phenylephrine-hydrochloride and Necrosis

Vascular compromise leading to cutaneous loss following surgical rhinoplasty is a devastating complication. The objective of this review is to identify all reported cases in literature published in English and summarize the current evidence to identify the patients at risk of this complication following surgery. A comprehensive literature review using Medline and Embase databases was performed to capture all reported cases of cutaneous vascular compromise following rhinoplasty from database inception through September 2020. Nonsurgical rhinoplasty cases were excluded. We identified eight studies that featured vascular cutaneous compromise following surgical rhinoplasty. A total of 18 patients were included in the analysis. The majority of the patients were females with a mean age of 30.9. Risk factors included smoking in 23.5% patients and revision setting. Extensive tip thinning, tight splinting and taping with dorsal onlay grafting, or combining extended alar base excision with revision open rhinoplasty were among surgical techniques associated with vascular compromise. The most commonly affected aesthetic nasal subunit in our review was the dorsum followed by the nasal tip. Conservative management primarily was utilized in 72.2% of patients, allowing the defect to heal by secondary intention. Studies reporting on cutaneous vascular compromise following surgical rhinoplasty are of low level of evidence. This review is the largest summary reporting on this complication to date, aiming to caution surgeons about associated techniques and management options. We also share an expert opinion on preoperative assessment of nasal skin to guide surgeons to potentially avoid rhinoplasty surgery in this subset of patients.

Topics: Esthetics, Dental; Female; Humans; Necrosis; Nose; Reoperation; Rhinoplasty

As the number of patients seeking surgical and nonsurgical rhinoplasty continues to increase, the risk of nasal skin compromise after surgery also has risen. Vascular insult to the nasal skin envelope can lead to permanent disfigurement that is nearly impossible to correct. Tissue loss often requires major reconstruction that yields suboptimal cosmetic results. This article discusses prevention, early recognition, and effective treatment that aim to mitigate skin necrosis and the resulting soft tissue destruction.

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Humans; Hyperbaric Oxygenation; Leeching; Necrosis; Nitroglycerin; Nose; Postoperative Complications; Rhinoplasty; Risk Factors; Skin; Vasodilator Agents

Opioid abuse is a common disorder affecting over 2 million Americans. Intranasal tissue necrosis is a previously described sequela of nasal opioid inhalation, with a similar presentation to invasive fungal rhinosinusitis (IFRS). The goal of this case report and systematic review is to evaluate the evidence supporting this uncommon disease, with qualitative analysis of the presentation, management and treatment outcomes.. MEDLINE, EMBASE, Google Scholar, Scopus, and Web of Science.. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were utilized to identify English-language studies reporting intranasal mucosal injury associated with prescription opioid abuse. Primary outcomes included clinical presentation, treatment strategies, and outcomes.. Systematic review identified 61 patients for qualitative analysis. Common clinical features include facial pain without a history of chronic sinusitis or known immunodeficiency. Diagnostic nasal endoscopy revealed superficial debris with underlying tissue necrosis, consistent with a preliminary diagnosis of IFRS. Characteristic pathologic findings include mucosal ulceration with an overlying acellular substrate, often with polarizable material. Fungal colonization is often reported, with several accounts of angiocentric invasion in immunocompetent patients. Complete symptom resolution is expected following surgical debridement with cessation of intranasal opioid inhalation, with 89% of identified patients experiencing a complete resolution of disease.. Intranasal opioid abuse is a prevalent condition associated with chronic pain and tissue necrosis that is clinically concerning for invasive fungal disease. Whereas IFRS must be excluded, even in patients without known immunodeficiency, complete resolution of symptoms can be expected following surgical debridement with cessation of opioid abuse. Laryngoscope, 1767-1771, 2018.

Topics: Administration, Intranasal; Adult; Analgesics, Opioid; Female; Humans; Mycoses; Necrosis; Nose; Opioid-Related Disorders; Rhinitis; Sinusitis

For decades the commonly held belief that local anaesthesia (LA) with vasoconstrictor can cause necrosis in end-arteries has been sustained by medical teachers, text books and clinical practice. This literature review, identifying 24 articles investigating the use of LA with epinephrine in fingers, toes, noses and ears, including more than 15,000 patients, finds no evidence to support this belief. No case of necrosis has been reported since the introduction of commercial lidocaine with epinephrine in 1948. This review concludes that it is safe to use lidocaine with adrenaline in end-arteries.

Topics: Anesthetics, Local; Contraindications, Drug; Ear; Epinephrine; Fingers; Humans; Necrosis; Nose; Toes; Vasoconstrictor Agents

We describe a 36-year-old patient with an aggressive, midline intranasal and naso- and oropharyngeal destructive process. For months the patient denied heavy abuse of nasal cocaine, but finally admitted it. Necrosis and atrophy of the inferior and middle nasal turbinates bilaterally, prominent naso and oropharyngeal ulcers, nasal septal as well as hard palate perforation were observed clinically. Repeated biopsies revealed focal areas of chronic inflammation and necrosis, but there was no evidence of vasculitis or granuloma formation. Since serum was slightly positive for antineutrophil cytoplasmic antibody, the initial diagnosis was Wegener's granulomatosis. In the United States there have been a few reports on a new cocaine-associated syndrome presenting as an aggressive, midline, intranasal and intrapharyngeal destructive process mimicking limited Wegener's granulomatosis and midline reticulosis. We report the first such case in Europe and offer guidelines for the diagnostic work-up of such cases.

Topics: Adult; Biopsy; Cocaine-Related Disorders; Diagnosis, Differential; Disease Progression; Granuloma, Lethal Midline; Granulomatosis with Polyangiitis; Humans; Male; Necrosis; Nose; Palate

We conducted this study to investigate the efficacy of the silicon gel application on the nares in prevention of nasal injury in preterm infants ventilated with nasal continuous positive airway pressure (NCPAP). Patients (n=179) were randomized into two groups: Group 1 (n=87) had no silicon gel applied to nares, and in Group 2 (n=92), the silicon gel sheeting was used on the surface of nares during ventilation with NCPAP. Nasal injury developed in 13 (14.9%) neonates in Group 1 and 4 (4.3%) newborns in Group 2 (OR:3.43; 95% CI: 1.1-10.1; P<0.05). The incidence of columella necrosis was also significantly higher in the Group 1 (OR: 6.34; 95% CI: 0.78-51.6; P<0.05). We conclude that the silicon gel application may reduce the incidence and the severity of nasal injury in preterm infants on nasal CPAP.

Topics: Administration, Topical; Continuous Positive Airway Pressure; Gels; Humans; Infant, Newborn; Infant, Premature; Necrosis; Nose; Prospective Studies; Silicon; Wounds and Injuries

Liquid rhinoplasty, otherwise known as nonsurgical or filler rhinoplasty, has earned increased attention for its ability to provide surgical rhinoplasty results at a fraction of the cost and without incising the skin. However, significant complications can arise, such as tissue necrosis, filler embolus, and vascular compromise if the procedure is performed without consideration of the principles and anatomy of the face and nose. As demonstrated in this article, a stepwise and patient-specific approach to performing liquid rhinoplasty will ensure safe, consistent, and desirable results.

Topics: Dermal Fillers; Humans; Necrosis; Nose; Rhinoplasty; Skin

Topics: Continuous Positive Airway Pressure; Humans; Infant; Infant, Newborn; Necrosis; Nose; Nose Deformities, Acquired; Surgical Flaps; Treatment Outcome

Skin necrosis is one of the most severe complications following filler injections, and can result in permanent aesthetic defects. Although an increasing number of studies have addressed the management of dermal filler complications, no study has described the spectrum of microbial pathogens. The aim of this study was to delineate the bacterial profile and prognostic factors of filler-related skin necrosis by reviewing the clinical and microbiological features of these patients. A retrospective medical record review of patients undergoing treatment for skin necrosis induced by fillers was conducted. In total, 10 cases were identified, with injection sites being the nasolabial fold (70%; n = 7), nasal dorsum (20%; n = 2) and nasal tip (10%; n = 1). Reviewing the culture results, the true culture-positive rate was found to be 50% after cases of contamination were excluded. To avoid permanent sequelae, all physicians should be aware of possible secondary infections when treating filler-induced skin necrosis.

Topics: Adult; Anti-Bacterial Agents; Culture Techniques; Dermal Fillers; Female; Gram-Negative Bacteria; Humans; Injection Site Reaction; Middle Aged; Nasolabial Fold; Necrosis; Nose; Prognosis; Re-Epithelialization; Retrospective Studies; Severity of Illness Index; Skin Diseases

To evaluate outcomes associated with the use of an angularis oris axial pattern flap (AOAPF) for rostral facial reconstruction in cats.. Nine adult client-owned cats.. Short case series.. Ten AOAPF were performed in nine cats after resection of a tumor. Wounds were located at the nose, infraorbital, supraorbital, frontal, eye, and ear canal region. Orbital exenteration (n = 3), pinnectomy (n = 2), nasal planum resection, total ear canal ablation (n = 2), and partial eyelid reconstruction (n = 3) were performed.. Short-term postoperative complications included flap edema (n = 10), suture dehiscence (n = 3), and distal tip necrosis (n = 3). All wounds resulting from minor complications healed by second intention in 5-15 days. Long-term complications included epiphora (n = 2), frequent grooming around the eyes (n = 2), and enucleation due to corneal ulcer secondary to impaired postoperative eyelid function (n = 1). Tumor recurrence occurred in 3 cases.. The AOAPF was a versatile and reliable option for rostral facial reconstruction in cats with acceptable long-term outcomes.

Topics: Animals; Cat Diseases; Cats; Necrosis; Neoplasm Recurrence, Local; Nose; Plastic Surgery Procedures; Postoperative Complications; Surgical Flaps

The V-Y island advancement flap is a useful reconstruction technique for nasal alar defects, but flap mobility is limited by the insertion of the muscles of facial expression into the dermis of the alae.. To describe a V-Y muscle sling myocutaneous island advancement flap (SMIAF) for improved mobility and intrasubunit reconstruction of alar defects.. A retrospective review of patient records and preoperative and postoperative photographs was performed on all patients with alar defects repaired with the SMIAF between April 2008 and October 2017. Patients and physicians rated aesthetic outcomes with the Patient and Observer Scar Assessment Scale (POSAS).. A total of 18 nasal alar defects were repaired with the SMIAF after Mohs micrographic surgery. All defects were located on the anterior two-thirds of the alar lobule and had a mean surface area of 0.42 ± 0.19 cm. No patients experienced flap necrosis. Patients and 3 independent dermatologic surgeons rated favorable aesthetic outcomes.. The SMIAF is a reliable reconstruction option with good aesthetic outcomes for small defects on the anterior two-thirds of the nasal ala.

