell
- Thornton Gynecology Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Linda R. Duska
- Thornton Gynecology Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA 22908, USA
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