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Passemard L, Hida S, Barrat A, Sakka L, Barthélémy I, Pham Dang N. 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 2024; 125:101498. [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] [MESH Headings] [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
- Department of Oral and Maxillofacial Surgery, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand F-63000, France
| | - Sarah Hida
- Department of Oral and Maxillofacial Surgery, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand F-63000, France
| | - Antoine Barrat
- Department of Oral and Maxillofacial Surgery, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand F-63000, France
| | - Laurent Sakka
- Laboratoire d'anatomie, Faculté de Médecine, Université d'Auvergne, 28, place Henri-Dunant, 63001, Clermont-Ferrand CEDEX 1, France
| | - Isabelle Barthélémy
- Department of Oral and Maxillofacial Surgery, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand F-63000, France; UMR Inserm/UdA, Université d'Auvergne, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Clermont-Ferrand 63003, France
| | - Nathalie Pham Dang
- Department of Oral and Maxillofacial Surgery, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand F-63000, France; UMR Inserm/UdA, Université d'Auvergne, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Clermont-Ferrand 63003, France.
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Miyazaki H, Takahashi Y, Kuruma T, Someda SK, Kakizaki H. Treatment strategies for orbital gas-producing necrotizing fasciitis secondary to odontogenic maxillary sinusitis: Technical notes. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101544. [PMID: 37392845 DOI: 10.1016/j.jormas.2023.101544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
This paper presents treatment strategies for orbital necrotizing fasciitis (NF) in a case of a 33-year-old male diagnosed with orbital NF, which developed after dental root canal treatment. Although orbital NF is rare, it is rapidly progressive and can easily lead to the loss of tissue and visual function, sometimes to a life-threatening extent. Prompt and adequate treatment has been a challenge yet remains quite essential. In addition to the conventional approach to NF, such as immediate antibiotic administration and drainage, orbital NF patients like this case were often treated by incorporating additional steps, which include: 1) performing minimally invasive but adequate removal of necrotic tissue through intraoperative use of ultrasound equipment and postoperative use of proteolytic enzyme-containing ointment for chemical debridement; 2) managing intraorbital pressure by lateral cantholysis and orbital floor removal (decompression); and 3) maintaining the aerobic conditions of the wound after surgical drainage via orbital wall removal. Thus far, satisfactory results in patients with extensive NF of the orbit, including the presented case, were achieved with regards to preserving periorbital tissues, vision, and ocular motility through a multidisciplinary approach. These should be considered as optional means of preserving the orbital tissue and visual function.
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Affiliation(s)
- Hidetaka Miyazaki
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Tessei Kuruma
- Department of Otolaryngology and Head and Neck Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Steffani Krista Someda
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
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Pertea M, Fotea MC, Luca S, Moraru DC, Filip A, Olinici-Temelie D, Lunca S, Carp AC, Grosu OM, Amarandei A, Veliceasa B. Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment-A New Case Report and Systematic Review. J Pers Med 2023; 13:1612. [PMID: 38003927 PMCID: PMC10672041 DOI: 10.3390/jpm13111612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Necrotizing fasciitis (NF) is a severe and aggressive pathology with a rapid progression and high mortality risk. Periocular NF is a rare condition associated with a lower mortality risk but significantly higher disabling sequelae. (2) Methods: We present the case of a 67-year-old homeless patient, a victim of assault, with multiple untreated comorbidities (diabetes mellitus, cardiac conditions, and schizophrenia) and a delayed diagnosis of periocular necrotizing fasciitis. The condition showed a cyclical evolution influenced by the existing comorbidities, and the patient underwent both surgical and medical treatment with a multidisciplinary team. Additionally, we report a systematic review of cases from the literature. (3) Results: The patient's survival outcomes were favorable; however, the sequelae were disabling, not only concerning aesthetic aspects but also due to the loss of the affected eye globe. The systematic review revealed the rarity of such cases and the peculiarities of the presented case compared to those reported in the literature up to this point. (4) Conclusions: Understanding the signs, symptoms, and predisposing factors, as well as the potential rare localizations of NF, including the periocular region, can lead to the early diagnosis and treatment with good functional and aesthetic outcomes, minimizing significant disabilities.
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Affiliation(s)
- Mihaela Pertea
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Madalina-Cristina Fotea
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Stefana Luca
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Dan Cristian Moraru
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Alexandru Filip
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Doinita Olinici-Temelie
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Dermatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Sorinel Lunca
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Second Surgery Clinic, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Adrian Claudiu Carp
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Oxana-Madalina Grosu
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Alexandru Amarandei
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Bogdan Veliceasa
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
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