Topics: Adult; Aged; Cicatrix; Esthetics; Female; Humans; Male; Middle Aged; Mohs Surgery; Myocutaneous Flap; Necrosis; Nose; Nose Neoplasms; Patient Reported Outcome Measures; Reproducibility of Results; Retrospective Studies; Rhinoplasty; Skin Neoplasms; Treatment Outcome

Like all surgical procedures, dorsal nasal flaps may be followed by both early and late complications. The aim of this study was to evaluate the surgical complications and cosmetic outcome of dorsal nasal flaps over a 7-year period in an academic dermatologic surgery unit.. Data were collected retrospectively for all patients undergoing dorsal nasal flap between 1 January 2006 and 31 December 2013. Early and late complications were recorded. Patients were contacted by phone to assess long-term outcomes.. A total of 35 patients were included. Early complications included bleeding (n=2), local infection (n=2) and focal flap necrosis (n=1). Late complications comprised flap thickening (n=7), restriction of the medial canthus (n=2), opening of the labionasal angle (n=1), stitch granuloma (n=1) and telangiectasia on the flap (n=1). Regarding the aesthetic result, seven patients were very satisfied with the flap. Four patients underwent corrective surgery and one patient had laser treatment for telangiectasia on the flap.. Two thirds of patients were satisfied with the aesthetic results and one third had late complications of the flap. Consequently, patients undergoing Rieger-Marchac procedures must be informed of the potential need for further corrective measures following nasal dorsal flap repair.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Esthetics; Female; Granuloma; Humans; Keratoacanthoma; Keratosis, Actinic; Male; Middle Aged; Necrosis; Nose; Nose Neoplasms; Patient Satisfaction; Postoperative Hemorrhage; Retrospective Studies; Rhinoplasty; Surgical Flaps; Surgical Wound Infection

Nonsurgical rhinoplasty with injectable dermal fillers has become an increasingly popular alternative to surgical procedures, in view of its relative low cost, convenience and rapid recovery, and low risk profile. The safety and efficacy of nonsurgical rhinoplasty remains a relatively contentious and ambiguous matter, given that there are few large-scale series reporting results or complications. This study reports the experience of a single clinician performing nonsurgical rhinoplasty in the largest cohort to date.. Patient demographics, indications, treatment details, and outcomes of patients treated between March of 2016 and January of 2019 were reviewed. The nonsurgical rhinoplasty technique described previously by Harb was used using hyaluronic acid dermal filler.. Nonsurgical rhinoplasty was performed in 5000 patients. The commonest indication was dorsal hump (44 percent). Swelling and erythema were self-limiting side effects encountered in approximately half of patients. Infection was seen in two patients, and localized skin necrosis was observed in three patients.. Nonsurgical rhinoplasty is a safe procedure with positive aesthetic results when performed by an experienced clinician. Knowledge of nasal anatomy, comprehensive training, and use of appropriate materials are key in ensuring safety and results.. Therapeutic, IV.

Topics: Adolescent; Adult; Aged; Cosmetic Techniques; Dermal Fillers; Edema; Erythema; Esthetics; Female; Humans; Hyaluronic Acid; Male; Middle Aged; Necrosis; Nose; Patient Satisfaction; Retrospective Studies; Rhinoplasty; Skin; Treatment Outcome; Young Adult

A 79-year-old man with liver failure, hypertension and hyperlipidemia presented with a 1.5-month history of progressive nasal crusting and pain on the inside of the nose, advancing into a necrotic columella and philtrum. On rigid endoscopy, debris extended to middle and inferior turbinate to midway posteriorly. Initial culture swabs and CT were negative. The patient underwent endoscopic biopsy of the lesion, with histopathological findings revealing abundant acute inflammation and minute fragments of atypical squamous epithelium, favouring reactive atypia. Non-invasive fungal hyphae were identified. Bacterial cultures revealed

Topics: Aged; Anti-Bacterial Agents; Diagnosis, Differential; Humans; Immunocompromised Host; Liver Failure, Acute; Male; Necrosis; Nose; Pseudomonas Infections; Pseudomonas putida

The paramedian forehead flap is commonly used in nasal reconstruction, and survival of the distal part of the flap is usually essential for a good cosmetic outcome. Venous congestion leading to tissue necrosis is a recognized complication with this flap. The standard paramedian forehead flap is designed with a number of aims. These are to include the supratrochlear artery, to maximize mobility of the flap pedicle, to maximize the reach of the flap, and to minimize cosmetic implications at the donor site. The supratrochlear artery does not possess sizable venae comitantes; thus, the main pathway for venous drainage of the paramedian forehead flap is through superficial veins. The pattern and location of the superficial veins varies and therefore a standard skin pedicle design cannot be expected to always include sufficient veins to prevent venous congestion and subsequent flap necrosis. This article demonstrates the superficial venous anatomy of the forehead using computed tomographic venography, clinical demonstration, and cadaveric dissection, and describes a technique that can be carried out to augment flap venous drainage by performing careful dissection to identify additional superficial veins at the margins of the flap skin pedicle. One or more veins can then be mobilized and included with the flap pedicle to augment its venous drainage. Use of this technique should lead to a lower incidence of flap necrosis secondary to venous congestion.

Topics: Cohort Studies; Esthetics; Female; Forehead; Graft Rejection; Humans; Hyperemia; Male; Necrosis; Nose; Phlebography; Plastic Surgery Procedures; Retrospective Studies; Rhinoplasty; Skin Transplantation; Surgical Flaps; Treatment Outcome; Wound Healing

Topics: Adult; Aged; Catheterization; Drainage; Endoscopy, Gastrointestinal; Endosonography; Female; Humans; Male; Middle Aged; Necrosis; Nose; Pancreas; Pancreatic Diseases; Plastics; Retrospective Studies; Stents; Ultrasonography, Interventional

OBJECTIVE The vascularized nasoseptal flap (NSF) has become the workhorse for skull base reconstruction during endoscopic endonasal surgery (EES) of the ventral skull base. Although infrequently reported, as with any vascularized flap the NSF may undergo ischemic necrosis and become a nidus for infection. The University of Pittsburgh Medical Center's experience with NSF was reviewed to determine the incidence of necrotic NSF in patients following EES and describe the clinical presentation, imaging characteristics, and risk factors associated with this complication. METHODS The electronic medical records of 1285 consecutive patients who underwent EES at the University of Pittsburgh Medical Center between January 2010 and December 2014 were retrospectively reviewed. From this first group, a list of all patients in whom NSF was used for reconstruction was generated and further refined to determine if the patient returned to the operating room and the cause of this reexploration. Patients were included in the final analysis if they underwent endoscopic reexploration for suspected CSF leak or meningitis. Those patients who returned to the operating room for staged surgery or hematoma were excluded. Two neurosurgeons and a neuroradiologist, who were blinded to each other's results, assessed the MRI characteristics of the included patients. RESULTS In total, 601 patients underwent NSF reconstruction during the study period, and 49 patients met the criteria for inclusion in the final analysis. On endoscopic exploration, 8 patients had a necrotic, nonviable NSF, while 41 patients had a viable NSF with a CSF leak. The group of patients with a necrotic, nonviable NSF was then compared with the group with viable NSF. All 8 patients with a necrotic NSF had clinical and laboratory evidence indicative of meningitis compared with 9 of 41 patients with a viable NSF (p < 0.001). Four patients with necrotic flaps developed epidural empyema compared with 2 of 41 patients in the viable NSF group (p = 0.02). The lack of NSF enhancement on MR (p < 0.001), prior surgery (p = 0.043), and the use of a fat graft (p = 0.004) were associated with necrotic NSF. CONCLUSIONS The signs of meningitis after EES in the absence of a clear CSF leak with the lack of NSF enhancement on MRI should raise the suspicion of necrotic NSF. These patients should undergo prompt exploration and debridement of nonviable tissue with revision of skull base reconstruction.

Topics: Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Necrosis; Nose; Plastic Surgery Procedures; Postoperative Complications; Reoperation; Retrospective Studies; Risk Factors; Surgical Flaps

Three adult Venezuelan patients with virologically confirmed Chikungunya fever, who developed extensive acute nasal skin necrosis early in the course of a life-threatening illness characterized by shock and multiple organ dysfunction syndrome, are discussed. One patient survived and fully recovered. Nasal necrosis has not previously been associated with the disease.

Topics: Adult; Aged; Chikungunya Fever; Fatal Outcome; Humans; Middle Aged; Necrosis; Nose; Nose Diseases; Skin Diseases; Venezuela

Injuries to the nose can be severe from both a functional and cosmetic perspective. After suffering a dog bite to the central part of the face, an 18-year old woman underwent replantation of the avulsed tissue with the help of microsurgical arterial anastomosis. A venous anastomosis was impossible and venous congestion was treated with leech therapy. Subsequent skin necrosis occurred after a few days and the replantation was revised, revealing healthy tissue immediately below. The defect was covered with a full-thickness skin graft. At follow-up review eight months later, the functional and cosmetic result was satisfactory. To our knowledge, this is one of few cases where an injury of this severity healed with a cosmetically acceptable result.

Topics: Adolescent; Amputation, Traumatic; Animals; Bites and Stings; Dogs; Female; Humans; Necrosis; Nose; Replantation; Skin Transplantation; Surgical Flaps

We have used the retroangular flap for the reconstruction of facial defects after excision of tumours. Important variables such as vascular mapping, type of anaesthesia, duration of stay in hospital, and the diagnosis and treatment of complications were taken into account in assessing its effectiveness. We studied 187 patients, 103 men and 84 women, who were treated with the retroangular flap, and the morphological and cosmetic results analysed. There are many vascular variations of the flap The patients were followed up for a median of 12 (range 12-125) years and their reconstructions were successful. The technique can be considered as one of first methods of choice for the reconstruction of cutaneous defects of the middle third of the face.

