phenylephrine-hydrochloride and Ischemia

Nonsurgical rhinoplasty is increasing in popularity, and when used appropriately, can be less costly and have less downtime than surgical rhinoplasty. It can offer patients a means of seeing how they would feel about a surgical rhinoplasty later. Injection can be safe but patients should still be counseled regarding the rare, possible risks of tissue loss and potentially irreversible tissue ischemia and irreversible blindness. Treatment with hyaluronidase can be partially effective when signs and symptoms are caught early; however, avoidance is still the best medicine along with seeking an experienced, qualified rhinoplasty plastic surgeon.

Topics: Humans; Ischemia; Nose; Rhinoplasty

Cold agglutinin disease (CAD) is a rare condition leading to blood agglutination and autoimmune hemolytic anemia. Cutaneous ischemia resulting from CAD in the head and neck is uncommon. Treatment regimens and outcomes vary widely in the literature and no clear protocol exists. This manuscript describes a patient with CAD who developed severe ischemia of the nose that resolved completely without sequellae following a medical regimen of aspirin, low molecular weight heparin, nitroglycerin ointment and hyperbaric oxygen therapy (HBOT). To our knowledge, this is the first reported case where nitroglycerin ointment or HBOT was successfully employed in the treatment of this complication.

Topics: Administration, Topical; Aged, 80 and over; Anemia, Hemolytic, Autoimmune; Anticoagulants; Combined Modality Therapy; Enoxaparin; Female; Humans; Hyperbaric Oxygenation; Ischemia; Nitroglycerin; Nose; Ointments; Vasodilator Agents

Limb Ischaemia is an exceptional complication of catecholamine toxicity caused by a phaeochromocytoma. We present a middle-aged female patient with severe subacute peripheral ishaemia, gangrene and eventual amputation of all four distal limbs due to a large non-metastatic left adrenal gland phaeochromocytoma and summarise the available literature concerning previously reported cases.

Topics: Adrenal Gland Neoplasms; Aged; Female; Foot; Hand; Humans; Ischemia; Nose; Pheochromocytoma

The therapeutical results such as recoveries or substantial improvements obtained by neurovascular decompressive functional morpho-corrective rhino-skull base surgery on 2124 cases of primary headaches (migraine with aura, migraine without aura, cluster headache, chronic paroxysmal hemicrania, tension-type headache) obliges a thorough review of the classical chapter on "rhinogenous headaches" (Bonaccorsi, Novak, Blondiau, Bisschop, Hoover, Clerico). In fact all those headaches seemingly "primary", but having a "central-peripheral" etiopathogenesis proved by a well documented (CT) volumetric reduction of "ethmoidosphenoidal subcribriform chamber" according to hemoangiokinetics purposes of endo-exocranial anastomotic circulation of this area, should be included in the chapter of "rhinogenous headaches". This endo-exocranial anastomotic circulation is considered a "functional unit" owing to the continuity of rhino-ophthalmic-encephalic trigeminal-vegetative and vascular circuits (Hannerz, Hardebo, Moskowitz). These morphological abnormalities of the rhino-skull base osteo-vascular-mucous structures acquire physio-pathological significance only in patients with "low pain threshold and elevated central integrative capability", modulated and timed by the neurogenic biorhythms. It is described the surgery of rhino-skull base by "neurovascular decompressive septo-ethmoidosphenoidectomy" procedure, either conservative or radical till the III grade monolateral with trigeminal and vegetative selective neurotomy that permits to save olfaction and to remove even the controlateral pain decompressing the circulation and eliminating stasis even on the opposite side. Further, it is emphasized that the neurological deficit or central irritative symptomatology (visual aura, sensory-motor paresis, epilepsy) disappears after surgical removal of the "peripheral rhinogenous trigger". It demonstrates a cause and effect relationship that is the central peripheral functional interdependence, even if it's included in the neuro-transmissive, biochemical, neuro-endocrine, constitutional background which is controlled by the psychical, vegetative and dysnociceptive biorhythms.

