Chin necrosis as a consequence of prone positioning in the intensive care unit

Jaw-related complications in COVID-19 patients; a systematic review

OBJECTIVE

The aim of this review was to highlight jaw-related complications in COVID-19 manifestations, their etiology, and prevention methods.

METHODS

A systematic review of literature was conducted. MEDLINE/PubMed, and Google Scholar were searched for the following keywords: "COVID-19" "Oral manifestations", "Musculoskeletal patients", "Mandible", "Jaw", "Osteonecrosis", "MRONJ", and "dry socket".

RESULTS

Only nine articles were included in this review. Jaw-related disorders associated with COVID-19 were dry socket, osteonecrosis, and orofacial pain related to temporomandibular joint disorders (TMD) and giant cell arteritis (GCA).

CONCLUSION

COVID-19 potentially predisposes to osteonecrosis due to thrombotic inflammatory phenomena caused by the disease itself or its therapeutic modalities. All jaw osteonecrosis cases reported so far in relation to COVID-19 affected the upper jaw. Orofacial pain in COVID-19 patients was related to TMD and GCA. Clinical evidence-based studies are required to investigate the actual prevalence and possible correlation between COVID-19 and jaw-related disorders.

Preventing iatrogenic facial pressure ulcers during spinal surgery: Prospective trial using a novel method and review of literature

To assess the outcome of a novel method of preventing facial pressure ulcers in spinal surgery and a review of literature. A prospective trial using a novel method of facial protection using paraffin tulle gras dressing to cover bony prominences during spinal surgical procedures was performed. Patients were reviewed at 24 hours and 6 weeks. A telephone survey was also conducted post discharge. Over an 8-month period, 12 patients (7F:5M, age 9-72 years) underwent spine surgery for tumour stabilisation (n = 7), deformity correction (n = 4), and degenerative presentation (n = 1) with mean operative time of 472 minutes (range 150-785 minutes) in prone position. All patients were managed by the same team using an agreed protocol. No pressure ulcers were noted in our study. One patient sustained minimal erythema, which resolved after 24 hours. All patients were satisfied with the care received. Facial pressure ulcers though much reduced are still common in spinal surgery. The common factors are the long duration of surgery, shear, friction, moisture, and intrinsic factors. Our strategy of an appropriate facial support and constant vigilance helped eliminate the incidence of iatrogenic facial ulcers in spinal surgery.

Extendable mirrors to improve anesthesia provider comfort for eye and positioning checks in prone patients: A pilot study

Prone positioning is frequently used for spinal surgery and is associated with risks including perioperative visual loss and stroke. Frequent eye checks and careful neck positioning are recommended. In our hospital’s current model, anesthesia providers are required to kneel on the operating room floor beneath operating room table, exposing themselves to hazards such as bodily fluids and back and knee strain. This maneuver is both time consuming and unpleasant. While new devices that enable easier visualization of patients in the prone position exist, they are costly and not universally compatible with all operating room tables. Our objective for this feasibility pilot study was to determine if simple, extendable mirrors increase anesthetist comfort during these cases. A nonrandomized survey-based feasibility pilot study was performed, evaluating comfort while performing eye checks with extendable lighted mirrors compared to the standard kneeling practice. A total of 41 nurse anesthetists and anesthesiology residents were analyzed. A mixed model logistic regression demonstrates a three-fold improvement in comfort with the prone position after mirror use (OR = 3.34; 95% CI: 1.06–10.48; p = 0.039). The frequency of eye checks did not change significantly with introduction of the mirror. Use of the extendable mirror improves anesthesia provider comfort with patients in the prone position. We postulate that it may be a useful addition to our practice.

Patient Positioning and Skin Sequelae: Ischemic Epidermal Necrosis from Tight Padding During Cardiac Surgery

Careful positioning and padding of pressure points during surgery are recommended to prevent pressure ulcers, vascular injury, and nerve damage in an immobilized patient. However, overpadding may have unintended consequences. We report a case of ischemia-induced full-thickness epidermal necrosis secondary to tight foam padding during a cardiac surgery.