Topics: Anesthesia, Local; Angiography; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Face; Facial Neoplasms; Female; Follow-Up Studies; Graft Survival; Humans; Male; Microsurgery; Necrosis; Nose; Perforator Flap; Plastic Surgery Procedures; Postoperative Complications; Skin; Skin Transplantation; Surgical Flaps

The treatment of epistaxis sometime requires an embolization. This may result in ischemic palate necrosis, oronasal communication and dental losses. The repair of these lesions is complex.. A 53-year-old patient, suffering from high blood pressure and hypercholesterolemia, benefited from bilateral embolization of the sphenopalatine arteries in order to treat a persistent epistaxis. He developed a middle cerebral artery stroke in the aftermath. During the treatment of the neurological sequelae, a necrosis of the 2/3 of the posterior aspect of the hard palate was discovered. The angio-MRI showed an obstruction of both sphenopalatine arteries and of their vascular supplies resulting in a bilateral involvement of the alveolar bone. The diagnosis of iatrogenic palate necrosis was made. Tissue repair was successfully achieved by two loco-regional flaps. The dental rehabilitation was made by mean of a removable prosthesis.. Palatine necrosis following embolization of the sphenopalatine arteries is uncommon. Ischemia resulted in a loss of substance in form of a punch, similar to noma's lesions. It could also be a consequence of the vascular background. The management of these lesions is complex and calls for forensic reflection about the iatrogenic origin.

Topics: Arteries; Embolization, Therapeutic; Epistaxis; Humans; Iatrogenic Disease; Male; Middle Aged; Necrosis; Nose; Palate, Hard; Pterygopalatine Fossa; Recurrence

Although there are several case reports of facial skin ischemia/necrosis caused by hyaluronic acid filler injections, no systematic study of the clinical outcomes of a series of cases with this complication has been reported.. The authors report a study of 20 consecutive patients who developed impending nasal skin necrosis as a primary concern, after nose and/or nasolabial fold augmentation with hyaluronic acid fillers. The authors retrospectively reviewed the clinical outcomes and the risk factors for this complication using case-control analysis.. Seven patients (35 percent) developed full skin necrosis, and 13 patients (65 percent) recovered fully after combination treatment with hyaluronidase. Although the two groups had similar age, sex, filler injection sites, and treatment for the complication, 85 percent of the patients in the full skin necrosis group were late presenters who did not receive the combination treatment with hyaluronidase within 2 days after the vascular complication first appeared. In contrast, just 15 percent of the patients in the full recovery group were late presenters (p = 0.004).. Nose and nasolabial fold augmentations with hyaluronic acid fillers can lead to impending nasal skin necrosis, possibly caused by intravascular embolism and/or extravascular compression. The key for preventing the skin ischemia from progressing to necrosis is to identify and treat the ischemia as early as possible. Early (<2 days) combination treatment with hyaluronidase is associated with the full resolution of the complication.. Therapeutic, IV.

Topics: Adult; Case-Control Studies; Cosmetic Techniques; Dermal Fillers; Female; Humans; Hyaluronic Acid; Hyaluronoglucosaminidase; Injections, Subcutaneous; Male; Nasolabial Fold; Necrosis; Nose; Outcome Assessment, Health Care; Retrospective Studies; Risk Factors; Skin; Young Adult

We report a case of skin necrosis of the nasal tip after an injection of ribose cross-linked porcine atelocollagen (Evolence; Colbar Life Science Ltd, Herzliya, Israel). A 22-year-old woman had a nasal augmentation. From the glabella to the nasal tip, 10 strokes were injected using 0.6 mL of Evolence. On the day of the injection, her nasal tip became cyanotic; a day after it, an erythematous condition developed and a white cheeselike material appeared. On the second day, it became necrotic. Epithelialization was completed for 2 weeks. Despite laser therapy, permanent scarring of the nasal tip was prominent at the 18-month follow-up. It was thought that the skin necrosis is caused by vascular interruption rather than by hypersensitivity because the skin necrosis was confined to the nasal tip. To avoid vascular interruption from a filler injection, aspiration is needed before injection. The least amount of filler should be released in each stroke with low-pressure injection.

Topics: Cicatrix; Collagen; Cosmetic Techniques; Cross-Linking Reagents; Cyanosis; Dermal Fillers; Erythema; Female; Follow-Up Studies; Humans; Injections; Laser Therapy; Necrosis; Nose; Re-Epithelialization; Ribose; Skin; Young Adult

Resorbable magnesium-based implants hold great promise for various biomedical applications, such as osteosynthesis and coronary stenting. They also offer a new therapeutic option for the treatment of chronic rhinosinusitis, but little data is yet available regarding the use of magnesium in the nasal cavity. To model this field of application, primary porcine nasal epithelial cells were used to test the biocompatibility of degrading pure magnesium and investigate whether the degradation products may also affect cellular metabolism. Magnesium specimens did not induce apoptosis and we found no major influence on enzyme activities or protein synthesis, but cell viability was reduced and elevated interleukin 8 secretion indicated proinflammatory reactions. Necrotic damage was most likely due to osmotic stress, and our results suggest that magnesium ion build-up is also involved in the interleukin 8 release. Furthermore, the latter seems to be mediated, at least in part, by the p38 signaling pathway. These effects probably depended on the accumulation of very high concentrations of magnesium ions in the in vitro set-up, which might not be achieved in vivo, although we cannot exclude that further, as yet unknown, factors played a role in the inflammatory response during the degradation process. In conclusion, the biocompatibility of pure magnesium with cells in the immediate vicinity appears less ideal than is often supposed, and this needs to be considered in the evaluation of magnesium materials containing additional alloying elements.

Topics: Animals; Biodegradation, Environmental; Cell Differentiation; Cell Survival; Cells, Cultured; Epithelial Cells; Inflammation; Interleukin-8; Magnesium; MAP Kinase Signaling System; Necrosis; Nose; Sus scrofa

Topics: Adult; Cocaine-Related Disorders; Crack Cocaine; Drug Contamination; Ear, External; Female; Humans; Leg; Levamisole; Necrosis; Nose; Skin

Topics: Continuous Positive Airway Pressure; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Necrosis; Nose; Pressure Ulcer; Treatment Outcome

Learning Objectives: After reading this article, the participant should be able to: 1. Examine a nasal defect to determine its true dimension and outline and plan the appropriate timing of reconstruction. 2. Develop a surgical plan to restore normal dimension, volume, symmetry, and outline. 3. Determine the need for local versus regional flap repair. 4. Understand and apply aesthetic principles of nasal reconstruction. 5. Use exact surgical templates to determine the position, dimension, and outline transferred tissues. 6. Distinguish the indications for a two- or three-stage forehead flap. 7. Use the modified folded forehead flap technique with primary and delayed primary support replacement. 8. Understand an approach to the late revision.. This article and accompanying video discuss a step-by-step approach to the reconstruction of a full-thickness heminasal defect in a demanding attractive woman who developed necrosis after cosmetic rejuvenation of the nasolabial fold by filler injection. Aesthetic principles were applied to develop a surgical plan to define the timing of reconstruction and true defect for repair with a full-thickness folded forehead flap transferred in three stages using a modified folded forehead flap for lining and primary and delayed primary support with a late revision to further refine nasal landmarks.

Topics: Cosmetic Techniques; Female; Humans; Necrosis; Nose; Rhinoplasty; Surgical Flaps

Hyaluronic acid (HA) is the most used dermal filler. Some complications associated with its use have been described, but most of them are rare and benign. We report an exceptional case of skin necrosis of the tip of the nose, in a 22-year-old patient, after HA injection. The initial appearance may occurred subsequent aesthetic sequels. After necrotic tissue excision, patient was followed in rapid succession. Daily local care has led to wound healing, without any important sequel. This rare complication reminds us that HA injections are not without risk, despite their apparent simplicity of use. Moreover, the case presented confirms the potential healing of the nasal tip, allowing treatment with wound healing, rather than other early invasive procedure.

Topics: Cosmetic Techniques; Female; Humans; Hyaluronic Acid; Injections; Necrosis; Nose; Skin; Viscosupplements; Wound Healing; Young Adult

The link between nasal inhalation of cocaine and nasal and palatal necrosis is well documented. In contrast, few data are available concerning nasal mucosa necrosis related to heroin snorting. The authors report here the retrospective analysis of 24 cases of orofacial lesions in patients with nasal heroin usage, collected between 2006 and 2012.. The cases concern 17 males and 7 females (median age 29.5 (range: 24-42)) with chronic consumption of intranasal heroin (from 2 months to more than 10 years). Six patients had a history of cocaine abuse. The median daily amount of heroin consumption was 5 g (range: 0.5-10). The complications were nasal perforation (11 cases), nasal ulceration or erythema (5 cases), nasal septum necrosis (5 cases), pharyngeal ulceration (3 cases), and palate damages (5 cases). The most common clinical signs and symptoms were nasal pain, purulent sputum, dysphagia, and rhinitis. Maintenance therapy with methadone (19 cases) or buprenorphine (3 cases) was initiated. In 8 cases, the injury improved.. The potential of heroin to induce destructive orofacial lesions should be considered when nasal damages are observed in patients with drug abuse. A multidisciplinary approach seems to be the most effective means of managing such patients.

Topics: Administration, Intranasal; Adult; Buprenorphine; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; Necrosis; Nose; Opiate Substitution Treatment; Palate, Soft; Pharynx

Hyaluronic acid filler injection is widely used for soft tissue augmentation. However, there can be disastrous complications by direct vascular embolization. We present a case of ischemic oculomotor nerve palsy and skin necrosis after hyaluronic acid filler injection on glabellar.blepharoptosis, exotropia and diplopia developed suddenly after the injection, and skin necrosis gradually occurred. Symptoms and signs of oculomotor nerve palsy continuously improved with steroid therapy. Skin defects healed with minimal scars through intensive wound care.Percutaneous filler injection of periorbital areas should be performed carefully by experienced surgeons, and the possibility of embolization should be considered promptly if symptoms develop.