Topics: Edema; Ethmoid Bone; Humans; Ischemia; Nasal Cavity; Nasal Septum; Nerve Compression Syndromes; Nose; Radiography; Sphenoid Bone; Treatment Outcome; Trigeminal Nerve; Vascular Headaches

Topics: Adult; Chin; Cosmetic Techniques; Dermal Fillers; Female; Humans; Hyaluronic Acid; Hyperbaric Oxygenation; Injections, Intradermal; Ischemia; Lip; Male; Middle Aged; Nose; Skin; Treatment Outcome

Nose filler injections are very popular in many Asian countries to improve nose shape and projection. However, due to the vascular supply of nose from the ophthalmic artery and its communication with branches of the facial artery in this region, there could be a possibility of ophthalmic complications in case of an accidental intra-arterial injection of filler material. This may cause devastating complications of partial or complete vision loss with or without associated cutaneous ischaemic changes. We present a case report of a patient who developed features of vascular involvement after two ml of HA filler injection in the nasal dorsum, tip and columella. The patient initially developed tell-tale signs of impending skin necrosis in the nasal and forehead skin followed by ptosis, severe pain and progressive vision loss in the right eye until a point where the patient could only perceive light. The patient was managed with multiple doses of hyaluronidase in the involved skin and two doses of retrobulbar injection for vision loss. Significant recovery in the skin and ophthalmic components occurred within 20 days of filler injection. This case demonstrates that recovery of the ischaemic ophthalmic and cutaneous changes secondary to probable intra-arterial injection could be accomplished using combined retrobulbar and periorbital intracutaneous injections of high-dose pulsed hyaluronidase. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Topics: Adult; Blindness; Cosmetic Techniques; Dermal Fillers; Female; Follow-Up Studies; Humans; Hyaluronic Acid; Hyaluronoglucosaminidase; Ischemia; Nose; Pulse Therapy, Drug; Recovery of Function; Risk Assessment; Severity of Illness Index; Skin; Treatment Outcome

Hyaluronic acid (HA) is the most popular agent today for intradermal injections to improve wrinkles and other cosmetic defects. Ischemic necrosis due to injection of HA is one of the serious complications. Because there are many vascular branches around the nose, caution and care should be given during facial filler injection. Although the incidence is rare, blindness and permanent visual loss may occur. We describe a 29-year-old woman presented with painful erythematous swelling with violaceous patch on right periocular area and glabella after HA filler injection. After injecting the filler, she felt pain and dizziness, and her vision became blurred. She immediately received hyaluronidase around the HA filler inject area and during hospitalized for 10 days, she was successfully treated with systemic steroid, vasodilator, prophylactic antibiotics, and LLLT (low-level laser therapy) without any defects.

Topics: Adult; Dermal Fillers; Female; Humans; Hyaluronic Acid; Injections, Subcutaneous; Ischemia; Nose; Oculomotor Nerve Diseases

Topics: Ear Auricle; Gangrene; Heart Arrest; Humans; Iris; Ischemia; Male; Middle Aged; Mydriatics; Nose; Pupil; Pupil Disorders; Thoracic Wall; Vasoconstrictor Agents; Visual Acuity

Topics: Administration, Inhalation; Brain Diseases; Cocaine; Cocaine-Related Disorders; Facial Bones; Fatal Outcome; Female; Humans; Ischemia; Maxillary Sinus; Maxillary Sinusitis; Nose; Palate; Paranasal Sinuses; Recurrence; Young Adult

This paper reports the case of a 50-year-old man who underwent superselective embolization after severe posterior rhinorrhagia caused by hypertension. Twelve hours after the procedure, left-sided hemiparesis and right-sided facial nerve paresis developed, followed by ulceration and necrosis of the soft palate, diaphragm, and right nasal ala. Reconstruction was implemented with porous polyethylene for the nasal pyramid, a forehead flap and a mucosal flap from the oral vestibulum for polyethylene coverage, and a rotational palatal flap for closure of the oroantral fistula. Exposure of the material occurred after 4 weeks, and removal was followed by satisfactory maintenance of the shape and function of the nose. Postembolization necrosis is a rare complication of the area, and there are very few similar reports in the literature.

Topics: Embolization, Therapeutic; Epistaxis; Facial Nerve Diseases; Facial Paralysis; Follow-Up Studies; Humans; Ischemia; Male; Maxillary Artery; Middle Aged; Mouth Mucosa; Necrosis; Nose; Nose Diseases; Oral Fistula; Palate, Soft; Paresis; Plastic Surgery Procedures; Polyethylene; Prosthesis Design; Prosthesis Implantation; Respiratory Tract Fistula; Skin Transplantation; Surgical Flaps