Topics: Biocompatible Materials; Cosmetic Techniques; Female; Humans; Hyaluronic Acid; Injections, Subcutaneous; Necrosis; Nose; Oculomotor Nerve Diseases; Retinal Artery Occlusion; Skin; Young Adult

Topics: Aged; Encephalitis, Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Mental Disorders; Necrosis; Nose

In March 2009, a new strain of influenza A/H1N1 virus was identified in Mexico, responsible for a pandemic. Worldwide, more than 13,500 patients died, most often from acute respiratory distress syndrome. Because sudden death cases were rare, involving mostly young apparently healthy persons, influenza A/H1N1 (2009)-related deaths may be misdiagnosed, which can raise medico-legal issues.. we report on an unexpected out-of-hospital death involving a young male with no past medical history and no vaccination. Fever was his only symptom. Laboratory tests: histology showed patchy necrotic foci with mononuclear inflammation in the lungs. The heart was histologically normal, but virological analyses using molecular biology on frozen myocardial samples showed high virus load. In conclusion, this case report shows that influenza A/H1N1 (2009) virus can be a cause of sudden cardiac death in the young and demonstrates the importance of quantitative virological analyses for the diagnosis of myocarditis.

Topics: Death, Sudden; DNA, Viral; Heart; Humans; Inflammation; Influenza A Virus, H1N1 Subtype; Influenza, Human; Lung; Male; Myocardium; Necrosis; Nose; Real-Time Polymerase Chain Reaction; Viral Load; Young Adult

Nasal amputation in the child is infrequent, and the procedure is not clearly defined. Early reconstruction certainly improves the child's life and social integration. The major risk is unsatisfactory growth of the reconstructed nose, which may persuade some surgeons to postpone the operation. The evaluation of this nasal reconstruction in a 5-year-old boy who had undergone subtotal amputation of the nose after 6 years of follow-up tends to confirm the therapeutic choice of early nasal reconstruction in the child. The results were considered quite satisfactory esthetically and psychologically beneficial and are concordant with those of other studies. Early management allowed us to obtain an esthetically acceptable reconstruction with respect to growth, thereby enabling the child to resume his studies rapidly and to achieve good social integration.

Topics: Amputation, Surgical; Child; Child, Preschool; Humans; Male; Necrosis; Nose; Purpura Fulminans; Reoperation; Rhinoplasty; Time Factors

Bronchoscopy can cause post-procedural throat discomfort due to oropharyngeal irritation. We report a rare complication of bronchoscopy that resulted in similar symptoms. A 30-year-old man complained of severe throat discomfort a day after bronchoscopy. Examination revealed a swollen, elongated uvula. The lower half of the uvula was completely white, consistent with uvular necrosis. He was managed conservatively with topical lidocaine and antihistamines. At a follow-up examination 2 weeks later his symptoms had substantially improved and the necrosed uvula had separated, leaving a shortened uvula with an irregular border. Simple precautions taken during bronchoscopy can avoid this rare complication that causes persistent symptoms.

Topics: Adult; Bronchoscopy; Humans; Male; Necrosis; Nose; Uvula

Topics: Adult; Female; Gels; Humans; Hyaluronic Acid; Injections, Intradermal; Necrosis; Nose; Nose Deformities, Acquired; Peripheral Vascular Diseases; Skin

Topics: Aged, 80 and over; Anti-Inflammatory Agents; Giant Cell Arteritis; Humans; Male; Methylprednisolone; Necrosis; Nose; Prednisone; Rhinoplasty; Thrombosis

Topics: Adult; Balloon Occlusion; Esophageal and Gastric Varices; Hematemesis; Humans; Male; Necrosis; Nose; Pressure

Topics: Amphotericin B; Antifungal Agents; Biopsy; Debridement; Fatal Outcome; Female; Hemochromatosis; Hepatic Encephalopathy; Humans; Intubation, Gastrointestinal; Liver; Liver Failure, Acute; Middle Aged; Mucormycosis; Necrosis; Nose; Nose Diseases; Opportunistic Infections; Triazoles

Topics: Adult; Alprostadil; Cosmetic Techniques; Female; Humans; Hyaluronic Acid; Infusions, Intravenous; Injections; Necrosis; Nose; Salvage Therapy; Skin; Vasodilator Agents

Despite the benefits from the minimally invasive technique, complications may occur, raising doubts about the safety of polymethylmethacrylate as an injectable filler material. The authors report their treatment of a patient from another institution with necrosis involving full-thickness nasal skin and upper lip after injection of polymethylmethacrylate in the nasolabial folds and nose for augmentation. An expanded median forehead flap was used to reconstruct the nose, and an Abbé flap was used for the upper lip. The flaps and the skin expander allowed reconstruction with correct texture, color, and dimensions, producing a good aesthetic and functional outcome.

Topics: Adult; Bone Cements; Forehead; Humans; Lip; Male; Necrosis; Nose; Polymethyl Methacrylate; Rhinoplasty; Skin Transplantation

Varicella zoster virus (VZV) is the causal agent of varicella (chickenpox) and herpes zoster (shingles). Primary VZV infection is a common childhood disease, but elderly patients and those having a compromised immune system are also at risk. We present the case of progressive necrosis of the nose skin in a patient with a compromised immune system and a generalised VZV infection. During the course of his hospital stay and follow-up, the lesion gradually improved with conservative treatment.

Topics: Aged; Debridement; DNA, Viral; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Necrosis; Nose; Rhinoplasty

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

Topics: Adult; Clinical Trials as Topic; Dermatology; Drug Interactions; Ear; Epinephrine; Evidence-Based Medicine; Fingers; Humans; Information Dissemination; Lidocaine; Male; Necrosis; Nose; Penis; Plastic Surgery Procedures; Research Design; Skin Diseases; Skin Neoplasms; Surgical Procedures, Operative; Suture Techniques; Young Adult

Topics: Cosmetic Techniques; Humans; Hyaluronic Acid; Lip; Male; Middle Aged; Necrosis; Nose

To evaluate the incidence and severity of nasal trauma secondary to nasal continuous positive airway pressure (nCPAP) in neonates.. Prospective observational study.. Neonatal intensive care unit (NICU) of the University Hospital of Lausanne, Switzerland.. All neonates admitted between January 2002 and December 2007 treated by nCPAP were eligible.. Patients' noses were monitored during nCPAP. Nasal trauma was reported into three stages: (I) persistent erythema; (II) superficial ulceration; and (III) necrosis.. 989 neonates were enrolled. Mean gestational age was 34 weeks (SD 4), mean birth weight 2142 g (SD 840). Nasal trauma was reported in 420 (42.5%) patients and it was of stage I, II and III in 371 (88.3%), 46 (11%) and 3 (0.7%) patients, respectively. Incidence and severity of trauma were inversely correlated with gestational age and birth weight. The risk of nasal trauma was greater in neonates <32 weeks of gestational age (OR 2.48, 95% CI 1.59 to 3.86), weighing <1500 g at birth (OR 2.28, 95% CI 1.43 to 3.64), treated >5 days by nCPAP (OR 5.36, 95% CI 3.82 to 7.52), or staying >14 days in the NICU (OR 1.67, 95% CI 1.22 to 2.28). Most cases of nasal trauma (90%) appeared during the first 6 days of nCPAP. Persistent visible scars were present in two cases.. Nasal trauma is a frequent complication of nCPAP, especially in preterm neonates, but long-term cosmetic sequelae are very rare. This study provides a description of nasal trauma and proposes a simple staging system. This could serve as a basis to develop strategies of prevention and treatment of this iatrogenic event.

Topics: Birth Weight; Continuous Positive Airway Pressure; Erythema; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Intensive Care, Neonatal; Male; Necrosis; Nose; Nose Diseases; Prospective Studies; Trauma Severity Indices; Ulcer

We report on a patient with Sharp-Syndrome who was referred to our emergency department with sepsis. In addition, the patient showed acral necrosis, particularly of the distal phalanges of the hands and of the tip of the nose.. Laboratory analyses showed an elevation of the inflammatory parameters (C-reactive protein elevation, leukocytosis). Furthermore, procalcitonin and the D-dimers were increased, antithrombin III, however, was decreased. The thoracic/abdominal computed tomography (CT) showed bilateral inferior lobe pneumonia with concomitant pleural effusions. As a secondary diagnostic finding the thoracic/abdominal CT and the abdominal ultrasound showed a markedly reduced size of the spleen. Finally, bacteria (Streptococcus pneumoniae) were found in the blood of the patient.. We diagnosed pneumococcal sepsis with disseminated intravasal coagulation and acral necrosis caused by pneumonia. The immune status was impaired due to immunosuppressive therapy (prednisolon and azathioprin) and functional asplenism. The patient was stabilized with antibiotic treatment, hydration, and drotrecogin (protein C). Transiently catecholamin treatment and oxygen substitution were necessary. Alprostadil was used to treat acral circulatory disorder.. This case report shows the importance of consequent screening for organ manifestations in autoimmune diseases. In particular, this case report highlights the relevance of prophylactic vaccination in patients with autoimmune diseases, primarily those with autosplenectomy. Furthermore, this article gives a short overview about the pathogenesis, the diagnostic criteria of the Sharp-syndrome. The frequencies of organ involvement and the treatment options are also discussed.

Topics: Disseminated Intravascular Coagulation; Female; Fingers; Humans; Immunosuppressive Agents; Mixed Connective Tissue Disease; Necrosis; Nose; Pneumococcal Infections; Sepsis; Streptococcus pneumoniae; Young Adult

Kawasaki disease (KD) is a multisystemic vasculitis disorder in children. The dermatological manifestations are described as polymorphic and nonspecific. However, they are important for diagnosis. They correspond to 3 out of the 5 major criteria that may be associated with the disease's constant fever. We report the case of a child aged 3 years 8 months who showed necrotic lesions on the cheeks and the nose, associated with an erythematous, macular eruption on the rest of the body. Necrotic lesions have been exceptionally reported. These misleading cutaneous aspects should not delay or rule out the diagnosis of KD, especially in atypical or incomplete forms. Early diagnosis of KD should be made before the onset of coronary lesions.

Topics: Cheek; Child, Preschool; Early Diagnosis; Exanthema; Face; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Male; Mucocutaneous Lymph Node Syndrome; Necrosis; Nose; Treatment Outcome

The aim of this study was to evaluate a modified surgical technique for premaxilla repositioning with concomitant autogenous bone grafting in bilateral trans-foramen cleft lip and palate patients.. The study included 50 bilateral trans-foramen cleft lip and palate patients. Bone graft was harvested from the mandibular symphysis in 24 patients. Whenever more grafting was necessary, the iliac crest bone was used as the donor site (26 patients). The premaxilla was displaced by rupturing the bone and the palatine mucosa, and repositioned in a more adequate position using a surgical guide. The premaxilla and the grafts were fixed with miniplates and screws or screws only. The surgical guide was kept in place for 2 months, whereas the miniplates and screws were removed after 6 months, together with the complete bilateral lip and nose repair. Follow-up examinations were performed at 3, 6, and 12 months by means of periapical and occlusal radiographs, and by clinical examination. Thereafter, the patients were referred for completion of the orthodontic treatment.. Overall, in 48 cases (96%) the treatment achieved total graft integration, with complete closure of the bucconasal and palatal fistulas, and premaxilla stability (either at first surgery or after reoperation). In the remaining 2 patients (4%), the treatment failed, due to necrosis of the premaxilla.. The procedure is complex and involves risk. However, the patient's social inclusion, especially at the addressed age group, is the best benefit achieved.

Topics: Bone Plates; Bone Screws; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Graft Survival; Humans; Male; Maxilla; Nasal Cavity; Necrosis; Nose; Nose Diseases; Oral Fistula; Osteotomy; Palate; Periosteum; Postoperative Complications; Respiratory Tract Fistula; Surgical Flaps

To explore the method of repairing nose defects of the apex, ala, septum, and even opposite ala nasi with ultralong pedicled superficial temporal fascia (STF) island flaps.. There were 29 cases of defects of the apex nasi, ala nasi, and nasal columella that were reconstructed, of which 12 cases were repaired with frontal-branched STF island flaps, 14 cases with apical-branched STF postauricular island flaps, and 3 cases with prefabricated apical-branched STF postauricular island flaps. The flap areas were arranged from 1.2 x 2.3 to 2.0 x 2.8 cm2, the length more than 15 cm on average. Liners were reconstructed at the stage of the prefabricating flaps, with free skin graft in the cases of the alae nasi defects. The surfaces of the wound after flap prefabrications were covered by skin graft as well.. Twenty-seven cases were successfully taken without blood circulation blocks; the color, texture, and figure were good, and the outcomes were satisfying. Seven nonprefabricated flap cases have epidermis necrosis due to the lack of artery perfusion pressure and venous return handicap, and the epidermis fall off after 1 month; 2 cases of which required secondary surgeries because of partial necrosis.. An ultralong pedicled STF island flap is an available way to repair defects of the apex nasi, ala nasi, and nasal columella. The benefits of a prefabricated flap are good blood circulation, primary made liner, and minute injury of the donor site. It is a good method of repairing defects of the apex nasi, ala nasi, nasal septum, and opposite ala nasi simultaneously.

Topics: Adolescent; Adult; Esthetics; Fascia; Female; Follow-Up Studies; Graft Survival; Humans; Hyperemia; Male; Middle Aged; Necrosis; Nose; Nose Deformities, Acquired; Nose Diseases; Plastic Surgery Procedures; Regional Blood Flow; Reoperation; Surgical Flaps; Temporal Arteries; Temporal Muscle; Tissue and Organ Harvesting; Treatment Outcome; Young Adult

Topics: Aged, 80 and over; Antineoplastic Agents; Carcinoma, Basal Cell; Chlorides; Drug Combinations; Herbal Medicine; Humans; Male; Necrosis; Nose; Phytotherapy; Plant Preparations; Sanguinaria; Skin Neoplasms; Zinc Compounds

Injection of dermal fillers is one of the most commonly performed cosmetic procedures. Serious complications from fillers are rare but potentially devastating to patients and physicians. Skin necrosis, such as nasal alar necrosis, is one of the most feared serious complications of dermal fillers, but there is a paucity of literature on the incidence of such events, as well as potential treatment options.. We present a review of the literature and three cases of nasal alar necrosis after dermal filler injection.. Nasal alar necrosis associated with dermal filler injection is a rare event. Proper technique and recognition of risk factors may reduce the incidence of this complication. Physicians should be aware of early intervention and treatment options should impending necrosis become apparent.

Topics: Adult; Anti-Bacterial Agents; Bacitracin; Bandages, Hydrocolloid; Biocompatible Materials; Collagen; Cosmetic Techniques; Debridement; Dermatologic Agents; Drug Therapy, Combination; Erythema; Face; Female; Glucocorticoids; Humans; Hyaluronoglucosaminidase; Injections, Intradermal; Male; Necrosis; Nose; Rejuvenation; Risk Factors; Skin Aging; Treatment Outcome; Triamcinolone

Topics: Catheterization; Epistaxis; Humans; Necrosis; Nose; Nose Deformities, Acquired; Pressure Ulcer

A 35-year-old woman with necrosis of the complete nasal tract due to nasal cocaine abuse is presented. Reconstruction was performed using a free radial forearm flap and rib cartilage grafts. Pre-existing skin of the nose was used for outer lining. The reconstruction led to an excellent functional and aesthetic result.

Topics: Adult; Cocaine-Related Disorders; Female; Follow-Up Studies; Humans; Necrosis; Nose; Nose Deformities, Acquired; Rhinoplasty; Surgical Flaps

Topics: Child, Preschool; Diagnosis, Differential; Emergency Medicine; Fatal Outcome; Foreign Bodies; Humans; Intestinal Volvulus; Intestine, Small; Male; Malpractice; Medical Errors; Necrosis; Nose; Time Factors

Topics: Adolescent; Ataxia Telangiectasia; Candida; Candidiasis; Common Variable Immunodeficiency; Female; Humans; Necrosis; Nose

Topics: Arteries; Biocompatible Materials; Collagen; Embolism; Female; Gangrene; Humans; Hyaluronic Acid; Injections; Middle Aged; Necrosis; Nose; Skin

We describe an unusual case of cutaneous necrosis of the nasal tip presenting to a facial reconstructive surgeon. The patient had developed this painless necrosis over a period of about 10 days. Her past medical history included rheumatoid arthritis. She described an exacerbation of her arthritic symptoms in the weeks preceding the development of the nasal tip necrosis. Her rheumatoid arthritis had been managed with corticosteroid and immunosuppressive therapy for more than 3 years. She had not previously experienced extra-articular manifestations (EAMs). A biopsy was taken and histological analysis identified a lymphocytic vasculitis. She was referred to her rheumatologist, and surgical management of her necrotic nasal tip commenced.

Topics: Aged; Arthritis, Rheumatoid; Biopsy; Female; Humans; Necrosis; Nose; Nose Diseases; Skin Diseases, Vascular; Treatment Outcome; Vasculitis; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Adjuvants, Immunologic; Adult; Blood Vessels; Embolism; Female; Humans; Hyaluronic Acid; Hyaluronoglucosaminidase; Injections, Intradermal; Necrosis; Nose; Skin

Topics: Formaldehyde; Humans; Intubation, Intratracheal; Necrosis; Nose; Polyvinyl Alcohol

The original transverse forked flap is effective in reconstructing the anterior wall of columella in a single stage without leaving a noticeable secondary deformity. A modification was done to allow reconstruction of the lateral walls of columella in addition. This three-dimensional reconstruction will provide enough coverage for a cartilage graft if used. This modification was applied to three patients with columella defects. A costal cartilage graft was used in one of these patients. All flaps survived and donor site scarring was unnoticeable. Elevation of the base of the forked flap allowed using it to reconstruct the anterior wall of columella while sparing the lateral wings to reconstruct the lateral walls of columella.

Topics: Adult; Cartilage; Child, Preschool; Female; Graft Survival; Humans; Leishmaniasis; Necrosis; Nose; Nose Diseases; Plastic Surgery Procedures; Surgical Flaps

The authors report a case of nasal reconstruction in a 5-year-old boy who had undergone subtotal amputation of the nose 8 months before in the context of meningococcus-induced purpura fulminans. Two-step surgery involved implantation of a forehead expansion graft preliminary to use of a contralateral forehead flap to cover a cartilaginous graft from the concha that reconstituted the ala nasi, columella, and septum. At 1 year of follow-up, the results were considered quite satisfactory esthetically and psychologically beneficial. Nasal amputation in the child is infrequent, and the procedure is not clearly defined. Early reconstruction certainly improves the child's life and social integration. The major risk is unsatisfactory growth of the reconstructed nose, which may persuade some surgeons to postpone the operation.

Topics: Age Factors; Amputation, Surgical; Child, Preschool; Ear, External; Forehead; Humans; IgA Vasculitis; Male; Meningococcal Infections; Necrosis; Nose; Nose Diseases; Plastic Surgery Procedures; Surgical Flaps; Tissue Expansion

Defects of the nasal ala can be difficult to repair in a one-stage procedure. We describe a laterally based nasalis myocutaneous island pedicle flap to repair small but deep defects of the superior nasal ala.. To describe a single-stage flap for repair of small defects on the nasal ala that confines the repair to one cosmetic unit.. We discuss the anatomy of the flap and illustrate the method of placing the flap.. We present several case examples and discuss potential applications of the flap. We also discuss the flap's limitations by citing an example of necrosis.. The nasalis myocutaneous island pedicle flap for repair of nasal alar defects is a new application of a one-stage procedure that yields excellent functional and cosmetic results. Knowledge of the limitations and the anatomy of the flap is crucial for a good outcome.