Facial reconstruction with only free microvascular flaps has rarely produced an aesthetic result. Menick stated, "Distant skin always appears as a mismatched patch within residual normal facial skin." In addition, earlier techniques using a single large nasal lining flap or bilateral nasal lining vaults incurred a high incidence of airway obstruction.. The authors describe 10 consecutive patients requiring reconstruction of the nasal vestibule and columella lining from October of 1997 through May of 2005. Most of them also required reconstruction of the floor of the nose, the platform on which the alar bases and columella rest, and defects of the facial units adjacent to the nose. Aesthetic nasal reconstruction used two separate skin paddles to reconstruct the lining for the nasal vestibule and columella, an artistically constructed nasal framework made of cartilage, a forehead flap for cover, and other flaps and grafts to reconstruct adjacent facial unit defects.. The average patient age was 41.8 years (range, 10.4 to 65.3 years). Follow-up (from the time of the first operative stage) averaged 26.4 months (range, 4 to 49 months). Nine patients had functional airways, and one required nasal airway support with internal silicone tubes. At the time of publication, eight patients had normal-appearing noses, and two were awaiting secondary surgery to correct persistent deformity.. Microvascular free flaps have proved to be highly reliable and efficacious for restoration of missing elements of the nasal lining and adjacent facial soft-tissue defects in total and subtotal nasal reconstruction. Combined with a forehead flap, this aesthetic approach allows for reconstruction of the center of the face layer by layer and facial unit by facial unit. Specific attention is paid to the artistic creation of normal nasal dimensions, proportion, and form using carved and assembled cartilage grafts and by secondary subcutaneous contouring. In addition, this technique produces a patent airway.

Topics: Adolescent; Adult; Aged; Amputation, Traumatic; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cartilage; Child; Humans; Ischemia; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps

Total loss of both lips is fortunately rare as reconstruction of such defects poses an enormous challenge. We present a case of concomitant loss of both lips as a result of fulminant pneumococcal septicemia, which was reconstructed with a free vertical rectus abdominis myocutaneous flap due to lack of traditional donor sites.

Topics: Adult; Arm; Debridement; Humans; Ischemia; Leg; Lip; Male; Nose; Plastic Surgery Procedures; Pneumococcal Infections; Sepsis; Surgical Flaps

In a prospective study, 15 consecutive patients who underwent simultaneous open rhinoplasty and alar base excision were included to investigate whether there is a problem with the blood supply of the nasal tip and columellar skin. During the surgical procedure in these patients, there was transection of the columellar arteries and external nasal arteries, and frequently of the alar branches of the angular artery. Yet, none of the patients had any evidence of ischemia of the nasal tip or columellar skin, and there was primary wound healing with a thin-line transcolumellar scar in all patients. Techniques to avoid injury to the lateral nasal artery and nasal tip plexus are discussed. It was concluded that simultaneous open rhinoplasty and alar base excision is safe as long as certain surgical principles are applied.

Topics: Adolescent; Adult; Arteries; Female; Humans; Ischemia; Lip; Male; Nose; Postoperative Complications; Prospective Studies; Rhinoplasty; Risk Factors; Wound Healing

Topics: Adult; Cocaine-Related Disorders; Cryoglobulinemia; Ear, External; Hepatitis C; Humans; Ischemia; Male; Nose; Skin Diseases, Vascular

Two male patients with chronic renal failure maintained on hemodialysis developed progressive clinical features of ischemic necrosis (so called calciphylaxis) of their extremities and penis. Both patients died. In one patient, penectomy provided tissue for histopathologic examination and there were changes of small artery calcification. A role of iron overload on the production of calciphylaxis is reviewed. This report is perhaps the first in nephrology literature on the occurrence of calciphylaxis involving penis and prepuce.

Topics: Aged; Arterial Occlusive Diseases; Calciphylaxis; Fatal Outcome; Foot; Gangrene; Hand; Humans; Iron; Ischemia; Kidney Failure, Chronic; Male; Necrosis; Nose; Penile Diseases; Penis; Renal Dialysis; Uremia

Topics: Aged; Arm; Bacterial Infections; Ear Diseases; Ear, External; Escherichia coli Infections; Female; Foot; Foot Diseases; Gangrene; Hand; Humans; Hypotension; Ischemia; Klebsiella Infections; Leg; Male; Middle Aged; Nose; Nose Diseases; Pneumococcal Infections; Pseudomonas Infections; Sepsis; Thrombosis

Topics: Adolescent; Adult; Aged; Angiography; Arteries; Cold Temperature; Ear; Female; Follow-Up Studies; Ganglia, Autonomic; Hand; Humans; Ischemia; Leg; Male; Methods; Middle Aged; Nose; Raynaud Disease; Sex Factors