Topics: Adult; Female; Humans; Male; Middle Aged; Mohs Surgery; Necrosis; Nose; Plastic Surgery Procedures; Surgical Flaps

Oral cavity cancers represent 30% of the cephalic extremity tumors. Their resection requires in the majority of the cases a reconstruction by soft tissue. The reconstruction must be simple by bringing some reliable, hairless, thin, resistant tissue to radiation therapy, with a limited morbidity and an acceptable scar ransom.. The purpose of our study is to define the place and the limits of nasolabial flap in the reconstruction of the anterior floor of the mouth after tumoral resection compared to the other surgical and microsurgical techniques.. We retrospectively studied patients with oral cancerous lesions of the anterior floor of the mouth reconstructed by nasolabial flap between 1997 and 2002. The patients benefited from a surgical resection of the tumor by respecting the safety margins, with an immediate reconstruction allowing the restoring of the oral functions. We tried to describe the limits of this flap and discussed its modalities of vascularization.. Fifty-three flap procedures were performed on 47 patients; forty-one have received a unilateral and 6 a bilateral nasolabial flap. The majority of tumors were squamous cell carcinomas (50 cases). The average age of patients were 64.8 years (45-78 years) with 40 men (75%) and 13 women (25%). A radical neck lymph nodes dissection with facial artery ligation was realized for 21 patients (15 ipsilateral and 3 bilateral) without affecting the outcome. As complications, we noted one complete necrosis and two partial necrosis of the flap, two postoperative wound complications with dehiscence as well as a massive local recurrence of initial tumor in one patient.. The nasolabial flap represents a simple functional and morphological option to other pedicled or microsurgically anastomosed flaps for the reconstruction of intermediate-sized mouth floor defects.

Topics: Aged; Female; Humans; Lip; Lymph Node Excision; Male; Middle Aged; Mouth Floor; Mouth Neoplasms; Necrosis; Neoplasm Recurrence, Local; Nose; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Surgical Flaps; Treatment Outcome

Reconstruction of isolated nasal lining defects can be extraordinarily daunting. This report defines the uniqueness of the surgical challenges inherent to reconstruction of the nasal lining and overviews the authors' approach to management.. A retrospective review was performed of 11 consecutive patients presenting for reconstruction of the nasal lining alone during the period from October of 1996 through March of 2003. There were four men and seven women with an average age of 49.2 years. The average follow-up was 4.2 years.. Five patients required reconstruction of the total nasal lining (floor, columella, vestibule), and the remaining reconstructions involved subtotal components. Coincidental necrosis of the nasal lining during total/subtotal nasal reconstruction was the most common cause. A single microsurgical free flap was used in eight patients (six radial forearm flaps). Three patients required two free flaps. There were no flap failures. Thirteen of 14 free flaps healed primarily. Dehiscence of the flap/nasal septal juncture occurred in one cocaine-injured nose. Ten of 11 patients demonstrated patent, functional nasal airways postoperatively.. Reconstruction of the nasal lining, alone, is a very challenging endeavor that demands careful surgical planning and precise technical execution. The use of microsurgical transfer for these defects allows considerable latitude for duplication of the missing complex three-dimensional anatomy and avoids sullying the adjacent facial soft tissues. Because of the adverse condition of the local tissues, the majority of these cases could not have been brought to a successful conclusion without the use of free tissue transfer, and this is particularly relevant in the cocaine-injured nose.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Cocaine-Related Disorders; Female; Granuloma; Humans; Lip; Male; Melanoma; Microsurgery; Middle Aged; Nasal Mucosa; Nasal Obstruction; Nasal Septum; Necrosis; Neoplasm Recurrence, Local; Nose; Nose Diseases; Nose Neoplasms; Pemphigus; Plastic Surgery Procedures; Reoperation; Retrospective Studies; Surgical Flaps

Foley's catheter is used for post-nasal packing in severe epistaxis. Various methods have been described for securing the catheter in position, all of which can be associated with patient discomfort, risk of alar necrosis or unsightliness. We describe a new method to secure the Foley's catheter without these problems. The ribbon gauze used for anterior nasal packing is tied over the catheter in multiple knots to secure it in place. This has been successfully tried on over 50 patients.

Topics: Acute Disease; Cartilage Diseases; Catheterization; Epistaxis; Hemostasis, Surgical; Humans; Necrosis; Nose

Granulomatous amebic encephalitis is an uncommon central nervous system (CNS) infection, usually caused by Acanthamoeba spp., which generally occurs in immunocompromised individuals. Balamuthia mandrillaris is a recently described free-living ameba that occasionally causes fatal CNS disease. The infection might start from a minor, slowly progressive, skin ulceration that can be present for weeks to months before neurologic changes occur. The clinical and histologic presentation is easily confused with many other diseases. Accurate diagnosis requires an awareness of this unusual presentation of amebiasis and identification of the amebic trophozoites in tissue and culture. Special stains are helpful, but immunofluorescence assays or electron microscopy is required to identify the organism as B mandrillaris. We present a fatal case of granulomatous amebic encephalitis that began as a cutaneous infection in an immunocompetent host.

Topics: Aged; Aged, 80 and over; Amebiasis; Amoeba; Animals; Diagnosis, Differential; Encephalitis; Fatal Outcome; Granuloma; Humans; Magnetic Resonance Imaging; Male; Necrosis; Nose; Skin Diseases, Parasitic

Pulmonary emphysema is a major component of the morbidity and mortality of chronic obstructive pulmonary disease (COPD). Currently there are no predictive biomarkers for COPD. Initial steps toward identifying potentially predictive biomarkers involve utilizing well-characterized mainstream smoke (MS) exposure conditions (dose-response) to identify changes in biomarkers of effect (inflammation, tissue injury, oxidative stress) in emphysema-susceptible and -resistant mouse strains. C57Bl/6 mice have been reported to develop emphysema when exposed chronically to cigarette smoke, while similarly exposed ICR mice do not. Male C57Bl/6 and ICR mice were exposed 2 h/day for 7 consecutive days to MS from a standard reference cigarette (2R4F) at 75, 250, and 600 microg total particulate matter (TPM)/L or filtered air. To confirm exposure, blood samples were collected toward the end of the last exposure and analyzed for carboxyhemoglobin, nicotine, and cotinine. Bronchoalveolar lavage (BAL) fluid samples were collected 2 or 12 h postexposure and analyzed for biomarkers of effect. MS dose differed slightly between strains. More necrosis was observed in nasal epithelium of exposed C57Bl/6 mice. Exposure concentration-dependent increases in apoptosis, chemokines, and neutrophil counts were greater in ICR mice. Similar increases in thymus and activated-regulated chemokine were only observed in C57Bl/6 mice. BAL fluid cells of C57Bl/6 mice appear to undergo necrosis, while the BAL fluid cells of ICR mice appear to undergo apoptosis following MS exposure. Utilizing two strains of mice we identified MS-responsive biomarkers of effect that may be predictive of COPD pathology. Chronic MS exposures are needed to link these biomarkers with emphysema.

Topics: Animals; Apoptosis; Biomarkers; Bronchoalveolar Lavage Fluid; Chemokines; Dose-Response Relationship, Drug; Emphysema; Epithelium; Inhalation Exposure; Male; Mice; Mice, Inbred C57BL; Mice, Inbred ICR; Necrosis; Neutrophils; Nicotiana; Nose; Particle Size; Smoke; Species Specificity

Chronic use of cocaine provokes vasoconstriction and irritation of the upper airway epithelium. These mechanisms can lead to tissue necrosis and perforations.. A 37-year-old woman had major centrofacial necrosis subsequent to chronic inhalation of cocaine. The tissue loss involved the right wing of the right ala nasi, the bony and soft palate and nearly all of the lateronasal walls. A microanastomosed antebrachial fasciocutaneous flap was used for reconstruction of the nasal vault. A classical veloplasty was used to close the palate. Velar competency was improved with a second procedure with Ortricochea sphincter pharyngoplasty. Later loss of the antebrachial flap required salvage with a flap from the lateral border of the tongue which provided a satisfactory functional result.. This case of extended necrosis is rare and treatment was complex. Such treatment can only be undertaken after total and definitive cessation of drug abuse, including tobacco smoking.

Topics: Adult; Cocaine-Related Disorders; Fascia; Female; Humans; Nasal Cavity; Necrosis; Nose; Palate, Hard; Palate, Soft; Skin Transplantation; Surgical Flaps

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Necrosis; Nose; Palate, Hard; Valacyclovir; Valine

To assess the efficacy of a modified facial translocation technique in preventing translocated facial bone graft from necrosis, which is the most common complication of facial translocation.. Prospective.. A lateral nasal flap was preserved and transposed to resurface the inner surface of the translocated facial bone graft in a facial translocation approach to skull base tumors in 35 patients including 24 patients with radiation therapy between July 1998 and December 2000.. Only one patient had bone graft necrosis. Thirty-four (97%) of 35 patients had intact mucosa covering the inner surface of the translocated facial bone graft. The outcome was not affected by preoperative or postoperative radiation therapy.. A modified facial translocation technique using a lateral nasal flap to resurface the inner defect of the translocated facial bone graft significantly improved the viability of the translocated facial bone graft, especially in patients who underwent radiation therapy. The use of a lateral nasal flap does not interfere with the detection of early local recurrence.

Topics: Adolescent; Adult; Aged; Facial Bones; Female; Graft Survival; Humans; Male; Middle Aged; Necrosis; Nose; Prospective Studies; Skull Base Neoplasms; Surgical Flaps

Inserting a nasogastric tube during various abdominal procedures is a common maneuver to decompress the upper gastrointestinal tract. Improper placement and taping of the nasogastric tube results in excessive pulling on the nasal ala and subsequent pressure necrosis. This complication not only carries serious cosmetic morbidity, it is also preventable if a proper taping technique is employed.

Topics: Adult; Clinical Competence; Humans; Intubation, Gastrointestinal; Necrosis; Nose; Nose Diseases; Pressure

Topics: Foreign Bodies; Humans; Magnetics; Nasal Mucosa; Nasal Septum; Necrosis; Nose

Management of complex and relentless large arteriovenous malformations with long term control and acceptable aesthetic results can be accomplished. This outcome requires selective intra-arterial embolization, judicious surgical resection, composite reconstruction with free tissue transfer, other ancillary procedures, or both, and careful serial follow-up examinations to rule out recurrent or persistent disease.

Topics: Adult; Arteriovenous Malformations; Cysts; Forehead; Humans; Inflammation; Male; Necrosis; Nose; Plastic Surgery Procedures; Radiography; Scalp; Treatment Outcome; Vascular Surgical Procedures

To describe an unrecognized clinical entity, nasal alar necrosis, and propose recommendations regarding the diagnosis, pathophysiology, and management of these cases.. Retrospective review of four patients with this condition.. Histories, treatments, and outcomes were evaluated using office and hospital chart data.. We noted that three patients had prior trauma or surgery, other than to the nose, in the head and neck region. All four patients had comorbidities such as diabetes, hypothyroidism, depression, or tobacco abuse. Three patients had sensory deficits over the distribution of the maxillary nerve, and three volunteered that they had a habit of picking the crusted wound. Two patients improved over several months with aggressive wound care. One patient refused treatment and another underwent successful reconstruction.. After malignant and granulomatous diseases were ruled out, our evaluations suggested that the pathogenesis was multifactorial including several factors alone or in combination, such as, hypoesthesia, self-mutilation, and an inadequate blood supply. Deficits in vascularity and sensory innervation must be considered as potential obstacles in reconstruction. Psychological problems causing factitious wounding may complicate therapeutic interventions.

Topics: Adult; Anti-Infective Agents, Local; Bacitracin; Female; Humans; Male; Middle Aged; Necrosis; Nose; Nose Diseases; Plastic Surgery Procedures; Retrospective Studies

We have introduced a method of securing a Foley's catheter in the nose, in the management of posterior epistaxis. Our method has the advantage of securing the catheter in situ, while maintaining traction on the balloon in the posterior nasal space and preventing nasal alar cartilage necrosis.

Topics: Cartilage; Cartilage Diseases; Catheterization; Epistaxis; Equipment Design; Humans; Necrosis; Nose

Topics: Child; Epistaxis; Fatal Outcome; Hemostatic Techniques; Humans; Necrosis; Nose; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Chloroform is a nongenotoxic-cytotoxic liver and kidney carcinogen and nasal toxicant in some strains and sexes of rodents. Substantial evidence indicates that tumor induction is secondary to events associated with cytolethality and regenerative cell proliferation. Therefore, pathways leading to toxicity, such as metabolic activation, become critical information in mechanism-based risk assessments. The purpose of this study was to determine the degree to which chloroform-induced cytotoxicity is dependent on the cytochromes P450 in general and P450 2E1 in particular. Male B6C3F(1), Sv/129 wild-type (Cyp2e1+/+), and Sv/129 CYP2E1 knockout (Cyp2e1-/- or Cyp2e1-null) mice were exposed 6 h/day for 4 consecutive days to 90 ppm chloroform by inhalation. Parallel control and treated groups, excluding Cyp2e1-null mice, also received an i.p. injection (150 mg/kg) of the irreversible cytochrome P450 inhibitor 1-aminobenzotriazole (ABT) twice on the day before exposures began and 1 h before every exposure. Cells in S-phase were labeled by infusion of BrdU via an implanted osmotic pump for 3.5 days prior to necropsy, and the labeling index was quantified immunohistochemically. B6C3F(1) and Sv/129 wild-type mice exposed to chloroform alone had extensive hepatic and renal necrosis with significant regenerative cell proliferation. These animals had minimal toxicity in the nasal turbinates with focal periosteal cell proliferation. Administration of ABT completely protected against the hepatic, renal, and nasal toxic effects of chloroform. Induced pathological changes and regenerative cell proliferation were absent in these target sites in Cyp2e1-/- mice exposed to 90 ppm chloroform. These findings indicate that metabolism is obligatory for the development of chloroform-induced hepatic, renal, and nasal toxicity and that cytochrome P450 2E1 appears to be the only enzyme responsible for this cytotoxic-related metabolic conversion under these exposure conditions.

Topics: Administration, Inhalation; Animals; Biotransformation; Carcinogens; Cell Division; Chloroform; Cytochrome P-450 CYP2E1; Cytochrome P-450 CYP2E1 Inhibitors; Immunohistochemistry; Kidney; Liver; Male; Mice; Mice, Inbred Strains; Mice, Knockout; Necrosis; Nose; Organ Size; Turbinates

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

This study reports intraspecific variations of native isolates of Leishmania (Viannia) braziliensis from patients with leishmaniasis from Salta, Argentina. These isolates induced skin lesions in golden hamsters, initially showing rapid development, reaching their largest size between 28 and 35 days postinfection (PI). Thereafter, the infections were self-limiting and total regression was observed at 80-150 days PI. The majority of the native isolates were characterized by low infectivity in the experimental animals, and a classic pattern of dissemination to systemic organs was established. However, unusual features for L. braziliensis were displayed by two isolates; one showed evidence of high infectivity in hamsters characterized by a short prepatent period and larger, severe and persistent lesions at the inoculation site. The other isolate, of low infectivity, showed cutaneous metastasis and recurrent systemic dissemination in the same animals, suggesting dissociation between infectivity and pathogenicity. Metastasis has been frequently described in hamsters infected with L. (V) guyanensis and L. (V) panamensis, but not in infections induced by L. (V) braziliensis, as was observed in this study. Active and/or regressive histopathologic lesions were observed, depending on the stage of the infection. An exudative and mixed inflammatory pattern with microabscesses and necrotic areas was observed during early infection, while well-defined granulomas and collagen formation were the predominant features detected at a later time. Amastigotes were easily detected in the tissues, although in low numbers. Schaumann bodies were always detected. The characterization of the unique features of these native isolates, and the verification of their reproducibility in vitro and in vivo will be useful tools in tests related to immunoprophylaxis and chemotherapy.

Topics: Animals; Argentina; Cricetinae; Disease Models, Animal; Granuloma; Humans; Leishmania braziliensis; Leishmaniasis, Cutaneous; Macrophages; Mesocricetus; Necrosis; Nose; Skin

A deep defect of the nasal alar rim or lobule may represent a unique and difficult challenge because of the lax free margin and structural support supplied by the alar rim and lobule. Traditional closure strategies, including granulation, full thickness skin grafting, or nasolabial transposition flaps may result in unsatisfactory cosmetic and functional outcomes.. This article describes our experience with the staged cheek-to-nose interpolation flap for repairing deep skin cancer excision defects of the nasal alar rim and lobule.. The staged cheek-to-nose interpolation flap was used immediately after Mohs micrographic surgery to repair 18 deep nasal alar rim/lobule defects. In 13 patients, a free cartilage graft was used to restore structural support.. The cosmetic and functional outcomes of each repair were judged from good to excellent by patient and surgeon. No cases of infection or flap necrosis occurred. To enhance the cosmetic outcome, three patients underwent spot dermabrasion within 2 months after flap detachment.. The staged cheek-to-nose interpolation flap, with or without free cartilage grafts, consistently provides good to excellent cosmetic and functional outcomes when performed on properly selected deep nasal alar rim/lobule defects.

Topics: Cartilage; Cheek; Collateral Circulation; Dermabrasion; Esthetics; Follow-Up Studies; Graft Survival; Granulation Tissue; Humans; Lip; Mohs Surgery; Necrosis; Nose; Nose Neoplasms; Patient Satisfaction; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Surgical Wound Infection; Treatment Outcome

Topics: Burns; Humans; Necrosis; Nose; Rhinoplasty; Splints

The authors describe a rare case of rhinocerebral mucormycosis. This is an acute, suppurative mycosis with poor prognosis. It has a particular affinity for rhinocerebral tissue and less frequently affects pulmonary tissue. Mucormycosis affects immunosuppressed patients and more than 75% of the cases involve patients suffering from acidosis, especially diabetic ketoacidosis. One characteristic feature is that the blood vessels are flooded causing thromboses, infarction and emboli. The disease is spread through the blood vessels or by expansion. The first clinical symptoms can be confused with an early stage of acute sinusitis with mucosanguineous rhinorrhea, facial tumescence and pain. In 50% of the cases there is rhinocerebral and orbital involvement. If the disease remains untreated it can prove fatal in 10 to 14 days. Effective treatment relies on an early diagnosis and prompt administration of intravenous amphotericin B as well as avulsion of the necrotic areas. To date only 200 cases of this severe pathology have been described. The present work is an attempt to throw further light on this disorder.

Topics: Adult; Amphotericin B; Diabetes Mellitus; Female; Humans; Mucormycosis; Necrosis; Nose

Hydrazine (N2H4) is used as a fuel for missiles and standby power systems of operational military aircraft. Maintenance of missiles and aircraft may result in accidental human exposure to high concentrations for brief periods of time. The purposes of this study were to assess the oncogenic potential of N2H4 in rats and male hamsters exposed to a high concentration of N2H4 for repeated short exposures and to investigate the relationships of acute and subchronic effects of N2H4 to nasal tumorigenesis. In phase 1 (acute and subchronic) and Phase 2 (lifetime experiments, groups of male and female Fischer 344 rats and male Syrian golden hamsters were exposed by inhalation to 0, 75 (Phase 2 only), or 750 ppm N2H4 for 1 (acute) or 10 (subchronic) 1-hr weekly exposures. Rodents were euthanized 24 hr after exposures 1 and 10 and 24 to 30 months poststudy initiation. Significant reductions in body weight were observed in N2H4-treated rodents compared to controls during the exposure interval. No hydrazine-induced mortality was detected. Histopathologic examination after the acute and subchronic exposures revealed degeneration and necrosis of transitional, respiratory, and olfactory epithelia in the anterior nose and, in rats exposed subchronically, squamous metaplasia of the transitional epithelium. Minimal to mild rhinitis resulted from N2H4 exposures. Apoptosis was observed in olfactory and squamous metaplastic transitional epithelium. Lesions occurred at sites reportedly having high air-flow and generally appeared to be more severe in the anterior portion of the nose. By 24 months, the squamous metaplastic transitional epithelium reverted back to normal-appearing transitional epithelium. By 24+ months, low incidences (sexes combined) of hyperplasia (5/194, 2.6%) and neoplasia (11/194, 5.7%) were detected, principally in the transitional epithelium of the 750 ppm N2H4-treated rats. A similar incidence of hyperplasia (2/94, 2%) and neoplasia (5/94, 5.3%) was detected in the high-exposure group of hamsters. The location and type of N2H4-induced proliferative lesions were similar to those reported in a chronic N2H4-exposure study (5.0 ppm x 6 hr/day x 5 days/week for 1 year) conducted in our laboratory, but the chronic study had much higher incidences (rats, sexes combined: hyperplasia 15.5% vs 2.6% and polypoid adenoma 44.6% vs 5.2%). The product (CD) of concentration + time was the same (750 ppm hours) for the high-dose groups for both studies, but the duration of

Topics: Adenomatous Polyps; Administration, Inhalation; Animals; Atrophy; Body Weight; Carcinogens; Cricetinae; Epithelium; Female; Hydrazines; Hyperplasia; Male; Mesocricetus; Metaplasia; Nasal Mucosa; Necrosis; Nose; Nose Neoplasms; Rats; Rats, Inbred F344

Topics: Humans; Necrosis; Nose; Rhinoplasty; Smoking

A child presenting with fever, unilateral nasal discharge and sinusitis was found to have an alkaline disk button battery in the right nostril causing severe mucosal damage and septal perforation. The case is presented and mechanisms of injury discussed.

Topics: Child, Preschool; Foreign Bodies; Humans; Male; Nasal Mucosa; Nasal Septum; Necrosis; Nose; Radiography

Topics: Aged; Ethanol; Facial Pain; Female; Follow-Up Studies; Glycerol; Humans; Injections; Necrosis; Nose; Trigeminal Ganglion; Trigeminal Neuralgia

Topics: Child; Cytokines; Female; Humans; Immunologic Deficiency Syndromes; In Vitro Techniques; Interferon-gamma; Mitogens; Mycobacterium Infections; Necrosis; Nose; Opportunistic Infections; Recombinant Proteins; Skin Ulcer; T-Lymphocytes

A case is reported of necrosis of the columella nasi due to prolonged intubation in a 21-year-old road traffic accident patient. He was intubated by the nasal route because of combined head and facial injuries. The necrosis was discovered during surgery for repair of the bony facial injuries. As the patient was in a poor condition, the lesion was not immediately repaired, and the necrotic area was only removed. Definitive repair was carried out four and a half months later, with closure of the oronasal communication with an intravelar veloplasty. Such maxillofacial complications of prolonged endotracheal intubation are rare. They are related to prolonged vascular compression by the tube. Such accidents must be recognized without any delay by carefully examining patients.

Topics: Adult; Humans; Intubation, Intratracheal; Male; Nasal Cavity; Nasal Septum; Necrosis; Nose; Respiration, Artificial

A 60-year-old woman with respiratory failure required ventilatory support using a continuous positive airway pressure face mask. She developed extensive necrosis of the skin of the bridge of the nose. A number of precipitating factors are discussed and suggestions made to minimise the risk of this complication.

Topics: Facial Dermatoses; Female; Humans; Lung Diseases, Obstructive; Masks; Middle Aged; Necrosis; Nose; Positive-Pressure Respiration; Pressure; Skin; Time Factors

The melolabial flap is a versatile technique for reconstruction of defects of the central face. Variations of this flap may be used to reconstruct the lower eyelids, the nose, the upper and lower lip, chin, and malar regions. Regional anatomy, indications, technical considerations, and avoidance of complications are discussed on the basis of 10 bilateral cadaver dissections of the melolabial area, in conjunction with 70 reconstructive cases that used this flap. Statistical analysis of the results reveals that flap viability is compromised by previous radiation and smoking. Consequently, alternate methods of reconstruction of the central face should be used in patients who have a history of these problems.

Topics: Face; Facial Muscles; Female; Follow-Up Studies; Humans; Male; Middle Aged; Necrosis; Nose; Postoperative Complications; Surgical Flaps

Topics: Aflatoxins; Animal Feed; Animals; Drug Interactions; Glycine max; Lip; Male; Mouth; Necrosis; Nose; Oryza; Penis; Skin Ulcer; Swine; Swine Diseases; T-2 Toxin; Zea mays

Topics: Adult; Ear; Gangrene; Humans; Leg; Lip; Male; Necrosis; Nose; Pneumococcal Infections; Purpura; Skin

Topics: Child; Ecthyma; Female; Gangrene; Humans; Leukemia, Myeloid, Acute; Necrosis; Nose; Opportunistic Infections; Osteonecrosis; Pseudomonas Infections; Skin

A patient with open wounds on his hands developed a severe case of typhus following exposure to a wild rabbit. Typhus resulted in extensive necrosis of the mid-face, including the nasal alae, pinna, and lips. The patient also sustained extensive extremity necrosis. A brief review of the epidemiology, pathophysiology, and treatment of this cause of facial necrosis is presented, as well as a discussion of dopamine gangrene. While this uncommon entity probably played a large part in the necrosis of this patient's extremities, these peripheral lesions are also compatible with typhus.

Topics: Adult; Animals; Face; Humans; Lip; Male; Necrosis; Nose; Rabbits; Time Factors; Typhus, Epidemic Louse-Borne

Trichoepithelioma histologically resembles basal cell epithelioma, but only rarely do the two lesions coexist. The case reported here documents a patient with hereditary trichoepithelioma who presented with a basal cell epithelioma of the medial canthus invading the lower eyelid. The clinical and histologic features of both entities will be discussed, as well as the possibility of malignant transformation of a trichoepithelioma to a basal cell epithelioma.

Topics: Adult; Carcinoma, Basal Cell; Female; Head and Neck Neoplasms; Humans; Necrosis; Nose; Skin Neoplasms; Surgery, Plastic

Biopsies of two patients with a clinical diagnosis of lethal midline granuloma were examined by electron microscopy, histology and cytology. Morphological changes included necrosis, inflammation, and infiltration of atypical histiocytic cells. Judging by the cellular characteristics, the DNA-content and -distribution pattern, this localised, invasive and destructive lesion is a low-grade malignant histiocytic tumour. Our results show that final tumour diagnosis can only be established by special cytological methods.

Topics: Connective Tissue; DNA; Female; Granuloma, Lethal Midline; Histiocytes; Humans; Microscopy, Electron; Middle Aged; Necrosis; Nose; Paranasal Sinuses

Following a consequent outline of his communication, the author subsequently describes his experiences, the possibilities of managing and personal techniques available in case of operative problems or postoperative complications such as bleeding, haematoma, dermal necrosis or scar formation or infection. The nasal physiology and its relation to the operative treatment, and the importance of a thoroughly preoperative evaluation of certain tissue characteristics are discussed. Postoperative skeletal alterations, such as insufficient or excessive removal of humps, cartilages and soft tissues as well as their surgical management are pointed out. Remarks about nasal tip correction conclude the presentation of the subject.

Topics: Adolescent; Adult; Dermatitis, Contact; Female; Hemorrhage; Humans; Male; Necrosis; Nose; Nose Diseases; Osteomyelitis; Postoperative Complications; Rhinoplasty; Surgical Wound Infection; Tissue Adhesives

Topics: Adenocarcinoma; Cartilage; Female; Fluorouracil; Humans; Middle Aged; Necrosis; Nose; Pelvic Neoplasms

Skin and soft tissue necrosis is an uncommon but increasingly recognized complication of coumarin anticoagulant therapy. A patient is described with extensive involvement of all four extremities and the nose, requiring amputation of three extremities. The characteristic clinical features of the disorder are reviewed, with a discussion of the pathology, pathogenesis, and possible treatment modalities.

Topics: Aged; Connective Tissue; Extremities; Female; Gangrene; Humans; Necrosis; Nose; Skin; Warfarin

Topics: Adult; Face; Female; Fever; Humans; Lip; Necrosis; Nose; Surgery, Plastic

Idiopathic mid-facial granuloma is an unusual highly destructive disease which was virtually unknown prior to 1955. Great confusion exists, due in large part to the terminology applied to this entity as well as the clinical similarity of the process to other destructive mid-facial lesions. A classical case of idiopathic mid-facial granuloma of Stewart's type is presented, with characteristic lesions limited to the mid-face. Definitive histopathological features consist of pleomorphic inflammatory granulation tissue with patchy necrosis and no system lesions or neoplasia in the autopsy tissues.

Topics: Face; Female; Granuloma, Lethal Midline; Humans; Middle Aged; Necrosis; Nose; Temporal Bone

Snout rubbing led to ulceration and necrosis in pigs subjected to it. Only animals of specific colouring were attacked.

Topics: Animals; Behavior, Animal; Darkness; Female; Housing, Animal; Male; Muscles; Necrosis; Nose; Skin; Skin Pigmentation; Skin Ulcer; Swine; Swine Diseases

Topics: Enteral Nutrition; Enterocolitis, Pseudomembranous; Humans; Infant, Newborn; Intestinal Perforation; Intubation, Gastrointestinal; Intussusception; Jejunum; Necrosis; Nose; Osmolar Concentration; Polyvinyls; Silicones

Topics: Adult; Humans; Iatrogenic Disease; Intubation, Intratracheal; Male; Middle Aged; Necrosis; Nose; Nose Diseases; Patient Care Planning

Topics: England; Eponyms; Ethmoid Bone; History, 19th Century; History, 20th Century; Humans; Nasal Polyps; Necrosis; Nose; Osteitis; Recurrence

Topics: Animals; Blood Circulation; Face; Humans; Neck; Necrosis; Nose; Postoperative Complications; Rats; Skin; Skin Transplantation; Transplantation, Autologous

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Hoarseness; Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Laryngeal Diseases; Male; Middle Aged; Mucous Membrane; Nasal Mucosa; Necrosis; Nose; Nose Diseases; Pharyngeal Diseases; Polyps; Respiratory Tract Diseases; Time Factors

Topics: Amputation, Traumatic; Craniocerebral Trauma; Ear, External; Facial Injuries; Female; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Lip; Male; Maxillofacial Injuries; Necrosis; Nose; Replantation; Time Factors

Topics: Animals; Carnivora; Drug Hypersensitivity; Ear; Female; Foot; Hibernation; Humans; Necrosis; Nose; Penicillins

Topics: Cerebrovascular Disorders; Diagnosis, Differential; Herpes Labialis; Humans; Hyperesthesia; Intracranial Embolism and Thrombosis; Lateral Medullary Syndrome; Male; Middle Aged; Necrosis; Neurologic Examination; Neurologic Manifestations; Nose; Physical Examination; Skin Ulcer

Topics: Accidents, Traffic; Adolescent; Adult; Aged; Automobile Driving; Child; Child, Preschool; Ear; Facial Injuries; Facial Nerve Injuries; Humans; Lip; Middle Aged; Necrosis; Nose; Orbit; Parotid Gland; Postoperative Care; Scalp; Skin; Surgery, Plastic; Wounds and Injuries

Topics: Cheek; Disease; Face; Humans; Necrosis; Nose; Nose Diseases; Plastics; Surgery, Plastic; Trigeminal Neuralgia